Cholinesterase inhibitors carbamates

Cholinesterase inhibitor (anti-cholinesterase, ChEI) is a chemical that prevents cholinesterases (ChEs) from breaking down. ACh, which consequently increases the level and duration of action of this neurotransmitter. ChEIs such as organophosphates (esters of phosphoric acid) and carbamates (esters of carbamic acid) - serve as insecticides, pesticides, warfare agents and drugs. 

Oxime carbamates are generally applied either directly to the tilled soil or sprayed on crops. One of the advantages of oxime carbamates is their short persistence on plants. They are readily degraded into their metabolites shortly after application. However, some of these metabolites have insecticidal properties even more potent than those of the parent compound. For example, the oxidative product of aldicarb is aldicarb sulfoxide, which is observed to be 10-20 times more active as a cholinesterase inhibitor than aldicarb. Other oxime carbamates (e.g., methomyl) have degradates which show no insecticidal activity, have low to negligible ecotoxicity and mammalian toxicity relative to the parent, and are normally nondetectable in crops. Therefore, the residue definition may include the parent oxime carbamate (e.g., methomyl) or parent and metabolites (e.g., aldicarb and its sulfoxide and sulfone metabolites). The tolerance or maximum residue limit (MRL) of pesticides on any food commodity is based on the highest residue concentration detected on mature crops at harvest or the LOQ of the method submitted for enforcement purposes if no detectable residues are found. For example, the tolerances of methomyl in US food commodities range from 0.1 to 6 mg kg for food items and up to 40 mg kg for feed items. ... 

Although bicyclophosphates do not inhibit acetylcholinesterase, they exhibit a synergistic toxic effect with materials that do. Individuals who have had previous exposure to cholinesterase inhibitors such as nerve agents and commercial organophosphate or carbamate pesticides may be at a greater risk from exposure to bicyclophosphates. 

Two important classes of cholinesterase inhibitors are the organophosphates and the carbamates, a few of which are widely used insecticides. Two such insecticides are chloropyrifos and carbaryl (structures shown). They are highly effective insecticides and, if used properly, appear to be without significant risk to humans (although the use of chloropyrifos and some other members of the class is somewhat controversial). 

The UK Pesticide Safety Directorate (PSD) has decided to use the TEF approach for assessment of combined risk from exposure to mixtures of acetyl cholinesterase inhibitors (organophosphate (OP) compounds and carbamates) (PSD 1999). Despite clear differences in the action of carbamates and OP compounds, the index compounds selected for all acetyl cholinesterase inhibitors were either aldicarb (carbamate) or chlorpyrifos (OP). The POD for determining relative potency was predetermined as the dose level that produced 20% inhibition of red blood cell cholinesterase in a 90-day dietary study in rats. 

Rivastigmine Transdermal (Exelon Patch) [Cholinesterase Inhibitor/Anti-Alzheimer Agent] Uses MUd/mod Alzheimer and Parkinson Dz dementia Action Acetylcholinesterase inhibitor Dose Initial 4.6-mg patch/d applied to back, chest, upper arm, T 9.5 mg after 4 wk if tolCTated Caution [ ] Sick sinus synd, conduction defects, asthma, COPD, urinary obst, Sz Contra Hypersensitivity to rivastigmine, other carbamates Disp Transdermal patch 5 cm (4.6 mg/24 h), 10 cm (9.5 mg/24 h) SE NA /D EMS See Rivastigmine OD See Rivastigmine... 

Pyridostigmine (Mestinon) is a quaternary ammonium carbamate. Neostigmine and pyridostigmine also have direct agonist activity at nicotinic receptors on skeletal muscle. Rivastigmine (Exelon) is a carbamate cholinesterase inhibitor with good penetration into the brain. 

Chemical Class Carbamate derivative cholinesterase inhibitor Clinical Pharmacology ... 

