ANS pt 2 - slides 1-17 Flashcards
why is there muscle weakness with myasthenia gravis
lower Nm receptor stimulation
what muscarinic agonist is used to treat glaucoma and xerostomia
pilocarpine
name an example of a neuronal nicotinic agonist
nicotine
what are two adverse effects of irreversible AChE inhibitors
excessive muscarinic stimulation
inhibition of neuromuscular transmission
what are 3 examples of nerve gases
sarin
tabun
VX
name 6 adverse effects of muscarinic antagonists
xerostomia
anhidrosis
urinary retention
constipation
blurred vision
photophobia
what muscarinic agonist is used to treat urinary retention and intestinal paralysis
bethanechol
what branch of the ANS would a neuronal nicotinic agonist stimulate
both the sympathetic and parasympathetic
name a charged AChE inhibitor
neostigmine
bethanechol is an example of what kind of drug
muscarinic agonist
what are the effects of muscarinic antagonists
tacchycardia
decreased sweat gland, bronchial, GI secretions and motility
relaxation of bronchia SM and detrusor muscle
mydriasis and cycloplegia
what are two adverse effects of irreversible AChE inhibitors
excessive muscarinic stimulation
inhibition of neuromuscular transmission
what drugs can trigger malignant hyperthemia
succinylcholine
general anesthetics
what is an example of a depolarizing blocker
succinycholine
what causes myasthenia gravis
inactivation of ACh Nm receptors by auto-antibodies
muscarine is found in what natural source
poisonous mushrooms
what is an example of irreversible AChE inhibitors
echothiophate
what 3 drugs can be used to treat AChE inhibitor effects
atropine
oxygen
diazepam
what targets do muscarinic agonists stimulate
all parasympathetic targets plus the sweat glands from the sympathetic NS
what is an example of an insecticide
malathion
what can occur at high doses of muscarinic antagonists
psychosis
delirium
(due ot excitation of the CNS)
what is typically the predominant effect of neuronal nicotinic agonists
sympathetic effects due to the increased release of Epi/norepi by the adrenal medulla
what is bethanechol used to treat
urinary retention and intestinal paralysis
AChE inhibitors typicall lead to increased effects at what cholinergic receptors
muscarinic and neuromuscular
what is an adverse effect of muscarinic agonists
overstimulation of parasympathetic targets
what does SLUDGE stand for
salivation
lacrimation
urination
diaphoresis
GI motlility
emesis
what muscarinic antagonist can be administered via transdermal patch as an antiemetic
scopolamine
why are most neuromuscular blockers administered parenterally
because they are permanently charged ammonium compounds
what receptors do neuromuscular blockers affect
nicitinic receptors on skeletal muscle
what are the adverse effects of AChE inhibitors
excessive stimulation of muscarinic and neuromuscular receptors
what is scopolamine
a muscarinic antagonist can be administered via transdermal patch as an antiemetic
what do muscarinic agonists do
stimulate muscarinic receptors
name a neutral AChE inhibitor
physostimgine
name 3 examples of non-depolarizing neuromuscular blockers
tubocurarine
rocuronium
cisatracurium
nicotine is what kind of drugs
neuronal nicotinic agonist
name 3 things AChE inhibitors can be used to treat
myasthenia gravis
paralysis induced by non-depolarising neuromuscular blockers
alzheimers disease
what NS does neuromuscular blockers affect
the somatic NS
what is Malignant hyperthermia
dangerously high temp
rigid muscles/spasms
rapid HR
due to overactivation of muscle receptors
what is myasthenia gravis
chronic autoimmune disease linked to defective transmission at the neuromuscular junction
will edrophonium make a subtherapeutic myasthenic patient better or worse
better
whats another word for muscarinic antagonists
anticholnergics
What do cholinomimetics do
act like ACh
what is a drug to treat malignant hyperthermia
dantrolene
what drug can be used to differentiate between a cholinergic crisis and severe symptoms of myasthenia
edrophonium
what is the mechanism of action of AChE inhibitors
temporarily inactivates acetylcholinesterase
name a short-acting AChE inhibitor
edrophonium
what is another name for parasympathomimetic
muscarinic agonists
what is the result of a neuronal nicotinic agonist
increased release of noradrenaline, adrenaline and acethycholine
what does a cholinergic crisis cause
repetitive overstimulation of nicotinic receptors lead to a neuromuscular block by depolarization (ie paralysis)
when does blockage of muscle contraction occur with neuromuscular blockers
when 70% of Nm receptors are blocked
what’s an adverse effects of neuromuscular blockers
excessive paralysis can result in cessation of breathing
how does succinylcholine work
overstimulates receptors until they become inactivated
what is the result of AChE inhibitors
increased ACh levels
what do cholinolytics do
blocks ACh-related effects
name 6 uses of muscarinic antagonists
reduce urinary urgency/incontinence
decrease hypermotility of gut
pre-op/palliative care to dry out secretions
eye exam/surgery
treat muscarinic poisoning
treat asthma (blocks bronchoconstriction)
what is the mechanism of action of muscarinic antagonists
blocks muscarinic receptors
what are 3 uses of neuromuscular blockrs
relaxation during surgery
endotracheal intubation+mechanical ventilation
name 3 reversible AChE inhibitors
neostigmine
physostigmine
edrophonium
what is a cholinergic crisis
excessive ACh levels at Nm and muscarinic receptors
how long is the duration of depolarizing neuromuscular blockers
5mins - metabolized by plasma cholinesterases
what poisonous mushrooms are muscarine found in
amatina muscaria
inocybe
clitocybe
when is improvement seen with myasthenia gravis
if ACh levels are increased at neuromuscular junctions
what medication can be used to reverse effects of AChE inhibitors if used quickly enough
pralidoxime
what are 3 contraindications of AChE inhibitors
GI obstruction
urinary obstruction
asthma
rank the sensitivity of muscles to neuromuscular blockers from highest to lowest
fast twitch
respiratory
slow twitch
what plant does atropine come from
atropa belladonna
what is dantrolene used to treat
malignant hyperthermia
what two muscarinic agonists are used to treat glaucoma
pilocarpine
carbachol
cycloplegia
loss of accommodation
how does dantrolene work
blocks calcium release from intracellular sarcoplasmic reticulum stores in skeletal muscle
will edrophonium make a cholinergic crisis better or worse
worse
how do non-depolarizing neuromuscular blockers work
by competing with acetylcholine for binding to muscle nicotinic receptor
what are 4 muscarinic antagonists
atropine
tolterodine
oxybutynin
solifenacin
insecticides and nerve gases are what type of drugs
irreversible AChE inhibitors
what is another name for muscarinic agonists
parasympathomimetics
what is echothiophate used to treat
glaucoma
pilocarpine and carbachol are what kind of drugs
muscarinic agonists
