Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm II Annie for Shelby > Cholinergics > Flashcards

Cholinergics Flashcards

1
Q

Nicotinic receptors are located where?

A

Brain

Autonomic ganglia

Skeletal muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What receptor in the brain is associated with memory?

A

M1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The secondary mechanism by which M2 receptors slow heart rate is what?

A

M2 receptors inhibit norepinephrine release which lowers the sympathetic stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stimulation of M3 receptors in the heart can cause what effect?

A

Coronary vasodilation

THIS IS NOT PARASYMPATHETIC!!!! Nitric oxide is released from endothelial cells which causes local vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pre-op, scopolamine can be used for what side effects?

A

dry up secretions

sedation and amnesia

anti nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is Echothiophate used?

A

Occasionally for narrow angle glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The top 4 side effects for muscarinic agonists

A

Diarrhea

Abdominal cramps

Salivation

Sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardiovascular effects of cholinesterase inhibitors

A

Mostly like parasympathetics

Bradycardia, lower contractile force, lower CO

Decreased sympathetic stimulation from desensitized nicotinic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Contraindications for muscarinic agonists.

A

Peptic ulcer

Bowel obstruction

Asthma

Coronary insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Do carbamates cross the BBB?

A

Physostigmine is tertiary and DOES

Neostigmine and pyridostigmine are quarternary and do NOT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Direct-acting cholinergic agonists bind to ____ receptors while cholinesterase inhibitors indirectly stimulate _____ receptors

A

Muscarinic

Muscarinic AND nicotinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Main 2 uses for Bethanechol (urecholine)

A

Stimulate GI peristalsis

Encourage urinary voiding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In what 2 ways does Varenicline (Chantix) work to aid smoking cessation?

A
  1. Causes just enough dopamine release to curb the craving for nicotine
  2. If the person does smoke, the Chantix blocks the nicotine receptors so the smoking is less pleasurable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is myasthenia gravis?

A

Muscle weakness due to antibodies attacking nicotinic receptors on the neuromuscular endplates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Does ACh cross the BBB?

A

Nope

It’s quartenary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cevimeline (Evoxac) stimulates what receptors? It causes less ____ than pilocarpine

A

M1 and M3

Sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the only systemic use for physostigmine? How does it work to help this?

A

Muscarininc antagonist poisoning

It increases ACh duration to overcome the CNS effects of the antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Apart from SLUDGE, what are some other signs of cholinesterase inhibitors?

A

Muscarinic manifestations!

Miosis, sweating, bronchoconstriction, nausea/vomiting, diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Echnothiophate forms a (reversible/irreversible) bond with AChE

A

Irreversible

Long-lasting effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Peripherally, nicotine effects may be similar to what?

A

BOTH parasympathetic and sympathetic neuron discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Muscarinic antagonist poisoning: what kind of toxicity and what can be used to help treat it?

A

CNS toxicity

Physostigmine (bc no good muscarinic agonists enter CNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 2 nerve agents we learned?

A

Sarin

Soman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Would you want to use carbamates orally?

A

Only physostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

After ACh is released and it diffuses to the skeletal muscle, what happens?

A

Nicotinic receptors are stimulated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where are muscarinic receptors located?

A

On smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What class is hexamethonium?

A

Ganglion blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the types of cholinergic receptors?

A

Muscarinic

Nicotinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Are muscarinic agonists used for open-angle glaucoma?

A

Nope

Too many SEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pilocarpine is used when?

A

Emergency narrow angle glaucoma attack

Last-resort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

SEs of Chantix that are of note

A

Flatulence 🐈💨

Nightmares

Psychosis

Suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Side effects of toxic doses of scopolamine

A

excitement

agitation

hallucinations

coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What drug/s are used for treating dry mouth from Sjogrens or head and neck radiation?

A

Pilocarpine

*Cevimeline (Evoxac) (DOC bc less sweating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When are cholinesterase inhibitors most useful?

A

In diseases in which cholinergic inputs are decreased

i.e. when the action of ACh needs to be extended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why does Chantix give psych SEs but only a few peripheral SEs?

A

It’s a PARTIAL AGONIST on a nicotinic receptor in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

The degree of effect of muscarinic blockers will depend a great deal on what?

A

The amount of prevailing parasympathetic tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Acute closed-angle or narrow angle glaucoma is commonly treated using what combo of meds until surgery can correct it?

A

Pilocarpine + cholinesterase inhibitor (commonly the organophosphate echothiophate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Treatment for nicotine poisoning

A

Atropine

Anticonvulsants

Intubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

CNS effects:

Low doses of nicotine cause ____ and ____.

