ANS drugs Flashcards
systemic effects of cholinomimetic drugs
Increase ACh activity:
- miosis, accommodation
- decrease heart rate by decreasing conduction velocity
- Increase secretions (glands, sweating, lacrimation, salivation)
- Increase GI/GU motility by relaxing external sphincters and increasing secretion
- bronchoconstriction and increased secretion in lung
Contraindications for cholinomimetics
COPD, asthma, peptic ulcers
examples of direct acting cholinomimetics (4)
Bethanechol, carbachol, methacholine, pilocarpine
Bethanechol: class and clinical use
direct acting muscarinic agonist: post op ileus, neurogenic ileus, urinary retention
Carbachol: class and clinical use
direct acting muscarinic agonist: constrict pupil for glaucoma patients
Methacholine: class and clinical use
direct acting muscarinic agonist: challenge test to Dx asthma
Pilocarpine: class and clinical use
direct acting muscarinic agonist: stimulate sweating (CF sweat test), tears, salivation (dry mouth in Sjogrens), constrict pupil for glaucoma
Mechanism of indirect acting cholinomimetics
Anticholinesterases
-stigmines: class
AChE inhibitors
Donepezil: class and clinical use
AChE inhibitor: Alzheimer disease
Galantamine: class and clinical use
AChE inhibitor: Alzheimer
Rivastigmine: class and clinical use
AChE inhibitor: Alzheimer
Edrophonium: class and clinical use
AChE inhibitor: Dx myasthenia gravis
Which anticholinesterase is used to Dx myesthenia gravis? Which is used to treat it? What is the difference between the two
Edrophonium: Pyridostigmine (and neostigmine): the length of time that they remain active
Which AChE inhibitor crosses the BBB? When is it used?
physostigmine: atropine (muscarinic antagonist) overdose
Neostigmine: class and clinical use
AChE inhibitor: postop ileus, reverse NMJ blockade, urinary retention
What does an AChE inhibitor overdose look like? What is the common cause?
DUMBBELSS (Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle, Lacrimation, Sweating, Salivation): Organophosphates from pesticides
How do you treat an AChE inhibitor intoxication
causes ^ in ACh in the terminal, give atropine to block ACh receptors and pralidoxime to regenerate AChE
Systemic effects of muscarinic antagonists
Sympathetic responses: decreased secretion (dry mouth, dry eyes, no sweating, decreased GI), hyperthermia and red skin (no sweating), mydriasis and cycloplegia, tachycardia, slow movement, urinary retention/constipation, CNS (hallucination, behavioral excitation)
What are some classes of drugs that have atropine-like side effects?
anthistamines, antipsychotics, TCAs, Quinidine, amantidine, meperidine
Atropine: class and clinical use
Muscarinic antagonist: produce mydriasis for eye exams, antisecretory, antidote for AChE inhibitor overdose
What are some shorter acting versions of atropine
tropicamide, homatropine
Ipratropium: class and clinical use
muscarinic antagonist: asthma, COPD
Scopolamine: class and clinical use
muscarinic antagonist: motion sickness, sedation
