Anticholinergic Agents/Muscarinic Antagonists

Question 1

Muscarinic antagonist mechanism of action

Answer 1

Competitive inhibitors of Ach at parasympathetic muscarinic receptors to increase the heart rate

Question 2

muscarinic antagonist overall effects

Answer 2

Inhibits salivary, bronchial, and GI secretions
Reduces gastric motility
Causes bronchodilation

Question 3

Muscarinic antagoists antagonize the ______ effects of ________ used to reverse NDMR

Answer 3

muscarinic; anticholinesterases

Question 4

atropine mechanism of action

Answer 4

Competitive acetylcholine antagonist at central and peripheral receptors, antimuscarinic, naturally occurring alkaloid

Question 5

atropine structure

Answer 5

Tertiary amine

Question 6

atropine cautions

Answer 6

careful use in narrow-angle glaucoma

Question 7

atropine indications

Answer 7

reversal, brady arrhythmias/vagal stimulation, oculocardia reflex, peritoneal stimulation

Question 8

atropine OB effects

Answer 8

Crosses placenta to increase FHR and decrease beat -to- beat variability in baby

Question 9

atropine dose

Answer 9

0.014 mg per mg of edrophonium

.2-.4mg for vagal stimulation

Question 10

atropine onset and duration

Answer 10

onset: < 1 min

duration: up to 30 min

Question 11

glycopyrrolate mechanism

Answer 11

Synthetic antimuscarinic, competitive Ach antagonist

Question 12

glycopyrrolate uses

Answer 12

in combo with Neostigmine for reversal, antisialogogue(xerostomia), increase HR

Question 13

glycopyrrolate structure

Answer 13

quaternary ammonium

Question 14

glycopyrrolate dose

Answer 14

0.2 mg per 1 mg Neostigmine

Question 15

glycopyrrolate onset

Answer 15

about 1 min IV; 15-30 min IM

Question 16

glycopyrrolate duration

Answer 16

2-4 hours

Question 17

does glycopyrrolate cause CNS effects or mydriasis

Answer 17

no

Question 18

scopolamine mechanism

Answer 18

Competitive antagonist of Ach at muscarinic receptors, antagonizes histamine and serotonin

Question 19

scopolamine uses

Answer 19

Decreases secretions, PONV, motion sickness/vertigo, dilate pupils and cycloplegia, unstable trauma pt, sedation/amnesia

Question 20

scopolamine in elderly

Answer 20

toxic psychosis

Question 21

scopolamine side effects

Answer 21

Effects from restlessness to agitation

Question 22

how can scopolamine be administered before surgery

Answer 22

IM or IV

Question 23

scopolamine typical dose

Answer 23

0.3-0.5 mg IM or IV

Question 24

cycloplegia

Answer 24

seen in scopolamine; paralyzing the ciliary muscle

Question 25

central anticholinergic syndrome

Answer 25

Overdose of scopolamine and sometimes Atropine(tertiary amines), phenothiazine

Question 26

central anticholinergic syndrome signs

Answer 26

anxiety, disoriented, hyperactive, sedation, seizure, mydriasis, increased HR, Atropine flush, dry/flushed skin, atropine fever
Can be mistaken for delayed recovery

Question 27

how to treat central anticholinergic syndrome

Answer 27

Treat with Benzos
Physostigmine: tertiary amine that crosses the BBB

Question 28

physostigmine dose

Answer 28

1-2 mg IV and may need to be repeated every 1-2 hours (physostigmine is metabolized rapidly)