Cholinergics II Flashcards
Among anticholinergics, Parkinson’s disease is treated using _ (2)
Trihexyphenidyl
Atropine
Among anticholinergics, motion sickness can be treated using _(2)
Atropine
Scopolamine
For induction of amnesia before surgery, _ is used
Scopolamine
Atropine, homatropine and tropicamide are used to elicit what 2 occular conditions?
Mydriasis
Cycloplegia
What 2 anticholinergics are used to decrease respiratory tract secretions?
Ipratropium
Tiotropium
Hyperactive GI and genitourinary tract muscle can be treated using (4)
Atropine
Methscopolamine
Oxybutynin
Solifenacin
Excessive bradycardia and hypotension can be treated with which anticholinergic drug?
Atropine
Poisoning with organophosphates or muscarine containing mushrooms can be treated using _
Atropine
Two anticholinergics used as pre-anesthetic medications are _
Atropine
Scopolamine
[Teritary/Quaternary] anticholinergics are most likely to produce CNS toxicities. What are 3 examples provided?
Tertiary
Atropine
Scopolamine
Trihexyphenidyl
Excess mydiasis, urinary retention, dry mouth and reduced sweating can be expected following overdose with _
Anticholinergics, PNS effects
The expected effector sites of antimuscarinic agents include _ (3). What can extremely high doses of antimuscarinic agents do?
smooth muscle, cardiac muscle, gland cells
Can potentially block nicotinic receptors in neuromuscular junctions
Tertiary muscarinic antagonists are used for the treatment of occular or CNS maladies. The 2 examples specifically provided are _. What was the example of the quaternary antimuscarinic agent?
Atropine and scopolamine
Methscopolamine
Loss of accomodation reflex is referred to as _. When mydriasis and cycloplegia are required, what are 3 topical agents used?
Cycloplegia
Atropine
Homatropine
Tropicamide
5 drugs used in ophthalmology for mydriasis and cycloplegia are atropine, homatropine, tropicamide, scopolamine and cyclopentolate. Arrange them in order of longest acting to shortest
ASHCT
During myocardial infarct, vagal reflexes can result in depression of SA (and AV) node activity, leading to bradycardia. What is the effect of atropine under these conditions?
Can be used to block muscarinic receptors in SA and AV node, leading to tachycardia. Too much atropine can be damaging though, needs to be dosed carefully
What class of drugs can be administed to patients before using inhaled anesthetics to prevent bronchospasm / laryngospasm?
Antimuscarinics
What is the effect of antimuscarinics of bronchial diameter and bronchial secretions?
Caused bronchodialation and decreases bronchial secretions
Antimuscarinics can be used for the treatment of patients with what 2 airway diseases? What is the first line treatment for these conditions?
Bronchitis and COPD (emphesema)
beta adrenergic agonists
How are tiotropium and ipratropium related to atropine? What are they used for?
Ipratropium - synthetic atropine analog
Tiotropium - Long lasting analog
Used for non-systemic treatment of bronchial hypersecretion
Systemic treatment of bronchial hypersecretion results in decreased fluidity. What results from decreased fluidity?
Airflow obstruction and increased infection
What are the effects of antimuscarinics of GI motility?
The reduce motility.
GI hypermotility caused by parasympathomimetics and antihypertensives can be counteracted using what class of drugs?
Antimuscarinics
What do Parkinson’s disease, heavy metal poisoning and difficulties swallowing have in common? How can this be alleviated?
All cause excessive salivation
Can be treated using antimuscarinics
What is xerostomia? What class of drug is expected to cause it?
Dry mouth
Antimuscarinics
How do antimuscarinics affect eccrine sweat glands? What branch of NS usually innervates these types of sweat glands?
Decrease sweat production
Sympathetic cholinergics
What is atropine fever? Who is most suceptible: children, adults, elderly?
Atropine blocks sweating, increase body temp
Children and infants
What is the effect of antimuscarinics on the muscles of the urinary bladder? [contract/relax] How does this affect urination?
Relax the muscles Reduce urination (Used to treat urgency, reduce bladder spasm following urologic surgery)
4 drugs were provided as examples of M3 selective muscarinic antagonists. What are they? Which 3 are long acting?
Oxybutinin (Short acting)
Darifenacin
Solifenacin
Tolterodine
How is cholinergic activity related to Parkinson’s disease? What is lost in Parkinsons that usually balanced out cholinergic input? How can this affect treatment for affected patients?
Too much cholinergic stimulation leads to tremor and rigidity
Dopaminergic neurotransmission
Combined levodopa and anticholinergics may be better
What is the most effective drug for the treatment of motion sickness? What are significant side effects (2)?
Scopolamine
Sedation and dry mouth
Prior to surgery, what class of drug can be used to cause amnesia?
Antimuscarinics
Among antimuscarinics, how are tertiary and quaternary compounds different? Which would you use to treat eye or CNS symptoms or be expected to cross mucus membranes?
Tertiary cross BBB, quarternary don’t.
Tertiary
Why is ipratropium better than atropine for the treatment of brochial symptoms? What specific disease is it good for?
Ipratropium is quaternary derivative of atropine, wont cross mucus membranes, doesn’t impair mucociliary clearance like a systemic atropine.
COPD
How are methscopolamine and scopolamine related? What is methscopolamine used for?
Quaternary deriv. of scopolamine. Used for GI problems (slows the GI)
What are the 4 tertiary antimuscarinics most likely to cause CNS side effects?
Atropine, scopolamine, homatropine and trihexiphenidyl
Regarding Atropine, True or False
- Binds to both nicotinic and muscarinic receptors
- Crosses the BBB, limiting the dosages used
- Salivary, sweat and bronchial glands insentitive to atropine
- Causes mydriasis and cycloplegia
False - only muscarinic
True
False - most sensitives glands listed
True
Drowsiness, amnesia, fatigue, dreamless sleep, euphoria are all possible side effects of antimuscarinics. True or false
True
The major use of scopolamine is _. It is also used preanesthetically to produce _
Prevent motion sickness
Amnesia
What is the major use of methscopolamine?
GI maladies, doesn’t cross mucus membranes
What is homatropine used for? How is it related to atropine?
Used topically to elicit mydriasis and cycloplegia
Very short acting relative to atropine
What is triheyphenidyl used for? (2)
Used to reduce uncoordinated movements assoc with Parkinsons
Reduce extrapyramidal side effects of anti-psychotics
What is tropicamide used for? Shorter or longer acting than homatropine?
Used topically to elicit mydriasis and cycloplegia
Shorter
Under what conditions will atropine be able to reduce GI secretions?
Really high doses with toxic effects
How may muscarinic antagonists affect men with prostatic hyperplasia (undesired side effect)?
Worsen urinary retention
Improved treatment of Parkinsons symptoms can be improved by combining what 2 (classes) of drug?
LEvodopa and muscarinic antagonist
How are quaternary compounds absorbed?
Not well or reliably
Atropine, scopolamine and methscopolamine affects both the nicotinic and muscarinic receptors equally. True or false.
False, those are 3 mainly muscarinic selective antagonists
What are the major glands that are most sensitive to atropine? What is a major use of this drug?
salivary, bronchial, and sweat glands
Overcome organophosphate poisoning
Scopolamine vs Methscopolamine: Which is used mainly for its CNS effects?
Scopolamine to prevent motion sickness
What are the 2 antimuscarinics used topically in the eye? Which is lionger lasting?
Tropicamide and Homatropine
Homatropine acts for longer
