Cholinomimetic agents Flashcards

1
Q

What are the clinical applications of bethanechol?

A

Postoperative ileus, neurogenic ileus, urinary retention.

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2
Q

What is the site of action of bethanechol?

A

“Bethany, call me to activate your bowels and bladder!”. Activates bowel and bladder smooth muscle, resistance to AchE.

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3
Q

What are the clinical applications of carbachol?

A

Glaucoma.

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4
Q

What is the site of action of carbachol?

A

Constricts pupil and relieves intra-ocular pressure in glaucoma.

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5
Q

What is the clinical application for methacholine?

A

Challenge test for diagnosis of asthma.

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6
Q

What is the site of action of methacholine?

A

Stimulates Muscarinic receptors in airway when inhaled.

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7
Q

What is the clinical application for pilocarpine?

A

Potent stimulator of sweat, tears, saliva. Open-angle/closed angle glaucoma.

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8
Q

What is the site of action of pilocarpine?

A

“You cry, drool, and sweat on your PILOw.”

Stimulates exocrine glands, contracts ciliary muscle of eye (open-angle), pupillary sphincter of eye (closed-angle). Resistant to AchE.

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9
Q

What is the clinical application for donepezil/galantamine/rivastigmine?

A

Alzheimer’s.

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10
Q

What is the site of action of donepezil/galantamine/rivastigmine?

A

Increased ACh due to blocked acetylcholinesterase.

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11
Q

What is the clinical application for edrophonium?

A

Historically, dx of myasthenia gravis (very short acting). Now, MG is diagnosed by anti-Acetylcholine receptor antibody test).

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12
Q

What is the site of action of edrophonium?

A

Increased Ach due to blocked acetylcholinesterase.

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13
Q

What are the clinical applications for neostigmine?

A

1) Post-op/neurogenic ileus and urinary retention
2) Myasthenia gravis
3) Post-op reversal of neuromuscular junction blockade.

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14
Q

What is the site of action of neostigmine?

A

Increased Ach due to blocked acetylcholinesterase. No CNS penetration.

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15
Q

What is the clinical application for physostigmine?

A

Anticholinergic toxicity.

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16
Q

What is the site of action of physostigmine?

A

Increased Ach due to blocked acetylcholinesterase. PHYSostigmine PHYXES atropine overdose. Penetrates CNS!

17
Q

What is the clinical application for pyridostigmine?

A

Myasthenia gravis (long-acting).

18
Q

What is the site of action of pyridostigmine?

A

PyRIDostiGMine gets RID of MG. Increased Ach, increased muscle strength.

19
Q

What are important risks of all cholinomimetic agents?

A

Exacerbation of COPD, Asthma, and peptic ulcers.

20
Q

How do organophosphates cause cholinergic poisoning?

A

Irreversibly inhibit cholinesterase.

21
Q

What are the symptoms of cholinergic poisoning?

A

DUMBBELSS.
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of Skeletal muscle and CNS, Lacrimation, Sweating, and Salivation.