Cholinergic Antagonist

Question 0

Scopolamine

Answer 0

Isopto Hyoscine/ transderm scop. Also a tertiary I mean plant alkaloid produces Peru Friel effect similar to those of atropine although has greater action on CNS. Anti-motion sickness produces sedation but at higher doses produces excitement

Question 1

Atropine

Answer 1

Isopto atropine. Tertiary a mean belladonna alkaloid with high affinity for muscarinic receptors. Binds competitively and prevents ACH from binding to sites. Block muscarinic activity and I resulting in mydriasis. Reduce his activity in G.I. tract low doses is a slight decrease in heart rate at higher doses causes increase in heart rate. Produces dryness of mouth

Question 2

Ipatropium and tiotropium

Answer 2

Atrovent, spiriva handi haler. Quaternary derivatives of atropine these agents are use for bronchodilators. For treatment of bronchospasm associated with COPD. Tiotropium has the advantage of one daily dose

Question 3

Tropicamide and cyclopentolate

Answer 3

Midryacyl/tropicacyl, ak-pentolate/cyclogyl. Ophthalmic solution for my dryasis and cycloplegia.

Question 4

Benzotropine and trihexyphenidyl

Answer 4

Cogentin,artane. Parkinson’s disease

Question 5

Darfenacin,fesoterodine,oxybutnin,solifenacin,tolterodine,trospiumchloride

Answer 5

Enablex,toviaz,ditropan,vesicare,detrol,sanctuary. Synthetic atropine like drugs used to treat overactive bladder blocks muscarinic receptors in bladder

Question 6

Ganglionic blockers

Answer 6

Block nicotinic receptors of both parasympathetic and sympathetic autonomic ganglia some also block I am channels show no selectivity toward parasympathetic or sympathetic ganglia. not effective as neuromuscular antagonist

Question 7

Nicotine

Answer 7

Depolarizes ganglia resulting in stimulation then paralysis of ganglia.

Question 8

Neuromuscular blocking agents

Answer 8

Block cholinergic transmission between motor nerve endings and nicotinic receptors on skeletal muscle. Act as either antagonists (nondepolarizing type) Or as agonist (depolarizing type).

Question 9

Neuromuscular blockers (non de polarizing competitive drugs)

Answer 9

Cisatracurium(nimbex), pancuronium (pavulon), rocuronium (zemuron), vecoronium.

Question 10

Nondepolarizing competitive blockers drug interactions cholineesterase inhibitors

Answer 10

Choline esterase inhibitor’s reverse action of nondepolarizing neuromuscular blockers. However with increased dosage cholinesterase inhibitor’s can cause a depolarizing block as a result of elevated acetylcholine concentrations.

Question 11

Halogenated hydrocarbon anesthetics

Answer 11

Drugs like desflurane enhance neuromuscular blockade by stabilizing NMJ

Question 12

Aminoglycoside antibiotics

Answer 12

Gentamicin and tobramycin inhibit acetylcholine release from cholinergic nerves by competing with calcium ions.

Question 13

Calcium channel blocker’s

Answer 13

Increase neuromuscular blockade of competitive blockers

Question 14

Depolarizing neuromuscular blocking agents

Answer 14

People arrive plasma membrane of muscle fiber similar to acetylcholine. However these agents are more resistant to degradation by acetylcholine esterase. Succinylcholine is only depolarizing muscle relaxant used today.

Question 16

Succinylcholine

Answer 16

Anectine, quelicin. Attaches to nicotinic receptor and Acts like acetylcholine to depolarize Junction. Remains in synaptic little longer than acetylcholine. Useful for endotracheal intubation

Question 17

glycopyrrolate

Answer 17

robinul

Question 18

propantheline

Answer 18

hyperhydrosis

Question 19

trimethophan

Answer 19

arfonad. ganglionic blocker (only one)

Question 20

typical dose for atropine

Answer 20

.4-1.0mg For bradycardia, repeat q 3-5 minutes up to 3X

Question 21

robinul dose

Answer 21

.2-.6 mg

Question 22

how do we use these drugs

Answer 22

Patients with (advanced) heart disease often have increased parasympathetic tone (what does that do?)
-Used most commonly for symptomatic bradycardia (what’s this?), pulseless electrical activity/electromechanical dissociation (what’s this?), and AV block (what’s this?)

Question 23

side effects of antimuscarinics

Answer 23

tachycardia,dry mouth,

Question 24

What are the effects of ganglionic blockers?”

Answer 24

PROFOUND hypotension via loss of sympathetic tone to the vasculature and histamine release.

• Predictably…Negative chronotrope, negative inotrope (with no reflex tachycardia…why?)
• Profound constipation

Question 25

doses for trimethophan (arfonad)

Answer 25

Given IV

• Very short duration of action (5-15 mins) -Typical adult dose:
• 1.0-3.0 mg bolus -0.5-6.0 mg/min

Question 26

therapeutic uses of neuromuscular blockers

Answer 26

Used extensively in surgery to prevent patient movement.

• Does NOT sedate, tranquilize, or anesthetize the patient!!!!

Question 27

Depolarizing Neuromuscular Blocker Logic

Answer 27

phase 1:membrane depolarizes which causes transient contractions, followed by flaccid paralysis
phase 2:membrane repolarizes but is desensitized to ach
short acting less than 8 minutes

Question 28

glycopyrrolate

Answer 28

robinul