why Pyridostigmine is not the DOC in case of Cobra bite?
Cobra bite is a case of where there is paralysis due to blockade of nmj
Overcoming this requires increased acetylcholine at the nmj which is done by giving ache inhibitor which is peripherally active eg. Quaternary amines like neostigmine
pyridostigmine is also a Quaternary amine …can’t cross BBB so used for peripheral effects
No point of giving a centrally acting Ache inhibitor( pyridostigmine) beacse there are no centrally acting effects to be reversed
Becoz pyridostigmine has slow onset as compared to neostigmine
Neostigmine is shorter acting and hence preferred.