L2

Question 1

Remind yourself… what are the muscarinic receptors? Where are they?

Answer 1

CHOLINGERIC receptors - bind ACh!!!
M1 - ganglia - slow EPSP
M2 
- Ganglia - IPSP
- Heart = ↓HR & contractility 
M3 - on GI, eyes, BVs, etc
- Smooth muscle contraction
- Gland secretion

Question 2

Are muscarinic receptors ion channels or GCPRs?

Answer 2

7TM GCPR
M1 & 3 - Gq
M2 - Gi

Question 3

Which muscarinic receptors are found in the GI? Fxn of each.

Answer 3

M3 - mediates smooth muscle contraction = motility; secretions
M2 - inhibits relaxation
Working together to maintain basal parasympa tone

Question 4

Which muscarinic receptors are found in BVs? Fxn of each?

Answer 4

Usually para sympa has no influence on BVs

But BVs do express M3 receptors that bind circulating ACh (not directly innervated by para) to aid relaxation

Question 5

What is the fxn of muscarinic receptors at sphincters?

Answer 5

M3 (M1?) = relax sphincter

Question 6

What are the 4 muscarinic agonists?

Answer 6

Carbamylcholine
Acetyl-beta-methylcholine
Bethanechol
Pilocarpine

Question 7

Which muscarinic agonist works at the heart? What would the effects there be?

Answer 7

Acetyl-beta-methylcholine

Net parasympa tone

Question 8

What muscarinic agonist works at the GI, bladder, and eye but is muscarinic only (vs nicotinic > muscarinic)?

Answer 8

Bethanechol

Question 9

What muscarinic agonist works at the GI, bladder, eye, and is nicotinic > muscarinic?

Answer 9

Caramylcholine

Question 10

Which muscarinic agonist is hydrophobic and used to treat the eye?

Answer 10

Pilocarpine

Question 11

Which 2 muscarinic agonists are resistant to AChE hydrolysis?

Answer 11

Resistant = bethanechol & carbamylcholine

Slow AChE hydrolysis = ABM

Question 12

What is the mneumonic for parasympa overstim = OD on muscarinic agonists?

Answer 12

SLUDE
Salivation
Lacrimation
Uriniation
Defication
GI motility
Emesis = vomiting

Question 13

What are the cardiovas symptoms of para overstim?

Answer 13

Hypotension - M3 vasodilation

Bradycardia - M2 at SA node and myocardium

Question 14

What are the resp symptoms of para overstim?

Answer 14

Bronchoconstriction
↑secretions
Both M3

Question 15

What are the GI symptoms of para overstim?

Answer 15

Vomiting

Ab cramps - activated smooth muscle

Question 16

What are the gland symptoms of para overstim?

Answer 16

↑Saliva, lacrimation, sweating

Question 17

What are the ocular symptoms of para overstim?

Answer 17

Constricted pupil - M3 on sphincter muscle

Spasm of accomidation - M3 @ ciliary body

Question 18

Explain the use of pilocarpine for glaucoma

Answer 18

Constricts circular muscles of eye - open iris - opens drainage canals

Question 19

Why would you use a muscarinic agonist for cateract extraction?

Answer 19

Stretch iris for suturing room

Question 20

What drug should you use for GI procedures? Why?

Answer 20

Bethanechol
Post-op obstruction, congenital megacolon, GERD
1. Create tone during surgery
2. Increase tone in sphincter to keep contents from refluxing

Question 21

Which drug do you use for urinary retention?

Answer 21

Bethanechol

Question 22

Which drug do you use for dry mouth?

Answer 22

Pilocarpnie applied directly to salivary gland

Question 23

6 contraindications for using muscarinic agonists

Answer 23

Asthma
Hyperthyroidism - AFib
Coronary insufficiency 
Peptic ulcers
Mechanical or inflam cause of GI obstruction/urinary tract
Peritonitis

Question 24

What are the 5 non-selective muscarinic ANTagnoists?

Answer 24

Atropine
Scopolamine
Tropicamide
Cyclopentolate
Glycopyrrolate

Question 25

What are the 4 selective muscarinic antagonists? What are each's affinity?

Answer 25

Pirenzepine - M1, medium M3 Tiotropium - M1 & M3, low M2 Tolterodine & darifenacin - M3

Question 26

Why do you use tolterodine/darifenacin?

Answer 26

Detrusor muscle in bladder | Goal to constrict sphincter

Question 27

Which muscarinic antagonist do you use for colds - why?

Answer 27

Ipratropium bromid | Relaxes bronchial smooth muscle

Question 28

Why would you use anti-muscarinics for chronic rhinitis?

Answer 28

↑airway passage | ↓secretions

Question 29

Which muscarinic antagonists could you use for chronic bronchitis/emphysema? Why these specifically?

Answer 29

Increase airway passage with NO change to sputum viscosity

Question 30

Which 2 drugs for intestinal hypermotility or diarrhea?

Answer 30

1. Glycopyrrolate | 2. Pirenzepine

Question 31

Which 2 drugs do you use for overactive bladder?

Answer 31

Darifenacin Tolterodine Selective for M3 receptor in detrusor muscle

Question 32

Which 2 drugs could you use to gain airway access for intubation pre-surg, prevent vagal reflexes during surg, and to recover from anesthesia?

Answer 32

``` Glycopyrrolate = charged Atropine = uncharged ```

Question 33

Which muscarinic antagonists are used to examine the retina and optic disc?

Answer 33

Cyclopentolate | Tropicamide - shortest acting option!

Question 34

Drug for motion sickness

Answer 34

Scopolamine prophylactically Block M3 receptors - Vestibular - Vomiting center @ nucleus of solitary tract

Question 35

3 contraindications for muscarinic antagonists

Answer 35

Narrow angle glaucoma Cardiac arrhythmia Chronic lung disease - most will be drying - Exceptions = ipratropium & tiotropium

Question 36

Symptoms of mushroom poisoning. treatment?

Answer 36

``` Mushrooms have muscarine - symptoms of OD: - Perspiration - Lacrimation - Salivation Treat with ATROPINE ```