Cholinergics Flashcards
Prototype muscarinic agonist
Acetylcholine
Acetylcholine is __ charged, so it can/can’t cross the BBB
Positively; can’t
Acetylcholine must be administered _____
Intravenously
Vascular effects of acetylcholine
Vasodilation due to stimulation of M3 receptors on vascular endothelium, causing release of nitric oxide
Decreased heart rate and contractility (M2 receptors)
Ophthalmic acetylcholine use
Complete miosis (pupil constriction/ciliary muscle contraction)
Prototype choline ester
Bethanechol
Bethanechol uses
Urinary retention
Synthetic choline ester function
More M-selective with prolonged action
Prototype alkaloid
Pilocarpine
Pilocarpine MOA
Agonist of all muscarinic receptors
Pilocarpine uses
Xerostomia/sjogrens
Glaucoma
Cevimeline MOA
Selective M1/M3 agonist alkaloid in lacrimal and salivary glands
Cevimeline uses
Sjogrens/xerostomia
Side effects of muscarinic agonists
Sweating, hypotension, cramping, diarrhea
Muscarinic agonist contraindications
Hyperthyroidism
Asthma
Peptic ulcer
Muscarinic agonist antidotes
Atropine
Epinephrine
Prototype muscarinic antagonist
Atropine
Atropine isa competitive antagonist of ____ receptors
All M receptors
Atropine does/does not cross BBB
Does
Atropine response is ___dependent
Dose
Atropine effects
Decrease saliva
Mydriasis
Tachycardia
Decrease gastric secreteions
Clinical uses of atropine
Reverse bradycardia
Induce Mydriasis
Antidote for insecticide and nerve gas poisoning
Relieve muscarinic side effects of other drugs
Adverse effects of atropine
Hot as a hare
Dry as a bone
Blind as a bat
Red as a beet
Mad as a hatter
Atropine drug interactions
Antihistamines
Antidepressants
Antipsychotics
Scopolamine MOA
Anti muscarinic
Blocks M3 receptors in vestibular apparatus of inner ear
Scopolamine use
Anti-emetic
Prevent motion sickness
Ipratropium bromide use
Bronchodilator
Ipratropium bromide is administered by ___
Inhalation
Ipratropium bromide has minimal side effects because ___
It is always ionized so it can’t cross membranes well
It is inhaled so systemic effects are minimal
Tropicamide use
Dilate eyes for eye exams
Tropicamide is shorter/longer acting than atropine
Shorter (6 hrs vs 4-6 days)
Tolterodine use
Overactive bladder disorder
Major concern of tolterodine
Cognitive decline of elderly patients