Cholinergics

Question 1

overactive bladder or incontinence

Answer 1

1) oxyBUTYnin
2) dariFENAcin

Note: dariFENAcin has less toxicity because it has less CNS penetration and is M3 SELECTIVE!

both are synthetic M-ANTAGONISTS

Question 2

motion sickness

Answer 2

scoPOLamine

note: 
...CNS affects
...oral  
...natural alkaloid 
...non-selective M-ANTAGONIST

Question 3

treat malathion toxicity

Answer 3

ATROPINE (1st)

PRALIDOXIMINE (2nd)

Question 4

decrease lung secretions

Answer 4

IPRAtropium

…NO CNS
…inhale
…bronchodilations

USE: COPD

Question 5

Tracheal intubation (most common)

Answer 5

succinylcholine

…NO CNS
…onset: 1-2 minutes
…duration: 5-8 minutes

Note: some people with pseudocholinesterase slow metabolism can have higher levels and higher levels of paralysis

Question 6

paralysis of skeletal muscle, non-depolarization agents (list in order of onset and duration)

Answer 6

R.A.V.P…..

1) ROcuronium
2) ATRAcurium
3) VEcuronium
4) PANcuronium

-CURONIUM (suffix), except for atracurium

RO…= (1-2min onset, 30-60min duration)
ATRA…= (2-4min onset, 30-60min duration)
VE…= (2-4min onset, 60-90min duration)
PAN…=(4-6min onset, 120-180min duration)

Question 7

Treatment for M-Agonists TOXICITY

Answer 7

ATROPINE
…an -M (muscarinic antagonist)

(symptoms of M-agonists tox. = SLUDGEM)

Question 8

Treatment for M-ANTAGONIST TOXICITY

Answer 8

PHYSOSTIGMINE
…an AchE(i) (with CNS penetration)

(symptoms of M-antagonist tox. = DR.BHM)

i.e.
(“Dry, Red, Blind, Hot, Mad”)
…as a…
(“Bone, Beet, Bat, Hare, Hatter)

i.e. anhidrosis, febrile, blurred vision, constipation, confusion and psychosis, etc.

Question 9

Treatment for AchE inhibitors

Answer 9

ATROPINE
…an -M (muscarinic antagonist)

(symptoms of AchE(i) tox. = SLUDGEM)
e.g. organophosphates or nerve gas

Question 10

Treatment for NMJ Blockers

Answer 10

if depolarizing, eg. succinylcholine, no TX

if non-depolarizing, e.g. RAVP, use AchE(i)…
e.g. NEOSTIGMINE or EDROPHONIUM

(symptoms of NMJ blockers = fasciculation, slowed HR)

Question 11

DIAGNOSIS of Myesthenia Gravis

Answer 11

EDROPHONIUM

…non-covalent AchE(i)
…IV only
…rapid onset and short duration

Question 12

TREATMENT of Myesthenia Gravis

Answer 12

NEOSTIGMINE

…reversible carbamate AchE(i)
…CNS effects

(can also be used to help speed along the GI tract after surgery)

Question 13

PT has post-surgical GI constipation

Answer 13

NEOSTIGMINE

Question 14

wide angle glaucoma

Answer 14

PHYSOstigmine

Question 15

CNS toxicity due to M-antagonists?

Answer 15

PHYSOstigmine