Cholinergic Antagonist

Question 1

ATROPINE

Antimuscarinics

Answer 1

1. Atropine (belladona alkaloid)
   - Nonselective for M1,M2,M3
   - Competitive
   - Enter CNS
   - Eye Dilation
   - GI- Antispasmodic (relax gi for IBS)
   - CV low- slight decrease in HR (block autoreceptor)
   - CV high- Increase HR (for bradycardia)

-DOSE 1.0mg every 3-5min 3 times

• Decrease secretions (dry mouth, less sweat, tears, and LUNGS) (for surgery)
• ANTIDOTE for Organophosphate Poison and Cholinergic agonist overdose

Question 2

SCOPOLAMINE

Selective Antimuscarinics

Answer 2

Scopolamine

• Atropine like
• longer duration
• more CNS action
• Motion sickness
• POST OP nausea and vomiting (relax gi?)

Question 3

IPRATROPIUM (Atrovent)

Selective Antimuscarinics

Answer 3

Ipratropium

• Quaternary derivative of atropine
• Bronchodilator for COPD (Inhaled)
• Positive Charge- NO CNS

Question 4

BENZTROPINE

Selective Antimuscarinics

Answer 4

Benztropine (Cogentin)
-Centrally Acting
-Treats Parkinsons Tremors
(inbalance of dopaminergic activity DA>ACh)

Question 5

GLYCOPYRROLATE

Selective Antimuscarinics

Answer 5

Glycopyrrolate (Robinul)

• Peptic ulcers
• Reduce Secretions in mouth, throat, airways and stomach (presurgery)

Question 6

NICOTINE

Ganglionic Blocker

Answer 6

• 10-20sec after inhalation and last for 2 hours
• Pass BBB
• Low Dose (1-2mg)
• High (Lethal) Dose >60mg

Question 7

Nondepolarizing Neuromuscular Blockers

Answer 7

1. Vecuronium
2. Cisatracurium (Nimbex)
3. Pancuronium (Pavulon)
4. Rocuronium (Zemuron)

Question 8

Nondepolarizing Neuromuscular Blockers REVERSAL

Answer 8

• Sugammadex (Bridion)

- Binds directly to NM Blocker

Question 9

Depolarizing Neuromuscular Blockers

Answer 9

• Succinylcholine (Anectine)
• rapid onset for ET intubation
• IV for sustained paralysis
• Respiratory paralyzed last
• muscle soreness
• hyperthermia
• hyperkalemia