Anticholinergics

Question 1

What are the 2 naturally occurring anticholinergics?

Answer 1

Atropine

Scopolamine

Question 2

Are naturally occurring anticholinergics tertiary or quaternary anticholinergics?

Answer 2

Tertiary

Question 3

Semi-synthetic anticholinergic

Answer 3

Glycopyrrolate

Question 4

Is glyco tertiary or quaternary?

Answer 4

Quaternary

Question 5

Which class of anticholinergics cross BBB?

Ex.

Answer 5

Tertiary amine anticholinergics

Atropine and scopolamine

Question 6

Atropine and scopolamine are what mixture?

Active form?

Answer 6

Racemic mixtures

Levorotary exhibits anticholinergic effects

Question 7

Natural anticholinergics contain what acid?

Answer 7

Tropic acid

Question 8

Semi-synthetic anticholinergics contain what acid?

Answer 8

Mandelic acid

Question 9

Anticholinergics work by

Answer 9

Fitting muscarinc cholinergic receptors just like Ach

Question 10

Anticholinergic =

Answer 10

Anti parasympathetic

Question 11

Which exhibits greater antisialagogue and ocular effects?

Answer 11

Scopolamine

Question 12

Which anticholinergic works fastest?

Answer 12

Atropine

Question 13

Which anticholinergic would you give with edrophonium?

Which with neostigmine?

Answer 13

Edrophonium- atropine

Neostigmine- atropine or glycopyrrolate

Question 14

Dose of atropine with edrophonium

Answer 14

7 mcg/kg

Question 15

Dose of atropine with neostigmine

Answer 15

0.6-1.2 mg

Question 16

Dose of glycopyrrolate with neostigmine

Answer 16

0.2-0.6mg

Question 17

Anticholinergics are specific to what receptors

Answer 17

Muscarinic

Question 18

Atropine Metabolism

Answer 18

30-50% excreted unchanged in urine

Hepatic metabolism results in tropic acid, groping, and glucuronide conjugated

Question 19

Does atropine cross BBB and placental barrier?

Answer 19

Yes

Question 20

Atropine terminal half life

Answer 20

2-3 hours

Question 21

Glycopyrrolate metabolism

Answer 21

Excreted as unchanged drug

Question 22

Which anticholinergic has most extensive metabolism

Answer 22

Scopolamine

Question 23

MOA of anticholinergic

Answer 23

Combine reversible with muscarinic cholinergic receptors and prevent Ach from binding

Question 24

Why scopolamine not combined with anticholinesterase for reversal of NDNMB

Answer 24

Pt would not wake up

Question 25

Which anticholinergic causes most sedative effects?

Answer 25

Scopolamine

Question 26

Which is most potent mydriatic anticholinergic and shouldn’t be given to glaucoma patients

Answer 26

Scopolamine

Question 27

CV implications with anticholinergics

Answer 27

Scop- decreases metabolic O2 requirements Atropine- no change Glyco- increases O2 needs

Question 28

Antisialagogue effects in order

Answer 28

Scop > glyco> atropine

Question 29

Drug of choice for treatment of central cholinergic syndrome and dose

Answer 29

Phyostigmine 15-60 mcg/kg

Question 30

Tx for anticholinergic OD

Answer 30

Phyostigmine 15-60 mcg/kg

Question 31

M1 receptors pharmacodynamics

Answer 31

Enhance cholinergic reflex bronchoconstriction

Question 32

M2 receptor pharmacodynamics

Answer 32

SA, AV, Decreases myocardial O2 demands Bronchodilator GI

Question 33

M3 receptor pharmacodynamics

Answer 33

Bronchodilation, iris, ciliary body, GI