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Glycopyrronium with neostigmine reversal — FRCA Primary MCQ

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EasyPharmacologyGlycopyrronium with neostigmine reversalFRCA Primary

A patient receives neostigmine and glycopyrronium for reversal of moderate neuromuscular block. Heart rate remains stable and secretions do not increase. Which effect is primarily provided by glycopyrronium?

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Correct answer: E — Increased acetylcholine at the neuromuscular junction

Glycopyrronium is an antimuscarinic that reduces muscarinic adverse effects of neostigmine, such as bradycardia, salivation and bronchial secretions. Neostigmine, not glycopyrronium, increases acetylcholine by inhibiting acetylcholinesterase. Sugammadex encapsulates aminosteroid neuromuscular blockers. The pearl is that anticholinesterase reversal affects muscarinic as well as nicotinic synapses.

Reference: RCoA Primary FRCA Syllabus 2026; Peck, Hill & Williams Pharmacology for Anaesthesia