Neostigmine is preferred over physostigmine for reversal of non-depolarizing neuromuscular blockade because neostigmine:

• A Does not cross the blood-brain barrier, avoiding CNS muscarinic side effects ✓
• B Crosses the blood-brain barrier and reverses central anticholinergic effects
• C Has a longer duration of action than vecuronium
• D Acts on nicotinic receptors directly

Explanation

Neostigmine is a quaternary ammonium compound that does not penetrate the blood-brain barrier, thereby avoiding central muscarinic effects such as confusion or seizures. It reverses neuromuscular blockade peripherally by inhibiting acetylcholinesterase at the neuromuscular junction. Physostigmine, being a tertiary amine, crosses into the CNS and is therefore not preferred for NMB reversal in theatre settings.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.