Question 1

Atropine: class + structure + use

Accepted Answer

ADD DETAILS FROM ANTI ARRHYTHMIC CARD
class
- antimuscarinic/anticholinergic
structure
- natural tertiary amine → crosses BBB
uses
- symptomatic bradycardia (most potent increase in HR)
- PEA/Asystole
- combination with anticholinesterase for NMB reversal (edrophonium)
- antisialagogue
- bronchodilation
- mydriasis (pupil dilation)
- cycloplegia (paralysis of accomodation)

Question 2

atropine: MOA

Accepted Answer

Competitive inhibition of Ach at muscarinic receptors of organs innervated by cholinergic postganglionic nerves blocking normal cholinergic tone allows sympthetic responses to dominate Increases HR by blocking acetylcholine effects on the SA node antagonizes histamine and serotonin

Question 3

atropine: PK

Accepted Answer

_Onset_: 1 min _DOA_: 30-60 min _E1/2_: 2.3 hrs _Vd_: 1.6 L/kg _PB_: 40%, mostly to alpha-1 glycoprotein _Metabolism_: hydrolysis in the liver _Elimination_: 18% unchanged in the urine

Question 4

atropine: SE

Accepted Answer

_NEURO_: blurred vision (mydriasis and cycloplegia) increased IOP sedation (central anticholinergic syndrome) - crosses the BBB & can cause delirium, irritability, stupor, restlessness, disorientation, hallucinations, respiratory depression, & coma _CV_: ↑ HR, CO, arrhythmias (PVC’s, AV dissociation) _PULM_: dry mouth (xerostomia) bronchodilation _GI/GU_: ↓GI motility and secretions urinary retention _SKIN_: inhibits sweating

Question 5

atropine: cautions/contraindications/drug interations

Accepted Answer

cautions/contraindications
- narrow angle glaucoma
- MG (unless used to treat side effects of AchE inhibitor)
- Elderly → CAS
- Pts where tachycardia would be harmful: thyrotoxicosis, pheochromocytoma, CAD
- Mobitz type II block
- GI obstruction/ileus
- avoid in hyperpyrexial patients because Atropine inhibits sweating
- Patients who have had heart transplants will be unaffected by antimuscarinics to increase HR
drug interactions
- Anticholinergic medications (including phenothiazines and TCAs) may increase anticholinergic effects when used concurrently
- avoid using sympathomimetic amines concurrently → may cause tachyarrhythmias

Question 6

atropine: dose

Accepted Answer

_Bradycardia_: 0.4-1.0 mg IV (max 3 mg) _Pre-op antisialogogue_: 0.2 to 0.4 mg IV 30-60 min prior. _Combination w/ anticholinesterase to reverse paralytic:_ Atropine 7-15 mcg/kg co-administered with edrophonium 0.5 – 0.75 mg/kg _Asystole, PEA_: 1 mg q 3-5 min _Bronchodilation_: 2 mg in 5 cc NS via nebulizer

Question 7

glycopyrrolate: class + structure + use

Accepted Answer

class
- synthetic anticholinergic/antimuscarinic agent
structure
- quaternary ammonium → does not cross BBB (consider in elderly)
uses
- preop antisialogogue - reduce salivary, tracheobronchial, & pharyngeal secretions & to reduce the volume & free acidity of gastric secretions (more potent than atropine)
- tx of vagal reflex bradycardia (Used to block cardiac vagal inhibitory reflexes during induction of anesthesia & intubation. Used intraoperatively for its moderate effects on inc. HR. Ideal for treating bradycardia resulting from airway manipulation, surgical manipulation, or anesthetic drugs → (less potent than atropine)
- NDNMB reversal with neostigmine - Used to antagonize muscarinic side effects during reversal of muscle relaxants w/anticholinesterase drugs

Question 8

glycopyrrolate: MOA

Accepted Answer

Competitive inhibition of Ach at muscarinic receptors of organs innervated by cholinergic postganglionic nerves blocking normal cholinergic tone allows sympthetic responses to dominate Increases HR by blocking acetylcholine effects on the SA node

Question 9

glycopyrrolate: PK

Accepted Answer

_Onset_: 2-3 min _Peak_: 3-5 min _DOA_: 2-4 hrs _E1/2_: 1.25 hrs _Vd_: 0.4 L/kg Poorly lipid soluble (quaternary ammonium structure) _Elimination_: 85% excreted unchanged in the urine

Question 10

glycopyrrolate: SE

Accepted Answer

_NEURO_: Blurred vision (mydriasis and cycloplegia) increased IOP _CV:_ ↑ HR, CO (moderate compared to atropine) tachydysrhythmias, AV dissociation, PVCs _PULM_: dry mouth (xerostomia) bronchodilation _GI/GU_: N/V, bloated feeling ileus constipation urinary retention ↓ secretions & GI motility _SKIN_: decreased sweating, overheating in children and the elderly

Question 11

glycopyrrolate: cautions/contraindications

Accepted Answer

Neonates and elderly Narrow angle glaucoma Myasthenia Gravis Pts where tachycardia would be harmful: thyrotoxicosis, pheochromocytoma, CAD Mobitz type II block GI obstruction/ileus Avoid in renal disease (renally excreted) Will not increase HR in heart TX DILUENT INCOMPATIBILITIES: Lactated Ringer’s solution; Pregnancy Cat. B

Question 12

glycopyrrolate: dose

Accepted Answer

_Antisialogogue & Bradycardia_: 0.1-0.2 mg IV/IM/SC _Combination w/ anticholinesterase to reverse NDNMB_ _​_ Glycopyrrolate (.01 - .02 mg/kg) given with neostigmine (.05 - .07 mg/kg) OR 0.2 mg glycopyrrolate for each 1.0 mg of neostigmine IV in same syringe OR 0.01 mg/kg glycopyrrolate

Question 13

scopolamine: class + structure + use

Accepted Answer

class
- anticholinergic/antimuscarinic
structure
- natural tertiary amine → crosses BBB
use
- sedation (most potent)
- antisialogogue (most potent)
- mydriasis and cycloplegia (most potent)
- bradycardia (least potent)
- motion induced N/V; N/V associated with anesthesia
- biliary and ureteral smooth muscle relaxation
- bronchodilation

Question 14

scopolamine: MOA

Accepted Answer

Competitive inhibition of Ach at muscarinic receptors of organs innervated by cholinergic postganglionic nerves blocking normal cholinergic tone allows sympthetic responses to dominate

Question 15

scopolamine: PK

Accepted Answer

_Onset_: 10 min _DOA_: 2 hrs _E1/2_: 4.5 hrs, although full recovery may take 3-7 days highly lipid soluble easily penetrates the BBB and placenta _Metabolism:_ extensive metabolism in liver _Elimination:_ 1% excreted unchanged in urine

Anticholinergics Flashcards