Cholinergic Agents

Question 1

Acetylcholine

Answer 1

Muscarinic agonist
Prototype (no clinical use due to half life rapidly broken down by ACHe)
Stimulates N&M Receptors
IV = parasympathetic effects

Question 2

Bethanechol (Urecholine)

Answer 2

Non Specific Muscarinic Agonist
*will not cross BBB due to charge
DOC to tax urinary Renton and to increase GI motility

Question 3

Pilocarpaine (isoptocarpine, pilocar)

Answer 3

Non specific M agonist
Topical for acute angle glaucoma tax

SE: blurred vision (topical), sweating (orally), headache and brow ache

Question 4

Cholinergic

Muscarinic Agonists Class SEs

Answer 4

Nausea, diarrhea, bladder tightness, sweating, salivation, bronchoconstriciton, constricted pupils

Question 5

Muscarinic Agonist Contras

Answer 5

Asthma/COPD due to bronchoconstriction
Peptic Ulcer Disease due to GI acid production
Bowel Obstruction due to peristalsis leads to a perf
Toxicity or poisoning look for SLUDGE (not as bad as organophosphate)

Question 6

Varenicline (chantix)

Answer 6

Partial Nicotinic agonist
Smoking cessation
W/ cigs = antagonist
W/o cigs = partial agonist

SE: SI, nightmares, psychosis

Question 7

Neostigmine (prostigmin)/pyridostigmine (mestinon)

Answer 7

Cholinesterase inhib-form covalent bond
**DOC for myasthenia Travis
Muscarinc agonist side effects
No CNS

Question 8

Phystigmine (eserine)

Answer 8

Reversal agent for atropine poisonings

Cholinesterase inhibitors

Question 9

Edrphonium

Answer 9

Short acting, injected
Used to correct dosing for myasthenia
Strength improves dose needs to go up
Strength worsens decrease dose

Question 10

Donepezil

Answer 10

Cholinesterase inhib

Used for alzheimers

Question 11

Organophosphates

Soman, sarin, tabun, VX

Answer 11

Cholinesterase inhib
SLUDGE sx
Tx w/ atropine until pupils dilate
Or tax w/ 2-PAM I’d under 3-4 hours since exposure
Must be sure its an o phosphate though cause 2-PAM will bind ACHe in absence of o phos

Question 12

Atropine

Answer 12

Muscarinic antagonists
Prototype
Increases HR, bronchodilator, GI motility down, Bladder down
Tx for bradycardia, muscarinic poisoning

Question 13

Scopolamine

Answer 13

antimuscarinic
Crosses BBB
Patch behind ear for motion sickness
Adverse: drowsiness, short term memory loss

Question 14

Trpicamide (mydriacil)

Answer 14

Muscarinic antagonist
Dilate pupil
topical
Relaxes ciliary muscles

Question 15

Ipratropium (atrovent)

Answer 15

Muscarinic antagonist
COPD, +/- asthma
Bronchodilator

Question 16

Tolterodine (Porto)

Fesoterodine, dariferacin, soliferacin

Answer 16

Muscarinic antagonist
Tax overactive bladder
***M3 selective

Question 17

Oxybutynin

Answer 17

Muscarinic antagonist

Tx bladder spasms

Question 18

Dicylcomine

Answer 18

Muscarinic antagonist

GI anti spasm

Question 19

Botox

Answer 19

Anti Muscarinic (not a true agonist)
Simply blocks the release of Ach
Tx urinary incontinence
SE can lose tone

Question 20

Muscarinic antagonists class adverse effects
(Hot mneumonic)

Answer 20

Hot, dry, maddens, blind, red
Mydriasis, tachycardia, GI motility down

DO NOT give atropine to glaucoma pt

Question 21

Succinylcholine

Answer 21

Depolarize got blocker
Initial stem but then lasts longer
Leads to desensitization
USed for rapid short acting effect (emergent trach for example)

SE cardiac arrest especially in hyper K
Burn pt is a no
Can cause malignant hyperthermia