Anticholinergics

Question 1

1. ) NMB’s are antagonists at what receptors?

2. )What is its effect at the receptor?

Answer 1

1. )Antagonists at muscular nicotinic receptors

2. ) Results in skeletal muscle relaxation

Question 2

what NMB’s agents do we have available?

What are their primary indication for use?

Answer 2

Atracurium
Cisatracurium 
Rocuronium 
Vecuronium 
Pancuronium

(these are all non-depolarizing NMB)

Endotracheal intubation; surgery

Question 3

How do you reverse the NMB ? What agent do you use?

Answer 3

Neostigmine (+/-) Atropine

Question 4

Succinylcholine

1. ) Drug class
2. ) MOA?
3. ) ADR?
4. ) Treatment?

Answer 4

1. ) Depolarizing
2. ) Competes with ACh for nicotinic receptors to mimic ACh and depolarize→ Muscle fasiculation→ paralysis
3. ). Malignant hyperthermia
4. ) Dantrolene

Question 5

Name all the anti-muscarinics

Answer 5

• Atropine
• Belladonna
• Cyclopentolate
• Scopolamine
• Homatropine
• Trihexyphenidyl
• Benztropine
• Glycopyrrolate
• Dicyclomine (Bentyl)
• Hyoscyamine (Levsin)
• Ipratropium (Atrovent)
• Tiotropium (Spiriva)
• Aclidinium (Tudorza)
• Umeclidinium (Incruse)
• Tolterodine (Detrol)
• Fesoterodine (Toviaz)
• Oxybutynin (Ditropan)
• Darifenacin (Enablex)
• Solifenacin (Vesicare)
• Trospium (Sanctura)
• Flavoxate (Urispas)

Question 6

*Many drugs have “anti-cholinergic” effects in addition

to those linked to their mechanistic target…What are they?

Answer 6

Diphenhydramine (Benadryl), SSRIs, TCAs, etc.

Question 7

Symptoms of Anticholinergic Toxidrome

Answer 7

• “Hot as a hare”
– Hyperthermia 
• “Dry as a bone”
– Dry mucous membranes 
• “Red as a beet”
– Skin flushed 
• “Mad as a hatter”
– Confusion, delirium
• “ lind as a bat”
– Mydriasis, blurred vision 
• “Seizing like a squirrel”
– Seizures 
• “Full as a flask”
– Urinary retention 
• “Tachy as a leisure suit”
– Tachycardia