Autonomic Drugs

Question 1

Antidote for Atropine Overdose

Answer 1

Physostigmine

Question 2

Symptoms of Muscarinic Agonist Overdose

Answer 2

DUMBBELS (or SLUDGE)

1. Diarrhea
2. Urination
3. Miosis
4. Bradycardia
5. Brohchosecretions
6. Emesis (vomiting/nausea)
7. Lacrimation
8. Salivation

Question 3

Methacholine

Answer 3

“Marathon Challenge”

• Choline Ester
• Muscarinic Agonist
• Induces Bronchospasms for Asthma Challenge Test

Question 4

M3 Receptor Locations

Answer 4

Smooth Muscle, Exocrine Glands, Vascular Endothelium

Question 5

Verenicline

Answer 5

“1-800-Very-Clean”

• Partial Nicotinic Agonist
• Used to treat nicotine addiction

Question 6

Carbachol

Answer 6

“Closed hoodie to protect from Carbon fumes from Nicotine smoker”

• Choline Ester
• Muscarinic and Nicotinic agonist
• Used to induce miosis (pupil constriction) during ocular surgery

Question 7

Succinylcholine

Answer 7

• Depolarizing Muscle Relaxer
• Tightly binds to Nicotinic receptor at Neuromuscular Junction and causes deplolarization and depletion of all calcium
• Use to paralyze muscles in short surgeries

Question 8

Botox

Answer 8

• Destroys Ach vesicles and prevents release at Neuromuscular Junction
• Causes flacid paralysis

Question 9

Alpha-Latrotoxin

Answer 9

• Black widow venom
• Causes massive release of Ach
• Causes depolarizing paralysis

Question 10

Diazinon

Answer 10

• Organophosphate that Irreversibly Binds Acetylcholinesterase
• Nerve gas
• Will kill you

Question 11

Pilocarpine

Answer 11

“Pile-of-Carp-ine”

• Alkaloid
• Muscarinic Agonist
• Used to treat glaucoma and Sjorgeren’s Syndrome

Question 12

Antidote for Acetylcholinesterase Inhibitor Overdose

Answer 12

Atropine

Question 13

Pyridostigmine

Answer 13

• Carbamate Acytocholinesterase Inhibitor that does not penetrate CNS
• Treatment for Myasthenia Gravis
• Antidote to Curare Overdose
• Can treat glaucoma

Question 14

Acytocholinesterase Inhibitor Overdose

Answer 14

DUMBBELS + Muscle Paralysis/Cramping/Fasiculations

Question 15

Ipratropium

Answer 15

“Cat-ipra-tro-pillar”

• Synthetic Muscarinic Antagonist
• Quarternary - does not get into CNS
• Causes pupil dilation, increases HR, etc

Question 16

Treatment for Organophosphate Poisioning

Answer 16

2-Pralidozime (2-PAM)

Atropine (for CNS)

Question 17

Antidote for Tubocurarine Overdose

Answer 17

Neostigmine or Pyridostigmine (Acetocholinesterase Inhibitor)

Question 18

Antidote to Malignant Hyperthermia

Answer 18

Dantrolene

Question 19

Trimethaphan

Answer 19

• Blocks Ganglionic Nicotinic Receptor
• Used to rapidly decrease blood pressure by inhibiting sympathetics (you inhibit parasympathetics too, but VSM has sympathetic tone)

Question 20

Antidote for Acetocholinesterase Inhibitor Overdose

Answer 20

Atropine

Question 21

Scopolamine

Answer 21

“Walrus with Scope”

• Alkaloid Muscarinic Antagonist
• Treats motion sickness
• Causes pupil dilation

Question 22

Potential problems with Succinylcholine

Answer 22

Hyperkalemia and Malignant Hyperthermia

Question 23

Atropine

Answer 23

• Alkaloid - can get into CNS
• Muscarinic Antagonist
• Reduces vagal tone (increase HR)
• Can be used to stop heart block
• Treat diarrhea
• Dilates pupil

Question 24

Effects of Stimulating Nicotinic Receptors

Answer 24

1. Skeletal Muscle Contraction
2. Epinephrine secretion from Adrenal Glands
3. Action Potentials in Post-Synaptic Autonomic Ganglia

Question 25

Pralidozime

Answer 25

Binds to organophosphate and removes it from Acetylcholinesterase Antidote to Organophosphate poisioning

Question 26

Explain Process of Nitric Oxide Mediated Vasodilation

Answer 26

**M3** Receptors on **Vascular Endothelium** trigger **Calcium influx**, which stimulates NO-Synthase to produce **Nitric Oxide** from Arginine. Nitric Oxide causes **vasodilation** in nearby smooth muscle by stimulating an increase in **cGMP** **cGMP** is degraded by **Phosphodiesterase** **PDE5** is the main Phosphodiesterase in the penis, and it can be inhibited with **Sildenafil** to maintain erections

Question 27

Symptoms of Muscarinic Antagonist Overdose

Answer 27

* "Dry as a Bone" - dry skin, eyes, mouth * "Red as a Beet" - vasodilation in skin * "Hot as a Hare" - no sweating * "Blind as a Bat" - no accomidation, increased ocular pressure * "Mad as a Hatter" - seizure, coma

Question 28

M1 Receptor Locations

Answer 28

Brain, Enteric Nervous System (gut)

Question 29

Neostigmine

Answer 29

* Carbamate Acytocholinesterase Inhibitor that does not penetrate CNS * Treatment for Myasthenia Gravis * Antidote to Curare Overdose * Can treat glaucoma

Question 30

Cevimeline

Answer 30

* Synthetic Muscarinic Agonist * Used to treat Sjorgren's Syndrome

Question 31

M2 Receptor Locations

Answer 31

Heart (SA and AV Nodes, Atrium)

Question 32

Cure for Succinylcholine Overdose

Answer 32

None; wait it out and put patient on ventilator

Question 33

Edrophonium

Answer 33

"Phone booth testing for Myasthenia Gravis" * Short-acting Acetylcholinesterase Inhibitor * Used to diagnose Myasthenia Gravis

Question 34

Tubocurarine

Answer 34

"Curare Crayons blocking the end-plate socket" * Competitive blocker of the Neuromuscular Junction * Quarternary compound * Binds nicotinic receptors and leaves muscles in flacid state * Long acting, used to paralyze muscles during surgery

Question 35

Bethanechol

Answer 35

"Beth holding bladder firehose and colon cement mixer" * Choline Ester * Muscarinic Agonist * Treatment for Urinary Retention or used to get GI tract moving again after surgery

Question 36

Physostigmine

Answer 36

* Carbamate Acytocholinesterase Inhibitor that rapidly penetrates CNS * Treatment for Atropine Poisioning * Treats Alzheimer's and Dementia * Can treat glaucoma