anticholinergics Flashcards
two other names for anticholinergics
parasympatholytics
antimuscarinics
where do anticholinergics exhibit their actions?
antagonize ACh at cholinergic post-ganglionic sites AKA muscarinic receptors
do anticholinergics in usual doses have an effect on post-ganglionic nicotinic receptors
no, just muscarinic receptors
atropine and scopalamine are what kind of anticholinergics
tertiary amines
alkaloids of the belladonna plant
glyco is what kind of anticholinergic
- semi-synthetic congener of belladonna alkaloid
- quaternary ammonium derivative
can glyco cross the BBB?
No, only the tertiary amines can
naturally occurring anticholinergics are esters formed by combining __ acid and an organic base of __ or __
tropic acid + either tropine or scopine
structurally, belladonna alkaloids resemble __
cocaine
do we Like the dextrorotary or Levorotary forms of anticholinergics
Like = Levorotary
which anticholinergics are racemic mixtures?
atropine and scop
are synthetic anticholinergics racemic mixtures?
no
does glyco contain tropic acid?
nope, mandelic acid, like nelson mandela
anticholinergics contain a __ portion that fits in the muscarinic receptor just like ACh
cationic
anticholinergics combine __ with muscarinic receptors without eliciting a response and prevent ACh from binding to the receptor
reversibly
competitive antagonist
muscarinic receptors are __ protein coupled receptors
G protein
avoid __ for glaucoma patients
scop
which anticholinergic is given for cardian preops because it decreases metabolic o2 requirements?
scop
“those patients are bombed out of their minds, dancing naked on the bed three days later”
can atropine actually slow the HR?
yes, atropine is not a pure antagonist, also has weak agonist effects
which anticholinergic has prolonged elimination in ESRD patients?
glyco
what is the reversal for restlessness/somnolence due to anticholinergics
physostigmine
which is the best antisialogogue?
scop, then glyco
but scop is sedating so glyco given most often
dosage of atropine to treat bradycardia
15-70 mcg/kg, has a ceiling effect where no further increase can be obtained
are anticholinergics very effective for treating bradycardia in infants and elderly?
not really, they don’t have as much vagal control of the heart compared to teens who faint when you come at them with a gelco
will anticholinergics help increase your HR after transplant?
nope, it’s de-innervated so gotta use epi
what do anticholinergics due to the airway?
dilate bronchi, decrease resistance, increase dead space
ipratroprium (atrovent) the most common = quaternary ammonium congener of atropine
central cholinergic syndrome red as a \_\_ dry as a blind as a mad as a hot as a
red as a beet dry as a bone blind as a bat mad as a hatter hot as a hare
treatment for central cholinergic syndrome?
physostigmine 15-60 mcg/kg
