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Pharmacology > Cholinergics > Flashcards

Cholinergics Flashcards

1
Q

onset/duration of tropicamide?

A

fast, short duration

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2
Q

rate of hydrolysis of physotigmine and neostigmine?

A

slow (hours)

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3
Q

which NMJ blockers have CV effects?

A

atracurium (minimum)

pancuronium (increase heart rate & BP)

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3
Q

which AChase inhibitor can enter CNS?

A

physostigmine

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5
Q

does it enter the CNS?

succinylcholine

A

no

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5
Q

how is pancuronium degraded?

A

kidney

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5
Q

side effects of oxybutynin?

A

high incidence of anti-muscarinic side effects

  • xerostomia
  • blurred vision
  • GI
  • CNS (drowsiness, confusion)
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5
Q

choline esters

A

acetylcholine, bethanechol

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6
Q

side effects of neuromuscular blocking agents

A

prolonged apnea

cardiovascular collapse (rare - histamine release)

anaphylaxis (rare)

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6
Q

administration of edrophonium?

A

IV

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6
Q

use of neostigmine

A
  • treats myasthenia gravis (oral)
  • prevents and treats post-operative atony of gut and bladder (oral)
  • reversal of paralysis by competitive NMJ blockers (IV)
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7
Q

what to use glycopyrrolate for?

A

block parasympathomimetic effects during reversal of NM blockade with anticholinesterase agents

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8
Q

which drug is used to treat anticholinesterase or muscarinic toxicity

A

atropine

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9
Q

administration of bethanechol?

A

oral, subcutaneous

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10
Q

administration of pilocarpine

A

orally, ophthalmic

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11
Q

therapeutic uses of physotigmine

A

glaucoma wide angle

toxicity by antimuscarinic drug poisoning

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12
Q

administration of physotigmine?

A

ophthalmic (glaucoma)

IV (antimuscarinic drug poisoning)

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13
Q

how is atracurium degraded?

A

Hofmann hydrolysis, spontaneously degrades in plasma to inactive metabolytes, and by plasma esterases

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14
Q

uses of atropine?

A
  • ophthalmic (mydriasis, cycloplegia)
  • anesthesia (block vagal reflexes)
  • anticholinesterase toxicity
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15
Q

how to treat muscarinic receptor antagonist poisoning?

A

physostigmine

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15
Q

administration of scopoloamine

A

transdermal patch

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16
Q

which of the musc. agonists can enter the CNS?

A

pilocarpine (tertiary amine)

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17
Q

therpeutic use of bethanechol?

A

urinary retention in the absence of obstruction

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19
Q

side effects of muscarinic antagonists

A
  • hot as a hare
  • dry as a bone
  • red as a beet
  • blind as a bat
  • drowsiness

no sweating, dry mouth, hot skin, mydriasis, cycloplegia, CNS action

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20
Q

with AChase inhibitors, what are the toxic side effects outside the SLUDGE?

A
  • medullary respiratory center depression, muscle paralysis
  • death due to respiratory failure
21
Q

use of scopolamine?

A

motion sickness, vestibular disease

22
Q

how is rocuronium degraded?

A

liver metabolism

22
Q

which drug is commonly given to block responses to vagal reflexes induced by surgical manipulation of visceral organs?

A

atropine

23
Q

onset/duration of edrophonium?

A

rapid, short

24
Q

therapeutic use of pilocarpine?

A
  • xerostomia
  • ophthalmically for wide angle glaucoma
  • emergency narrow angle glaucoma
25
Q

which NMJ blockers release histamine?

A

atracurium

pancuronium

26
Q

how does succinylcholine work?

A

agonist of nicotinic receptors at NMJ, cause opening of cation channel

28
Q

adminstration of ipratropium?

A

inhalation

28
Q

alkaloids

A

atropine, scopolamine

29
Q

function of tropicamide?

A

ophthalmic solution to produce mydriasis and cyloplegia

30
Q

which drugs should be avoiding in patients with hyperthyoidism?

A

bethanechol, pilocarpine (musc agonists)

32
Q

which of the naturally occurring alkaloids has greater CNS penetration

A

scopolamine

(more CNS penetration and prominent effects than atropine)

34
Q

use of oxybutynin?

A

treats overactive bladder and incontinence

35
Q

musc agonists should be used with caution in which patients?

A
  • asthma/COPD
  • urinary, GI obstruction and peptic ulcer
  • CV disease (bradycardia, hypotension, hyperthyroidism)
36
Q

how do NMJs work?

A

compete fwith ACh for unoccupied end-plate nicotinic receptors without activating the channel

37
Q

uses of edrophonium

A
  • diagnosis of myasthenia gravis
  • distinguish cholinergic crisis from myasthenic crisis
  • reverse paralysis
39
Q

how do you treat competitive NMJ toxicity?

A

nestogimine or edrophonium

combine with glycopyrrolate to reduce muscarinic actions (bradycardia, GI/GU secretions/motility)

40
Q

toxic effects of muscarinic antagonists

A

mad as a hatter (ataxia, restlessness, excitement, hallucinations, delirium, coma)

40
Q

does glycopyrrolate penetrate the CNS?

A

no

42
Q

pralidoxime

A

reactivates AChase peripherally, treat quickly because no longer effective after enzyme has aged

43
Q

administration of neostigmine?

A

oral, IV

45
Q

therapeutic use of rocuronium?

A

faciliate endotracheal intubation

46
Q

long acting NMJ blocker

A

pancuronium

47
Q

therapeutic use of NMJ blockers?

A

adjusvant in surgical anesthesia to obtain relaxation of skel muscle (mainly abdominal wall)

allows for much lighter level of anesthesia

49
Q

use of ipratropium

A

COPD

rhinorrhea associated with common cold or rhinitis

50
Q

SLUDGE

A

salivation, lacrimation, urination, defecation, GI, emisis (vomiting)

51
Q

therapeutic use of succinylcholine?

A

muscle paralysis

53
Q

effects of muscarinic antagonists

A
  • mydriasis and cycloplegia (paralysis of accommodation)
  • relax non-vascular smooth muscle (airways, GI, urinary bladder)
  • inhibit exocrin egland secretion (sweat, salivary, etc.)
  • increase HR
  • CNS effects (low - sedation, high - delirium)
54
Q

how is vecuronium degraded?

A

liver

55
Q

you should use muscarninic antagonists with caution in which patients?

A
  • glaucoma
  • prostatic hypertophy - difficulty voiding
  • tachycardia
56
Q

side effects of succinylcholine

A
  • prolonged apnea
  • hyperthermia
  • muscle pain (fasciculation)
  • hyperkalemia
57
Q

why aren’t muscarinic agonists administered IV?

A

will cause hypotension due to activation of muscarinic receptors of vascular endothelium

58
Q

does ipratropium cross into CNS?

A

no, quaternary amine

59
Q

administration of tropicamide?

A

ophthalmic solution

60
Q

aminosteroid

A

rocuronium

atracurium

vecuronium

pancuronium

Pharmacology (9 decks)

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