18_19 continues

Question 1

Hyperhidrosis:

Answer 1

overstimulation by acetylcholine.

Oxybutynin (mAch antagonist), glycopyrrolate (mAch antagonist), benztropine (anticholinergic)

Question 2

Alzheimer’s (dementia)

Answer 2

Disruption of cholinergic transmission due to accumulations in entorhinal cortex and hippocampus (major destination of cholinergic projections.
Donepezil (central AchI), rivastigmine (central AchI), galantamine (central AchI)

Question 3

Parkinson’s:

Answer 3

loss of dopaminergic neurons in substantia nigra, causing bradykinesia, rigidity, impaired postural balance, rest tremors. Imbalance between dopaminergic input and cholinergic transmission in the putamen.
Trihexyphenidyl (anticholinergic), benztropine (anticholinergic)

Question 4

Dilated fundus examination

Answer 4

induced mydriasis.

Atropine (mAch antagonist), scopolamine (mAch antagonist), hyoscyamine (mAch antagonist)

Question 5

Acute angle glaucoma

Answer 5

partial or absolute blockade of canal of schlemm.

Pilocarpine (mAch agonist), physostigmine (reversible AchI)

Question 6

Chronic glaucoma

Answer 6

treated with organophosphates (irreversible AchI).

Ecothiophate (irreversible AchI), diisopropyl flourophosphate (irreversible AchI)

Question 7

Ischuria (urinary incontinence)

Answer 7

kidneys, bladder and sexual organs contain cholinergic supply.
Oxybutynin (mAch antagonist; relieve urinary and bladder difficulties)

Question 8

Paralytic ileus:

Answer 8

disruption of normal intestinal movements.

Neostigmine (reversible AchI; limited due to side effects)

Question 9

Sjogren’s syndrome

Answer 9

xerostomia (dry mouth).

Pilocarpine (mAch agonist)

Question 10

Peptic Uclers

Answer 10

Pirenzepine (mAch antagonist)

Question 11

Ogilvie syndrome

Answer 11

impairment in ability of intestine to propel food though GI tract.
Pyridostigmine (reversible AchI)

Question 12

Bronchoconstriction:

Answer 12

Including chronic bronchitis, COPD, astma.

Atropine (mAch antagonist), ipratropium (mAch antagonist), tiotropium (mAch antagonist)

Question 13

Sinus Bradycardyia

Answer 13

SA and AV node have M2 receptors. All 1A anti arrhythmic drugs (quinidine, disopyramide, procainamide) inhibit cholinergic input to heart and must be used with caution.
Atropine (mAch antagonist)

Question 14

Deadly mushrooms

Answer 14

aminita muscaria, inocybe erubescens. Contain muscimol, ibotenic acid and muscraine.
Atropine (mAch antagonist)

Question 15

Schistosomiasis:

Answer 15

paralytic disease caused by parasitic worm.

Metriphonate (irreversible AchI)

Question 16

Motion sickness

Answer 16

motion felt but not seen.

Scopolamine (mAch antagonist)

Question 17

Lambert-Eaton Syndrome

Answer 17

autoimmune attack against pre-synaptic voltage-gated calcium channels. Weakness, fatigue, blurred vision

Question 18

Myasthenia Gravis

Answer 18

autoimmune attack against nicotinic receptors at neuromuscular junction.
Edrophonium, neostigmine, pyridostigmine, ambenoium, physostigmine (all reversible AchI).

Question 19

Hemicholinium-3:

Answer 19

block choline transport into neuron. Experimental use only.

Question 20

Vesamicol:

Answer 20

block Ach uptake into vesicles from the cytosol. Experimental use only.

Question 21

Botulism toxin

Answer 21

digest synaptobrevin, syntaxin, SNAP-25.
Treatment: focal dystonia, torticollis, achalasia, strabismus, blepharospasm, wrinkles, hyperhidrosis.
Complications: cardiac arrhythmias, syncope, hepatotoxicity, anaphylaxis.