High doses of nicotine cause ____, _____, and increased _____.

A

Low: alertness and attention

High: tremor, vomiting, increased respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

🚨 Major warning signs of nicotine poisoning 🚨

A

Vomiting 🤮

Convulsions 🥴

HTN and arrhythmia 💔

Paralysis/respiratory arrest 😵

Coma 💀

40
Q

Muscarinic receptors are linked to what?

A

G proteins

41
Q

Side effects of Varenicline (Chantix)

A

Gassssssss 🐈💨

nausea/vomiting 🤮

Vivid nightmares 👹

Psychosis 🤡

Suicide 😶

42
Q

What are the 3 carbamates?

A

Neostigmine

Pyridostigmine

Physostigmine

43
Q

What is “aging” with organophosphates?

A

Over time, the bond between the AChE and the organophosphate becomes irreversible

One of the phosphorus — oxygen bonds are broken off so 2-PAM cannot bind and release the substance

44
Q

Nicotinic receptors are rapidly ______

A

Desensitized

45
Q

What 2 drugs are used for long-term therapy in MG?

A

Neostigmine

Pyridostigmine

46
Q

Side effects of pilocarpine

A

Blurred vision

Brow ache

47
Q

Eye, GI, GU, and respiratory effects of cholinesterase inhibitors

A

Similar to muscarinic agonists because of the dominant parasympathetic tone in these tissues

48
Q

Effects of ganglion blockers

A

Mydriasis

Ortho hypotension

Urinary retention

Tachycardia

49
Q

How do you use edrophonium to see if the dose of the long-term drug they are on for MG is at the proper dose?

A

Inject edrophonium.

If they get stronger, the dose of the drug needs to be upped.

If they get weaker, the dose of the drug was too high and should be lowered.

50
Q

Cholinesterase inhibitor (cholinergic agonist) toxicity treatment

A

Atropine

2-PAM (RAPIDLY)

51
Q

Gland secretion is MOST increased by which muscarinic agonist?

A

Pilocarpine

52
Q

Organophosphate are used as _____ and _____. They are HIGHLY _____ soluble

A

Pesticides and nerve gasses

Lipid

53
Q

Varenicline (Chantix) is a _____ on a nicotinic receptor subtype in the _____.

A

Partial agonist

Brain

54
Q

Nicotinic agonists initially cause what effect at the NMJ?

What happens with lasting stimulation?

A

Initially muscle stimulation/contraction

Then de-sensitization which results in flaccid paralysis

55
Q

Diisopropyl fluorophosphate (DFP) is what?

A

A pesticide/organophosphate

56
Q

Edrophonium forms a (reversible/irreversible) bond with AChE

A

Reversible

Remember, short duration of action

57
Q

They majority of atropine use is ___ due to the drug’s (ability/inability) to penetrate the CNS.

A

Peripheral

Inability (very high doses will get into the CNS as in reversal of toxicities)

58
Q

What is SLUDGE?

A

Salivation 🤤

Lacrimation 😭

Urination 🚽

Defecation 💩

Gastric Distress 🐈💨

Emesis 🤮

59
Q

Release of ACh into the synaptic cleft is blocked by what drug?

A

Botox

60
Q

When is organophosphate poisoning fatal?

A

If aging is not prevented

61
Q

Tolterodine (Detrol)
Fesoterodine (Toviaz)
Darifenacin (Enablex)
Solifenacin (Vesicare)

A

Overactive bladder!!!!!!!!!

62
Q

After AChE breaks down ACh, choline is taken back up into the nerve terminals by what kind of mechanism?

A

High affinity transport

63
Q

What muscarinic agonist has the MOST GU/bladder effects?

A

Bethanechol (Urecholine)

64
Q

ACh stimulation causes effects similar to parasympathetic stimulation with the exceptions of what?

A

Vasodilation from M receptors on vessels

Sweating

65
Q

HOW do muscarinic agonists treat glaucoma?

A

They reduce IO pressure by causing contraction of

  • the iris circular muscle
  • AND the ciliary muscle

This increases the angle between the lens and iris and aqueous humor can flow out

66
Q

Nicotinic receptors are linked to what?

A

Sodium channels

67
Q

Edrophonium is used because of it’s (long/short) duration of action

A

SHORT

5-10 mins

68
Q

Pralidoxime (2-PAM) is a very strong _____

A

Nucleophile

69
Q

What is glycopyrroalte (Robunil)?

What drug class?

