18_19 continues Flashcards
Hyperhidrosis:
overstimulation by acetylcholine.
Oxybutynin (mAch antagonist), glycopyrrolate (mAch antagonist), benztropine (anticholinergic)
Alzheimer’s (dementia)
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)
Parkinson’s:
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)
Dilated fundus examination
induced mydriasis.
Atropine (mAch antagonist), scopolamine (mAch antagonist), hyoscyamine (mAch antagonist)
Acute angle glaucoma
partial or absolute blockade of canal of schlemm.
Pilocarpine (mAch agonist), physostigmine (reversible AchI)
Chronic glaucoma
treated with organophosphates (irreversible AchI).
Ecothiophate (irreversible AchI), diisopropyl flourophosphate (irreversible AchI)
Ischuria (urinary incontinence)
kidneys, bladder and sexual organs contain cholinergic supply.
Oxybutynin (mAch antagonist; relieve urinary and bladder difficulties)
Paralytic ileus:
disruption of normal intestinal movements.
Neostigmine (reversible AchI; limited due to side effects)
Sjogren’s syndrome
xerostomia (dry mouth).
Pilocarpine (mAch agonist)
Peptic Uclers
Pirenzepine (mAch antagonist)
Ogilvie syndrome
impairment in ability of intestine to propel food though GI tract.
Pyridostigmine (reversible AchI)
Bronchoconstriction:
Including chronic bronchitis, COPD, astma.
Atropine (mAch antagonist), ipratropium (mAch antagonist), tiotropium (mAch antagonist)
Sinus Bradycardyia
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)
Deadly mushrooms
aminita muscaria, inocybe erubescens. Contain muscimol, ibotenic acid and muscraine.
Atropine (mAch antagonist)
Schistosomiasis:
paralytic disease caused by parasitic worm.
Metriphonate (irreversible AchI)
Motion sickness
motion felt but not seen.
Scopolamine (mAch antagonist)
Lambert-Eaton Syndrome
autoimmune attack against pre-synaptic voltage-gated calcium channels. Weakness, fatigue, blurred vision
Myasthenia Gravis
autoimmune attack against nicotinic receptors at neuromuscular junction.
Edrophonium, neostigmine, pyridostigmine, ambenoium, physostigmine (all reversible AchI).
Hemicholinium-3:
block choline transport into neuron. Experimental use only.
Vesamicol:
block Ach uptake into vesicles from the cytosol. Experimental use only.
Botulism toxin
digest synaptobrevin, syntaxin, SNAP-25.
Treatment: focal dystonia, torticollis, achalasia, strabismus, blepharospasm, wrinkles, hyperhidrosis.
Complications: cardiac arrhythmias, syncope, hepatotoxicity, anaphylaxis.
Acetyl cholinesterase inhibitors:
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
Centrally-acting inhibitors
cross blood brain barrier. Donepezil, rivastigmine, galantamine.
Treatment: Alzheimer’s.
Complications: diarrhea, nausea, vomiting, cramps, anorexia, vivid dreams.
Muscarinic Receptor agonists:
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.
Nicotinic Receptor agonists:
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
Muscarinic Receptor antagonists:
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.
Nicotinic Receptor antagonists:
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.
