Cholenergic Pharm

Question 1

Drugs that may be used to treat dry mouth (xerostima)

Answer 1

Pilocarpine, Cevimeline

*both are cholinomimetics, MAchR agonists

Question 2

Drugs to treat fatigue in patient with myasthenia gravis

Answer 2

Pyridostigmine (most common), Neostigmine

*AChE inhibitor

Question 3

Drugs to treat dyspnea in COPD

Answer 3

Ipratropium, Tiotropium (longer lasting)

*Inhaled MAChR (M3) antagonists

Question 4

Mechanism of action for Varenicline

Answer 4

Partial agonist of a4B2 NAChR in the brain

Question 5

Anticipated adverse effects of Varenicline

Answer 5

nasuea, behavior changes, agitation, depression, suicidal ideation, attempted and completed suicide

*if these occur, pt should discontinue it and contact doc

Question 6

Physiologic effects of nicotine poisoning (activation of NAChRs) in the cardiac, pulmonary, renal and musculoskeletal systems

Answer 6

• Cardio: HTN and arrythmias
• Pulmonary: respiratory paralysis
• Renal: HTN?
• MSK: paralysis

Question 7

Drugs to treat urinary incontinence

Answer 7

Oxybutynin (side effects), Darifenacin, Solifenacin, Tolterodine, Trospium (nonselective)

*MAChR (M3) antagonists

Question 8

Expected side effects in patient treated with MAChR (M3) antagonists (Oxybutynin, Darifenacin, Solifenacin, Tolterodine) for urinary incontinence

Answer 8

Xerostima, dry eyes, dry mouth, dizziness, constipation, UTI

Question 9

Drug to treat arrhythmia in patient who overdoses on diphenhydramine

Answer 9

Physostigmine

• centrally and peripherally as AChE inhibitor
• Diphenhydramine has anticholenergic properties

Question 10

Ganglionic blocking drugs (Mecamylamine, NAChR antagonist) affect in anesthesia

Answer 10

Blocks autonomic outflow, parasympathetic activity normally dominates, so “sympathetic” end organ effects would be observed

CNS: sedation, tremor
Eye: cycloplegia, mydriasis
CV: vasodilation, hypotension, decreased contractility, tachycardia
GI: reduced secretions and inhibited motility
GU: urinary retention