A

Prevents vagal bradycardia in surgery

Muscarininc antagonist

70
Q

Brain effects of cholinesterase inhibitors at low and high doses

A

Low dose: Improve memory via M1 and Nn

High dose: desensitize nicotine receptors = convulsions and respiratory arrest

71
Q

Oxybutynin (Ditropam)

Trospium (Sanctura)

A

Prevent bladder spasms

72
Q

Where are muscarinic receptor effects most pronounced?

A

Eye, GI, bladder, salivary and sweat glands

73
Q

Ganglion blockers are considered ________________.

A

No depolarizing competitive antagonists

74
Q

Muscarininc agonists effects on the eye:

  • pupil
  • intraocular pressure
  • accommodation
A

Pupil constriction (miosis)

Intraocular pressure decreased

Accommodation for near vision only (blurred vision)

75
Q

What drug is used to help diagnose MG?

A

Edrophonium injection

76
Q

Side effects of toxic doses of atropine

A

hallucinations

delirium

coma

77
Q

MOA of 2-PAM

A

It’s a strong nucleophile that attracts the organophosphate and irreversibly binds to it

It either prevents the organophosphate from binding to the AChE or releases it from the AChE if it’s already bound and hasn’t “aged”

78
Q

How do you reverse a nondepolarizing blocker?

A

Neostigmine!!

A cholinesterase inhibitor/cholinergic agonist

79
Q

Side effect of 2-PAM

A

Hypertension

80
Q

Scopolamine side effects include ____ which are do to the drug’s (ability/inability) to penetrate the CNS.

A

Sedation and amnesia

Ability (very readily!)

81
Q

How do cholinesterase inhibitors work?

A

They increase the duration of action of ACh at the synaptic cleft by inhibiting its breakdown by AChE

82
Q

Are we going to give 2-PAM with carbamate poisoning?

A

Maybe not

It doesn’t undergo “aging” so it’s probably not useful and can make things worse by inhibiting AChE

83
Q

The carbamates form a ____ bond with effects lasting ____

A

Covalent

1/2 to 6 hours

84
Q

When will you see SLUDGE side effects?

A

Toxicity of cholinesterase inhibitors

Super similar to muscarine poisoning but with MSK effects too

85
Q

NMJ effects of cholinesterase inhibitors at low and high doses

A

Low dose: increase strength of muscle contraction

High dose: initial contraction of muscles followed by neuromuscular blockade

86
Q

MOA of organophosphates

A

They phosphorylation the AChE to form a very long-lasting bond

The bond then “ages” with time to make it irreversible

MUST treat quickly!!!

87
Q

What 2 things will happen when you inject ACh right into the veins that would not happen with normal parasympathetic stimulation

A
  1. Sweating

2. Vasodilation due to direct stimulation of M3 receptors on endothelial cells that releases N.O.

88
Q

What muscarinic agonist will have the MOST effects in the GI and urinary systems?

A

Bethanechol (Urecholine)

89
Q

What are pilocarpine and cevimeline both used for, and what is the major difference between them?

A

Both used for dry mouth

Pilocarpine will cause profound sweating

Cevimeline is more selective for M1 receptors so you don’t sweat as much

(Salivation is M1 and M3)

90
Q

What kinds of signs would you see in someone with muscarinic agonist poisoning?

A

Diarrhea

Abdominal cramps

Salivation

Sweating

Bronchoconstriction

Blurred vision

Nausea/vomiting

(Similar to SLUDGE but noooo MSK effects since Nicotinic receptors are not being stimulated)

91
Q

What are the effects of nicotine at low doses and at high doses?

A

Low doses: alertness and attention

High doses: tremor, vomiting, fast respiration

92
Q

What kinds of peripheral effects will nicotine have?

A

Cardiac- will be mostly sympathetic (HTN, fast HR)

Gastrointestinal- will be mostly parasympathetic (vomiting, diarrhea, urination)

(Remember nicotine will act at the ganglia and cause parasympathetic and sympathetic effects)

93
Q

When you are treating organophosphate poisoning, what will you treat it with and when will you know you’ve given enough?

A
  1. Atropine until pupils become dilated
  2. 2-PAM given RIGHT AWAY
  3. Mechanical respiration
94
Q

Organophosphates and Carbamates (neostigmine, pyridostigmine, etc) are both cholinesterase inhibitors. Which one will cause poisoning that you should give 2-PAM for?

A

Organophosphates

95
Q

How do you treat atropine poisoning?

A

Physostigmine (gets into CNS)

Valium

Ice packs

96
Q

Who should never receive Succinylcholine?

A

People with extensive soft tissue injury/burns

May cause too much K+ to be released during prolonged depolarization and could cause cardiac arrest

Pharm II Annie for Shelby (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions