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Top Drawer Medications > Anticholinergics > Flashcards

Anticholinergics Flashcards

1
Q

What is the dose of atropine when used with edrophonium as a reversal

A

0.014 mg/mg edrophonium

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2
Q

Dose of atropine when used for bradycardia

A

0.2-0.4 mg

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3
Q

Indications for atropine

A
  • Reversal with Enlon
  • Brady Arrhythmias
  • Vagal stimulation ( Ex. by occulocardia reflex or peritoneal stimulation).
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4
Q

In what patients should you cautiously use atropine

A
  • Narrow-angle glaucoma –> (atropine = sympathetic stimulation which dilates pupils and decreases outflow of intraocular aqueous humor, which increases IOP)
  • crosses the placenta to increase FHR and decrease beat-to-beat variability in baby
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5
Q

MOA of atropine

A
  • Competitive acetylcholine antagonist @ central and peripheral receptors
  • antimuscarinic
  • naturally occurring alkaloid
  • Tertiary amine
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6
Q

CV effects of atropine

A

Increased HR

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7
Q

Would glyco or atropine be a better choice to increase HR in eye surgery, pneumoperitoneum for lap cases, pull on peritoneum or cervix?

A

Atropine because it is better for increasing HR from vagal stimulation

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8
Q

Onset and DOA of atropine

A

Onset = < 1 min

DOA = 30 min (IV)

2-4 hours (IM)

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9
Q

Is atropine a tertiary or quarternary amine

A

Tertiary amine

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10
Q

Other name for glycopyrolate

A

Robinul

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11
Q

Dose of robinul when used as a reversal with neostigmine

A

0.2 mg/mg Neo

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12
Q

Indications for robinul

A

Reversal agent, antisialoguge, bradycardia

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13
Q

MOA & CV effects of glycopyrolate

A

MOA:

  • competitive ACh antagonist
  • synthetic antimuscarinic

CV:

  • increase HR (not as extreme as atropine)
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14
Q

Why might you give robinul in preop

A

In situation you want pt “dry” and need to increase HR

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15
Q

Onset and DOA of Glycopyrollate

A

Onset:
- 1 min IV
- 15-30 min IM

DOA:
- vagal blocking = 2-3 hours
- antisialogous = up to 7 hours

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16
Q

T or F: glycopyrollate readily crosses BBB and placenta

A

F — quarternary ammonium does not cross easily

17
Q

Indication for scopolamine

A
  • decrease secretions
  • PONV
  • motion sickness/vertigo
  • unstable trauma patient
  • dilate pupils and cycloplegia
18
Q

Contraindications for scopalamine

A

Can cause toxic psychosis in elderly

  • effects from restlessness to agitation
19
Q

MOA of scopalamine

A

Competitive antagonist of ACh at muscarinic receptors

Antagonizes histamine and serotonin

tertiary amine, naturally occurring Alkaloid

20
Q

Clinical considerations for scopalamine

A
  • causes a lot of amnesia — good for trauma pts, women who get N/V
  • decrease secretions/motion sickness
  • don’t touch eyes after handling this med (can dilate pupils for 12 hours).
  • remove after 24 hours and wash hands!
21
Q

T or F: scopolamine crosses BBB

A

T - tertiary compound, naturally occurring alkaloid

22
Q

Glycopyrrolate uses/effects:

A

Used in combo with Neostigmine for reversal; antisialogogue (xerostomia); increases HR
Causes NO CNS symptoms or mydriasis: quartenary ammonium

23
Q

Glycopyrrolate drug class and MOA:

A

Synthetic antimuscarinic; competitive ACh antagonist

24
Q

Glycopyrrolate (___)

A

___ (Robinul)

25
Q

Central Anticholinergic Syndrome treatment and dose:

A

Treat with Physostigmine: tertiary amine that crosses BBB
Dose: 1-2 mg IV and may need to be repeated every 1-2 hrs (physostigmine is metabolized rapidly)

26
Q

Central Anticholinergic Syndrome signs:

A
  • anxiety
  • disoriented
  • hyperactive
  • sedation
  • seizure
  • mydriasis
  • increased HR
  • atropine flush
  • dry/flushed skin
  • atropine fever

Can be mistaken for delayed recovery from anesthesia

27
Q

Scopolamine dose (conc.):
duration:

A

Dose:

  • 0.3-0.5 mg IM or IV
  • 1.5 mg transdermal patch

Concentration:

  • 0.4 mg/cc

DOA: 24-48 hrs

28
Q

Glycopyrrolate dose:
onset:
DOA:

A

0.2 mg per 1 mg Neostigmine

onset: about 1 min IV
15-30 min IM

DOA: 2-4 hrs

29
Q

Scopolamine is a (tertiary amine/quaternary ammonium)

A

tertiary amine

30
Q

Glycopyrrolate is a (tertiary amine/quaternary ammonium).

A

quaternary ammonium

31
Q

Atropine is a (tertiary amine/quaternary ammonium).

A

tertiary amine

32
Q

Atropine dose:
onset:
duration:

A

0.014 mg/mg of edrophonium
OR
0.2-0.4 mg for vagal stimulation

onset: 1 min

duration: up to 30 mins

33
Q

Primary reason for giving muscarinic antagonist agents?

A

Used to antagonize the muscarinic effects of anticholinesterases used to reverse NDMBs

(anticholinesterases cause increase in ACh, which stimulates the parasympathetic pathway and causes SLUDGE)

34
Q

General effects of all muscarinic antagonists:

A

Opposite of SLUDGE:
inhibits salivation, lacrimation
reduces gastric secretions and motility
causes bronchodilator
increases HR

35
Q

Muscarinic antagonists’ MOA and primary effect:

A

Competitive inhibitors of ACh at parasympathetic muscarinic receptors –> primary effect is to increase HR

Top Drawer Medications (13 decks)

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