The organophosphate inhibitors are sometimes referred to as "irreversible" cholinesterase inhibitors, and edrophonium and the carbamates are considered "reversible" inhibitors because of the marked differences in duration of action. However, the molecular mechanisms of action of the three groups do not support this simplistic description. 

Some quaternary carbamate cholinesterase inhibitors, eg, neostigmine, have an additional direct nicotinic agonist effect at the neuromuscular junction. This may contribute to the effectiveness of these agents as therapy for myasthenia. 

Pralidoxime (2-PAM) Organophosphate cholinesterase inhibitors Adult dose is 1 g IV, which should be repeated every 3-4 hours as needed or preferably as a constant infusion of 250-400 mg/h. Pediatric dose is approximately 250 mg. No proved benefit in carbamate poisoning. 

Organophosphate and carbamate cholinesterase inhibitors (see Chapter 7) are widely used to kill insects and other pests. Most cases of serious organophosphate or carbamate poisoning result from intentional ingestion by a suicidal person, but poisoning has also occurred at work (pesticide application or packaging) or, rarely, as a result of food contamination or terrorist attack (eg, release of the chemical warfare nerve agent sarin in the Tokyo subway system in 1995). 

The acute toxic effects of the cholinesterase inhibitors, like those of the direct-acting agents, are direct extensions of their pharmacologic actions. The major source of such intoxications is pesticide use in agriculture and in the home. Approximately 100 organophosphate and 20 carbamate cholinesterase inhibitors are available in pesticides and veterinary vermifuges used in the USA. 

Insecticides fall largely into three main chemical groups 1) the organochlorines whose action is primarily on the peripheral nervous system 2) organophosphates, and 3) carbamates. The latter two classes are cholinesterase inhibitors. 

The carbamates, like the organophosphorus insecticides, are cholinesterase inhibitors. However, the reaction is rapidly reversible. Carbaryl has a half life in the soil of about 8 days and is decomposed by ultraviolet light. The carbamates metabolize rapidly in animals and show little, if any, propensity for storage in animal tissues. Additional properties and reactions of carbamates are discussed in the section on fungicides. 

Fonnum, F., Sterri, S.H. (2006). Tolerance development to toxicity of cholinesterase inhibitors. In Toxicology of Organ-ophosphate and Carbamate Compounds (R.C. Gupta, ed.), pp. lSl-61. Elsevier Academic Press, San Diego, CA. 

Exposure to a toxic dose of OP results in inhibition of acetylcholinesterase and butyrylcholinesterase activities. The most common method to measure OP exposure is to assay acetylcholinesterase and butyrylcholinesterase activities in blood using a spectrophotometric method (EUman et al, 1961 Wilson et al, 2005 Worek et al, 1999). The drawbacks of activity assays are that they do not identily the OP. They show that the poison is a cholinesterase inhibitor but do not distinguish between nerve agents, OP pesticides, carbamate pesticides, and tightly bound, noncovalent inhibitors like tacrine and other anti-Alzheimer drugs. In addition, low-dose exposure, which inhibits less than 20% of the cholinesterase, carmot be determined by measuring acetylcholinesterase and butyrylcholinesterase activity because individual variability in activity levels is higher than the percent inhibition. 

These compounds inhibit the hydrolysis of the neurotransmitter acetylcholine by the enzyme acetylcholinesterase within the mammalian nervous system (Zwiener and Ginsburg, 1988). This inhibition causes acetylcholine levels to rise, thus causing cholinergic hyperstimulation at muscarinic and nicotinic receptors. There are important differences in the way carbamates and OPs bind to acetylcholinesterase as well as their abililty to affect the CNS. Carbamates are reversible inhibitors of cholinesterase enzymes. Carbamates create a reversible bond to the cholinesterase enzyme through carbamylation which can spontaneously hydrolyze, reversing toxicity. Carbamate poisoning produces toxicity similar to that of OPs however, the toxicity is usually of a shorter duration and less severe in nature (Lifshitz et al, 1994). In contrast, OPs inhibit cholinesterase via an irreversible bond of phosphate radicals... 

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