Exam I cholinergics and adrenergics Flashcards
What drugs are choline esters and what type of compound are they
acetylcholine, carbachol and bethanechol
quarternary ammonium
why is bethanechol slower acting than carbachol and Ach
because it resists cholinesterases more
choline esters and alkaloids act as agonists or antagonists on cholinergic R?
agonists
what drugs are the alkaloids that act on chilinergic R
muscarine, nicotine and pilocarpine
describe structures and modes of absoprtion for muscarine and nicotine
nictoine is tertiary amine so absorbed at most sites
muscarine is quaternary amine and highly toxin if ingested because can enter brain
What Ach R are found in the nerves
M1 and the NN (dendrites) NM(NMJ)
What Ach R are in the CNS
M4 M5 and NN
What Ach R are in the Heart, and smooth m
M2
What Ach R are in the glands, smooth m and endothelium
M3
where are nACHR
skel muscle
What happens in vasculature in the presence of high levels of Ach
constriction
compare high doses Ach and low action on the heart
small cause vasodilation and dec in BP
large causes bradycardia and dec AV node conduction velocity and hypotension
Differentiate smooth m contraction caused by M2 Ach R and M3
M2 directly activates contraction
M3 reduces cMP formation and reduces relaxation caused by adrenergic effects
What Ach R predominate the brain and which ones the spinal cord
mACHR in brain and
spinal cord nACH R
What are the ACH effects on the GI and GU tracts
nausea, vomiting, diarrhea, voiding of urine
What are the side effects of too much muscarinic ACH
nausea, vomiting, diarrhea, urinary urgency, salivation, sweating, cutaneous vasodilation, bronchial constriction
How do we block negative sideeffects of choline esters and ilocarpine
atropin, antimuscarinic compounds
What are the major contraindications for mAchR agonists
asthma, hyperthyroidism, coronary insufficiency, acid-peptic disease
What are signs of acute toxicity of direct acting cholinergics
convulsions, coma and respiratory arrest
depolarization blockads–> respiratory paralysis, HTN and cardiac arrythmias
What is metacholine used for
to Dx hyperreactivity of broncial airway
What is Bethanechol used for
to Tx urinary retention and heartburn
selective mAchR agonist
What type of pharm agent is carbachol
nonspecific cholinergic agonist that is used for Tx of glaucoma
used to make miosis during surgery or ophthalmic examination
What is cevimeline
oral tablet used to treat xerostomia (dry mouth)
metabolized via p450 and eliminated in urine
What is pilocarpine used to treat
xerostomia, also head and neck cancer Tx related to xerostomia
miosis for opthalmic procedures and glaucoma
mAchR agonist
What is Varenicline used to Tx and how does it work
smoking cessation
partial agonists to a4b2 nAchR in brain
released dopamaine thought to curve craving
what are side effects of varenicline
nausea, neuropsychiatric symptoms like change in behavior, agitation, depressed mood, suicidal ideation
What are indirect acting cholinergic agonists
cholinesterase inhibitors
What are the chemical groups of Achesterase inhibitors
alcohol
carbamic acid esters
organophosphates
What is structure and mech of alcohol indirect-acting cholinergic agonists
alcohol group and quaternary ammonium group
bind to AchE is non-covalent and reversible
What are types of organophosphate indirect acting cholinergic agonists
echthiophate, parathion, malation, sarin, soman and tabun
Describe the binding of organophosphates
bind to AchE covalent and irreversible
Describe pharmakinetics of quaternary and charged AchE inhibitors
relatively insoluble in lipids and absorption from conjunctiva, skin and lungs is poor
parenteral admin
no CNS involvement
duration of effect determined by stability of inhibitor-enzyme complexx
describe pharmacokinetics of teriaty and uncharged AchE inhibitors
well absorbed everywhere
CNS distribution
more toxic than polar quaternary carbamates
e.g. physotigmine, donepezil, tacrine, rivastrigmine, galantamine
describe pharmacokinetics of organophosphates
lipid-soluble and readibly absored making dangerous to humans
distributed everywhere
includes CNS toxicity
coavalent and irreversible so usually biotransformation pathways
describe AchE inhibitors activity of CV system
SAN and PAN ganglia
PAN dominates so CO decreases
modest bradycardia, dec contractility of atria
decrease in BP
What are the main therapeutic uses of agents that stimulate AchR
galucoma, GI and urinar tracts, NMJ (myasthenia gravis)
heart (rarely for certain atrial arrhythmias
alzheimer disease
What do we use to reverse NMJ blocking in anestheia
AchE inhibitors
how do AchE inhibitors help with glaucoma
reduce intraocular pressure by stimulating mAchR of ciliary body causing contraction allowing outflow of aqueous humor
What are symptoms of anticholinergic overdose
cutaneous vasodilation, anhidrosis, anhydrotic hyperthermia, nonreactive mydriasis, delirium, hallucinations, reduction or elimination of the desire to urinate
What is used to reverse overdose of anticholinergic effects
physostigmine because crosses bbb
what happens when you combine a nondepolarizing NMJ blocking agent with AchE inhibitor
diminsh the blockade
What happens with succinylcholine and AchE inhibitors
enhance phase 1 block and antagonize phase 2 block
What happens with cholinergic agonists(direct) and AcheE inhibitor
enhance effects of cholinergic agonists
what happens when you combine beta blocker and AchE inhibitor
enhance bradycaric effects
what happens when you combine systemic corticosteroids with AchE inhibiors
enhance muscle weakness seen in patients with myasthenia gravis
what are the dominant initial signs of acute AchE inhibitiro intoxication
miosis, salivation, sweating, bronchial constriction, vomiting, diarrhea
how do you Dx deliberate poisoning
AchE activity measurement in RBC and plasma
What are cholinesterase regenerators used for
they restore stimulation of motor nerve after organophosphorus dosage that blocks the stimulus
What is pyridostigmine
a prophylactic for AchE inhibitor poisoning,
military use it if in area where might be exposed to nerve gas
what is the prototype antimuscarininc compound
atropine