Question 22

Acetyl cholinesterase inhibitors:

Answer 22

Edrophonium, neostigmine, pyridostigmine, ambenoium, physostigmine.
Treatment: Lamber-Eaton syndrome, Myasthenia gravis, glaucoma, urinary or GI motility, reverse induced surgical paralysis.
Complications: bronchospasm, bradycardia, cardiac arrest, hypotension, salivation, hyperhidrosis

Question 23

Centrally-acting inhibitors

Answer 23

cross blood brain barrier. Donepezil, rivastigmine, galantamine.
Treatment: Alzheimer’s.
Complications: diarrhea, nausea, vomiting, cramps, anorexia, vivid dreams.

Question 24

Muscarinic Receptor agonists:

Answer 24

Methacoline: used in bronchial challenge test for differential diagnosis of allergic asthma.
Complications: headache, pruritus, throat irritation.
Contraindications: recent heart attack or stroke, aortic aneurysm, uncontrolled HTN.
Carbachol: treat glaucoma.
Bethanechol: facilitate urinary tract motility.
Cevimeline, pilocarpine: treatment of xerostomia in Sjogren’s.

Question 25

Nicotinic Receptor agonists:

Answer 25

Succinylcholine: immobilize patients for surgical procedures and intubation.
Complications: muscle rigidity, myalgia, raised intraocular pressure.
Contraindications: upper motor neuron lesions, skeletal muscle myopathies, malignant hyperthermia

Question 26

Muscarinic Receptor antagonists:

Answer 26

Atropine: antidote for mushroom poisoning, acetylcholinesterase inhibitor overdose, organophosphate poisoning. Treatment of acute symptomatic bradycardia, excessive salivation/mucus secretion during surgery.
Complications: cardiac arrhythmia, respiratory depression, raised intraocular pressure, xerostomia, constipation, blurred vision.
Contraindications: narrow angle glaucoma (persists in eyes for more than 72 hours).
Scopolamine: treatment for motion sickness, nausea, vomiting.
Complications: drug-induced psychosis, somnolence, xerostomia, blurred vision.
Contraindications: narrow angle glaucoma.
Pirenzepine, methscopolamine: treat peptic ulcer.
Complications: cardiac arrhythmias, malignant hyperthermia, anaphylaxis, constipation, xerostomia, urinary retention.
Glycopyrrolate: treat surgically-induce or vagally induced bradycardia.

Complications: cardiac arrhythmias, malignant hyperthermia, anaphylaxis, constipation, xerostomia, urinary retention.
Ipratropium, tiotropium: treat COPD, asthma. Ipratropium more effective than beta agonist in treating COPD than asthma.
Complications: paralytic ileus, anaphylaxis, oropharyngeal edema.
Oxybutynin, propantheline, terodiline: treat hyperreflexic and overactive bladder, urge incontinence.
Complications: dry mouth, constipation, urinary retention.
Ipratropium, tiotropium: treat COPD, asthma. Ipratropium more effective than beta agonist in treating COPD than asthma.
Complications: paralytic ileus, anaphylaxis, oropharyngeal edema.
Oxybutynin, propantheline, terodiline: treat hyperreflexic and overactive bladder, urge incontinence.
Complications: dry mouth, constipation, urinary retention.

Question 27

Nicotinic Receptor antagonists:

Answer 27

Pancuronium (LA), tubocurarine (LA), vecuronium (IA), rocuronium(IA), mivacurium: induce neuromuscular blockade in surgery, intubation.
Complications: hypertension, tachyarrhythmia, apnea, bronchospasm, respiratory failure, salivation, flushing (mivacurium).
LA = long acting; IA = intermediate acting.
Trimethaphan, mecamylamine: treat HTN in patients with acute aortic dissection.
Complications: paralytic ileus, urinary retention, respiratory arrest, syncope, orthostatic hypertension, dyspepsia, diplopia, sedation.