Cholinesterase Inhibitors

Question 1

How do the physiological effects of cholinesterase inhibitors differ from that of muscarinic agonists?

Answer 1

Airways (vasoconstriction)
Act on skeletal muscle
(stimulate muscle or paralysis)

Question 2

A cholinergic crisis is an example of an adverse effect of a cholinesterase inhibitor. What can bring this on?

Answer 2

Organophosphate poisoning or nerve agents

Question 3

A common acronym to describe adverse effects in cholinesterase inhibitors is “SLUDGE.” What does this stand for?

Answer 3

Salivation
Lacrimation
Urination
Defecation
GI Distress
Emesis

Question 4

An adverse side effect of cholinesterase inhibitors is skeletal muscle fasiculations. What can this lead to?

Answer 4

Paralysis (tachyphylaxis)

Question 5

Hypotension and bradycardia are adverse effects of cholinesterase inhibitors and can lead to ____

Answer 5

shock

Question 6

CNS stimulation and seizure are adverse effects of cholinesterase inhibitors and can lead to ____

Answer 6

coma

Question 7

What are four contraindications for cholinesterase inhibitors?

Answer 7

1) Asthmatics
2) Cardio complications
3) Intestinal/Urinary Obstruction
4) Peptic ulcer disease

Question 8

Neostigmine
-3 uses?
-Contraindications?
-Quat/Non-quat?

Answer 8

1) Paralytic Ileus (bladder atony)
2) Inflammatory Bowel
3) Peritonitis

1) IF Bowel
2) Peritonitis
3) Intestinal or bladder obstruction

Quat (does not enter CNS!)

Question 9

What are the three drugs used to treat Alzheimer’s Disease? Are they quat or non-quat?

Answer 9

*Donepezil, Rivastigmine, Galantamine

Non-quat (enter CNS!)

Question 10

What are the two drugs used to treat myasthenia gravis?

Answer 10

Neostigmine and *Pyridostigmine

Question 11

What two ways can you treat glaucoma? Using what drugs?

Answer 11

1) Cholinesterase Inhibitors (Echothiophate)
2) Cholinergic Agonists (Pilocarpine, Carbachol)

Question 12

What medication is the antidote for organophosphate poisoning?

Answer 12

2-PAM (Pralidoxime)

Question 13

What medication is used to treat atropine or anti-muscarinic poisoning

Answer 13

Physiostigmine

Question 14

What drug is given prophylactically to protect against nerve agents

Answer 14

Pyridostigmine

Question 15

How do you treat Sarin and VX poisoning?

Answer 15

Atropine and 2-PAM

Question 16

How do you treat parathion and malathion (OP’s) poisoning ?

Answer 16

Atropine, 2-PAM, Symptomatic support

Question 17

Of the cholinesterase inhibitors, which are quat? non-quat?

Answer 17

Quat: Neostigmine and pyridostigmine
Non-Quat: Alzheimer’s drugs and physostigmine

Question 18

4 steps to treating acute cholinesterase poisioning?

Answer 18

1) 2-4 mg Atropine IV
2) 2mg IM Q10 min prn
3) Administer pralidoxine
4) Symptomatic treatment
(diazepam for seizures)

Question 19

____ is an auto-immune disorder associated with motor weakness. It is caused by antibody mediated immunological attack direct at Ach receptors

Answer 19

Myasthenia Gravis

Question 20

Alzheimer’s Disease is caused by decreased ___ ____, which decreased Ach synthesis

Answer 20

Choline Acetyltransferase

Question 21

How can you die from botox? Treatment?

Answer 21

Diaphragmatic paralysis
Tx: Antibody; symptomatic support

Question 22

Side effect of treating glaucoma with cholinergic agonist? cholinesterase inhibitor?

Answer 22

Miosis; change lens shape (myopia)