(5) Autonomic Nervous System Drugs I (Acetylcholine)

Question 1

Methacholine

Answer 1

Class-direct-acting cholinergic receptor agonist Effect- binds muscarinic receptors in airway Txt-asthma challenge test

Question 2

Carbachol

Answer 2

Class- direct-acting cholinergic receptor agonist Effect-Constricts pupil &; relieves intraocular pressure Txt- glaucoma

Question 3

Bethanechol

Answer 3

Class- direct-acting cholinergic receptor agonist Effect-stimulates bladder or GI w/o cardio involvement

Question 4

Nicotine

Answer 4

Class- direct-acting cholinergic receptor agonist Txt- smoking cessation

Question 5

Pilocarpine

Answer 5

Class-direct-acting cholinergic receptor agonist Effect-M1 receptor agonist for sweat, tears, saliva -contracts ciliary mm &; pupillary sphincter Txt-open&; closed-angle glaucoma -Xerostomia (dry mouth)

Question 6

Neostigmine

Answer 6

Class-reversible cholinesterase inhibitor Effect-Increase ACh NOT in CNS Txt- Myasthenia gravis

Question 7

Edrophonium

Answer 7

Class- reversible cholinesterase inhibitor Effect-Increase ACh Txt- myasthenia gravis diagnosis

Question 8

Physostigmine

Answer 8

Class-reversible cholinesterase inhibitor Effect-Increase ACh & penetrates CNS Txt-Myasthenia gravis & “phyxes” Atropine overdose

Question 9

Pyridostigmine

Answer 9

Class- reversible cholinesterase inhibitor Effect-increase ACh Txt-long-acting myasthenia gravis

Question 10

3 Reversible Cholinestearse Inhibitor Txt for Alzheimer’s Disease

Answer 10

Donepezil, Galantamine, Rivastigmine

Question 11

Irreversible cholinesterase inhibitors

Answer 11

Organophosphates (pesticides, sarin gas) Malathion (not hydrolyzed by insects)

Question 12

Signs of organophosphate toxicity

Answer 12

SLUDGE- salivation, lacrimation, urination, diarrhea, gastric emptying DUMBBLESS- diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal mm; CNS, lacrimation sweating, salivation

Question 13

2 methods to increase aqueous humor outflow for primary angle glaucoma

Answer 13

Muscarinic receptor agonists Prostaglandin analogs

Question 14

3 methods to decrease aqueous humor production for primary angle glaucoma

Answer 14

alpha-2 receptor agonists B-receptor antagonists Carbonic anhydous inhibitors

Question 15

Atropine

Answer 15

Class-anticholinergic (competitive antagonist) belladonna alkaloid Effect-blocks M1, M2, M3 Txt-bradycardia &; cholinesterase inhibitor overdose

Question 16

Scopolamine

Answer 16

Class-anticholinergic (competitive antagonist) Effect-greater CNS effect than atropine Txt-motion sickness

Question 17

Hyoscyamine

Answer 17

Class- anticholinergic (competitive antagonist) Txt-GI spasms/ IBD

Question 18

Ipratropium; tiotropium

Answer 18

Class- anticholinergic (competitive antagonist) synthetic Txt-Asthma/ COPD

Question 19

Dicyclomine

Answer 19

Synthetic Anticholinergic for IBD

Question 20

Tropicamide

Answer 20

Synthetic anticholinergic for topical eye exams

Question 21

Benztropine

Answer 21

Synthetic anticholinergic for Parkinson’s and drug-induced Parkinson’s

Question 22

3 anticholinergic drugs for overactive bladder

Answer 22

Oxybutinin, Tolterodine, Solifenacin

Question 23

Effects of anticholinergic drugs

Answer 23

Mydriasis, sweating, decreased secretion, bronchodilation, increased HR, decreased GI motility, atonic bladder

Question 24

Contraindications for anticholinergic drug use

Answer 24

glaucoma, prostatic hyperplasia, dementia, delirium

Question 25

Signs of anticholinergic toxicity

Answer 25

Increased temp, dry/ flushed skin, tachycardia, urinary retention, disorientation, cycloplegia, mydriasis

Question 26

D-tubocurarine

Answer 26

Class- Non-depolarizing nicotinic ACh antagonist Effect- NMJ blocking Txt-mm relaxation during surgery

Question 27

Succinylcholine

Answer 27

Class- depolarizing nicotinic ACh antagonist Effect- NMJ block Txt-sustained mm paralysis during sedation

Question 28

Cevimeline (Evoxac)

Answer 28

new synthetic direct agonist for xerostomia and dry eyes used after radiation tx or for pts with Sjogren's syndrome

Question 29

Components of FDA-Approved Drug label

Answer 29

Animal Pharmacology Clinical Studies Indications & Usage Contraindications Precautions Adverse Reactions Overdosage Dosage & Administration How Supplied

Question 30

What is the Anticholinergic Risk Scale?

Answer 30

- ASR is a way to quantify the risk of drugs w/ anticholinergic properties on geriatric patients (in efforts to prevent delirium, falls & cognitive impairment) - The scale ranges from 1 to 3 points (3 = highest risk)

Question 31

Name 2 important drugs listed under the 3 point column of the Anticholinergic Risk Scale.

Answer 31

1. Diphenhydramine 2. Chlorpheniramine (These are both Antihistamines that have Anticholinergic properties)

Question 32

Signs of Organophosphate Toxicity?

Answer 32

Organophosphates = sarin gas & pesticides - DUMBBELSS: Diarrhea, Urination, Miosis, Bradycardia, Bronchoconstriction, Excitation of Skeletal muscle & CNS, Lacrimation, Salivation & Sweating - SLUDGE: Sweating, Lacrimation, Urination, Diarrhea, Gastric Emptying

Question 33

Dose-Related Atropine Toxicity

Answer 33