ANS: Anticholinergic

Question 1

Cholinergic receptor subtypes

Nicotinic

Answer 1

Pentameric, 5 subunits. Ligand gated ion channels

Question 2

Cholinergic receptor subtypes

Muscarinic

Answer 2

G protein coupled. M1, M3, M5 inositol phosphate pathway. M2, M4 inhibit adenylyl cyclase and reduce cAMP

Question 3

M1

Answer 3

CNS, stomach

Question 4

M2

Answer 4

Cardiac muscle, CNS, a/w smooth muscle

Question 5

M3

Answer 5

A/w smooth muscle, glandular tissues

Question 6

M4, M5

Answer 6

CNS

Question 7

NM

Answer 7

Skeletal muscle at NMJ

Question 8

Nn

Answer 8

Autonomic ganglia, adrenal medulla, CNS

Question 9

Antimuscarinic drugs: MOA

Answer 9

Competitively antagonize Ach at muscarinic receptors. Cation pt fits into Ach’s place, inhibits binding. Allows SNS to dominate. Only reversed if Ach conc increases.

Question 10

Antimuscarinics

Two diff structure types

Answer 10

Natural (atropine and scop) are tertiary amines. Alkaloids of belladonna plant. Crosses BBB and resp epithelium
Semi-synthetic (glyco and robinal) quaternary ammonion deriv

Question 11

Atropine 
Effect on: sedation/mydriasis/nausea, 
inc HR, 
relaxing smooth muscle, 
anti-sialogogue

Answer 11

Sed +
Hr +++(Give if hr in 20s, kicks in fast)
Smooth musc ++
Anti sial +

Question 12

Scopolamine 
Sedation/nausea/mydriasis 
Inc hr 
Relax smooth musc 
Anti sialogogue

Answer 12

Sed +++
Hr +
Relax +
Anti +++

Question 13

Glycopyrrolate 
Sedation, nausea, mydriasis 
Inc hr 
Relax smooth muscle 
Anti sialogogue

Answer 13

Sed 0
Inc hr ++
Smooth muscl ++
Anti ++ (less SE than other drugs)

Question 14

IV atropine
Onset
Duration
E 1/2t

Answer 14

1 min
30-60 min
2.3 hrs

Question 15

IV atropine

Metab/excretion

Answer 15

18% unchanged in urine, rest undergoes hydrolysis

Question 16

IV glycopyrrolate
Onset
Duration
E 1/2 t

Answer 16

2-3 min
30-60 hrs
1.25 hrs

Question 17

IV glyco

Excretion

Answer 17

Unchanged via urine. Caution w renal pts.

Question 18

Scopolamine

Metabolism, excretion

Answer 18

Extensively metab with only 1% excreted unchanged in urine

Question 19

Tx bradycardia young vs old pts

Answer 19

Young pts have high baseline vagal tone, more tachycardia. Elderly have less tone, less pronounced tachycardia

Question 20

Antimuscarinics always given when

Answer 20

W anticholinesterase drugs when antagonizing NMB

Question 21

Ipratropium
Use
Dose

Answer 21

Bronchodilation
MDI 40-80 mcg/2 puffs
0.25-0.5 mg via neb

Question 22

Ipratropium
Onset
Consider in whom before what

Answer 22

30-90 min

Asthmatics, COPD, smokers prior to a/w instrumentation

Question 23

Ortho cases use anticholinergics for what

Caution using in who

Answer 23

Mydriasis and cycloplegia

Narrow angle glaucoma dangerous- increases IOP

Question 24

Anticholinergics reduce what d/t opioids

Answer 24

Biliary and ureteral spasm. Biliary spasm can mimic angina

Question 25

Scopolamine dose IV IM Transdermal

Answer 25

pre op. 0.3-0.5 mg or 5 mcg/kg IM 1.5 mg transdermal (5mcg/hr over 72 hrs) nausea

Question 26

Atropine doses Pre op iv Bradycardia iv Neb- bronchodilation

Answer 26

0.2-.4 mg 0.4-1 mg 2mg in 5 ml NS

Question 27

Glycopyrrolate | IV dose pre op and bradycardia

Answer 27

0.1-0.2 mg IV

Question 28

Central anticholinergic syndrome What causes it What happens Tx

Answer 28

Scopolamine and atropine Restless, hallucinate, unconscious, tired. Delayed emergence in PACU Physostigmine 15-60 mcg/kg IV repeated Q1-2hrs

Question 29

Atrovent and spiriva for what

Answer 29

COPD bronchodilation

Question 30

Ditropan, Detrol, for what

Answer 30

Overactive bladder, nonspecific m receptor

Question 31

Enablex, vesicare for

Answer 31

Overactive bladder. M3 specific, good if CAD

Question 32

AChE inhibitors Action Increases what 3 things

Answer 32

Elevates conc of Ach by decreasing its metabolism. Increases transmission at Nm junction (reverses competitive NMB), increases PNS tone, increases central cholinergic activity

Question 33

AChE inhib | Helpful in what disease which 2 specifically

Answer 33

MG- Nm junction disease. Pyridostigmine and neostigmine

Question 34

AChE inhib | Role in glaucoma, which drug

Answer 34

Increases outflow of aqueous humor, physostigmine

Question 35

AChE inhib | Role in abdomen

Answer 35

Helps dispenses, increases smooth muscle motility, neostigmine

Question 36

AChE inhib | Specific for AD

Answer 36

Cognex, aricept, ex Elon, razadyne

Question 37

AChE inhib | Total roles

Answer 37

MG, glaucoma, abd distension, AD/cognitive dysfunction

Question 38

AChE inhib | Adverse effects

Answer 38

Peripheral ach effects GI tract. NVD, anorexia, flatulence, cramping. Dose dependent

Question 39

AChE inhib | Contraindications

Answer 39

Unstable or severe CV disease Uncontrolled epilepsy Active PUD

Question 40

Muscarinic agonists | Indications/drugs

Answer 40

Asthma (methacholine), miosis/decreased IOP (carbachol), GI and urinary tract motility (Bethanechol)

Question 41

Depolarizing muscle relaxant | Name and action

Answer 41

Succ. Continuous activation of nicotinic receptor channels results in depolarization blockade

Question 42

Nicotinic antagonists Non depolarizing muscle relaxants Action and names

Answer 42

Prevents endogenous ach binding to nicotinic receptors and subsequent muscle cell depolarization. Paralysis Pancuronium, rocuronium, vecuronium