ANS-Antimuscarinics Flashcards
What is Atropen
Atropine
Atropine
class/ category
Belladonna alkaloid; Anti-muscarinic
Atropine
Uses and MOA
Uses
* Treatment of bradycardia
* organophosphate (nerve agent) poisoning
* reversal of NDNMB
MOA
Non-selective, competitive muscarinic antagonist
Atropine
Dosing
0.5-1 mg IV every 3-5 min, max total dose 3 mg
Atropine
Onset, peak, duration
Onset: 1-2 min
Peak: 2-6 min
Duration: 15-30 min
Atropine
elimination
Renal
Atropine
CV effects
- ↑ HR, the most of the antimuscarinics
- Low doses, < 0.1 mg, associated with paradoxic bradycardia
Atropine
Pulm effects
- Bronchodilator
- Inhibits bronchial secretions
Atropine
CNS effects
- Crosses BBB, dose-dependent CNS stimulation
- Mydriasis and cycloplegia, but less than Scopolamine
- May cause central anticholinergic syndrome
Atropine
GI effects
- ↓ LES and barrier pressure
- ↓ GI motility and GI secretions (including gastric acid)
Does atropine increase or decrease risk of emergence delirium
increase risk of emergence delirium
which medication is the least effective Antisialagogue (of the antimuscarinis
atropine
which medications Inhibits SNS innervation of sweat glands and what does it cause
2
Atropine and glycopyrrolate, ↑ body temperature
Releative contraindications of atropine and glycopyrrolate
- Narrow-angle glaucoma
- febrile patients
Atropine should be used causiously with pateints presenting with what?
+5 examples
Use caution when tachycardia already present or may be deleterious
Ex.
* CAD,
* aortic stenosis,
* hypertrophic cardiomyopathy,
* pheochromocytoma,
* thyroid storm
What are the toxicity symptoms of atropine
Tachycardia;
mydriasis/cycloplegia;
restless/confused;
unable to swallow, urinate, sweat; hot, red skin; fever; hallucinations; delirium; coma; death
Do not use which medication for infranodal AV block
give examples
Atropine
2nd degree AV block Type II or 3rd degree AV block
Caution with benign prostatic hypertrophy, bladder-neck obstruction for which medication?
atropine
tertiary amine can/cannot cross BBB
CAN cross BBB
what is Robinol
Glycopyrrolate
Glycopyrrolate
class/ catetory
Synthetic Anti-muscarinic
Glycopyrrolate
uses, MOA
Uses:
* Reversal of NDNMB, antisialagogue
* treatment of bradycardia
Mechanism of Action:
Non-selective, competitive muscarinic antagonist
Glycopyrrolate
Dosing
Reversal of NDNMB:
0.2 mg of Glycopyrrolate for every 1 mg of Neostigmine IV, slowly over 2-5 min
Antisialagogue or bradycardia:
0.1-0.2 mg IV push
Glycopyrrolate
onset, peak, duration
Onset: Rapid
Peak: 3-7 min
Duration: 2-4 hr
Glycopyrrolate
elimination
Renal
Glycopyrrolate
CV effects
↑ HR, but less than Atropine
Glycopyrrolate
pulm effects
- Bronchodilator
- Inhibits bronchial secretions
Glycopyrrolate
CNS effects
- Does not cross BBB, no CNS effect, no sedation
- No mydriasis or cycloplegia
- Unlikely to cause anticholinergic syndrome
Glycopyrrolate
GI effects
- ↓ LES and barrier pressure
- ↓ GI motility
- Inhibits pancreatic and GI secretions, including gastric acid
glycopyrrolate has what action on salivation?
Antisialagogue - Inhibits salivary gland secretions
glycopyrrolate should not be used in tx of which medication, and what are the associated side effects/ patient population?
Avoid use for treatment of dexmedetomidine-associated bradycardia in children (risk of profound HTN)
