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Pharmacology > ANS: Anticholinergic > Flashcards

ANS: Anticholinergic Flashcards

1
Q

Cholinergic receptor subtypes

Nicotinic

A

Pentameric, 5 subunits. Ligand gated ion channels

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2
Q

Cholinergic receptor subtypes

Muscarinic

A

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

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3
Q

M1

A

CNS, stomach

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4
Q

M2

A

Cardiac muscle, CNS, a/w smooth muscle

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5
Q

M3

A

A/w smooth muscle, glandular tissues

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6
Q

M4, M5

A

CNS

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7
Q

NM

A

Skeletal muscle at NMJ

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8
Q

Nn

A

Autonomic ganglia, adrenal medulla, CNS

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9
Q

Antimuscarinic drugs: MOA

A

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.

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10
Q

Antimuscarinics

Two diff structure types

A

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

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11
Q 
Atropine 
Effect on: sedation/mydriasis/nausea, 
inc HR, 
relaxing smooth muscle, 
anti-sialogogue
A

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

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12
Q 
Scopolamine 
Sedation/nausea/mydriasis 
Inc hr 
Relax smooth musc 
Anti sialogogue
A

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

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13
Q 
Glycopyrrolate 
Sedation, nausea, mydriasis 
Inc hr 
Relax smooth muscle 
Anti sialogogue
A

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

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14
Q

IV atropine
Onset
Duration
E 1/2t

A

1 min
30-60 min
2.3 hrs

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15
Q

IV atropine

Metab/excretion

A

18% unchanged in urine, rest undergoes hydrolysis

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16
Q

IV glycopyrrolate
Onset
Duration
E 1/2 t

A

2-3 min
30-60 hrs
1.25 hrs

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17
Q

IV glyco

Excretion

A

Unchanged via urine. Caution w renal pts.

18
Q

Scopolamine

Metabolism, excretion

A

Extensively metab with only 1% excreted unchanged in urine

19
Q

Tx bradycardia young vs old pts

A

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

20
Q

Antimuscarinics always given when

A

W anticholinesterase drugs when antagonizing NMB

21
Q

Ipratropium
Use
Dose

A

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

22
Q

Ipratropium
Onset
Consider in whom before what

A

30-90 min

Asthmatics, COPD, smokers prior to a/w instrumentation

23
Q

Ortho cases use anticholinergics for what

Caution using in who

A

Mydriasis and cycloplegia

Narrow angle glaucoma dangerous- increases IOP

24
Q

Anticholinergics reduce what d/t opioids

A

Biliary and ureteral spasm. Biliary spasm can mimic angina

25
Q

Scopolamine dose
IV
IM
Transdermal

A

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

26
Q

Atropine doses
Pre op iv
Bradycardia iv
Neb- bronchodilation

A

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

27
Q

Glycopyrrolate

IV dose pre op and bradycardia

A

0.1-0.2 mg IV

28
Q

Central anticholinergic syndrome
What causes it
What happens
Tx

A

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

29
Q

Atrovent and spiriva for what

A

COPD bronchodilation

30
Q

Ditropan, Detrol, for what

A

Overactive bladder, nonspecific m receptor

31
Q

Enablex, vesicare for

A

Overactive bladder. M3 specific, good if CAD

32
Q

AChE inhibitors
Action
Increases what 3 things

A

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

33
Q

AChE inhib

Helpful in what disease which 2 specifically

A

MG- Nm junction disease. Pyridostigmine and neostigmine

34
Q

AChE inhib

Role in glaucoma, which drug

A

Increases outflow of aqueous humor, physostigmine

35
Q

AChE inhib

Role in abdomen

A

Helps dispenses, increases smooth muscle motility, neostigmine

36
Q

AChE inhib

Specific for AD

A

Cognex, aricept, ex Elon, razadyne

37
Q

AChE inhib

Total roles

A

MG, glaucoma, abd distension, AD/cognitive dysfunction

38
Q

AChE inhib

Adverse effects

A

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

39
Q

AChE inhib

Contraindications

A

Unstable or severe CV disease
Uncontrolled epilepsy
Active PUD

40
Q

Muscarinic agonists

Indications/drugs

A

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

41
Q

Depolarizing muscle relaxant

Name and action

A

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

42
Q

Nicotinic antagonists
Non depolarizing muscle relaxants
Action and names

A

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

Pharmacology (19 decks)

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