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P&T Block 1 > L2 > Flashcards

L2 Flashcards

1
Q

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

A 
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
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2
Q

Are muscarinic receptors ion channels or GCPRs?

A

7TM GCPR
M1 & 3 - Gq
M2 - Gi

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3
Q

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

A

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

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4
Q

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

A

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

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5
Q

What is the fxn of muscarinic receptors at sphincters?

A

M3 (M1?) = relax sphincter

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6
Q

What are the 4 muscarinic agonists?

A

Carbamylcholine
Acetyl-beta-methylcholine
Bethanechol
Pilocarpine

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7
Q

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

A

Acetyl-beta-methylcholine

Net parasympa tone

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8
Q

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

A

Bethanechol

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9
Q

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

A

Caramylcholine

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10
Q

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

A

Pilocarpine

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11
Q

Which 2 muscarinic agonists are resistant to AChE hydrolysis?

A

Resistant = bethanechol & carbamylcholine

Slow AChE hydrolysis = ABM

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12
Q

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

A 
SLUDE
Salivation
Lacrimation
Uriniation
Defication
GI motility
Emesis = vomiting
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13
Q

What are the cardiovas symptoms of para overstim?

A

Hypotension - M3 vasodilation

Bradycardia - M2 at SA node and myocardium

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14
Q

What are the resp symptoms of para overstim?

A

Bronchoconstriction
↑secretions
Both M3

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15
Q

What are the GI symptoms of para overstim?

A

Vomiting

Ab cramps - activated smooth muscle

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16
Q

What are the gland symptoms of para overstim?

A

↑Saliva, lacrimation, sweating

17
Q

What are the ocular symptoms of para overstim?

A

Constricted pupil - M3 on sphincter muscle

Spasm of accomidation - M3 @ ciliary body

18
Q

Explain the use of pilocarpine for glaucoma

A

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

19
Q

Why would you use a muscarinic agonist for cateract extraction?

A

Stretch iris for suturing room

20
Q

What drug should you use for GI procedures? Why?

A

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

21
Q

Which drug do you use for urinary retention?

A

Bethanechol

22
Q

Which drug do you use for dry mouth?

A

Pilocarpnie applied directly to salivary gland

23
Q

6 contraindications for using muscarinic agonists

A 
Asthma
Hyperthyroidism - AFib
Coronary insufficiency 
Peptic ulcers
Mechanical or inflam cause of GI obstruction/urinary tract
Peritonitis
24
Q

What are the 5 non-selective muscarinic ANTagnoists?

A 
Atropine
Scopolamine
Tropicamide
Cyclopentolate
Glycopyrrolate
25
Q

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

A

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

26
Q

Why do you use tolterodine/darifenacin?

A

Detrusor muscle in bladder

Goal to constrict sphincter

27
Q

Which muscarinic antagonist do you use for colds - why?

A

Ipratropium bromid

Relaxes bronchial smooth muscle

28
Q

Why would you use anti-muscarinics for chronic rhinitis?

A

↑airway passage

↓secretions

29
Q

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

A

Increase airway passage with NO change to sputum viscosity

30
Q

Which 2 drugs for intestinal hypermotility or diarrhea?

A
  1. Glycopyrrolate

2. Pirenzepine

31
Q

Which 2 drugs do you use for overactive bladder?

A

Darifenacin
Tolterodine
Selective for M3 receptor in detrusor muscle

32
Q

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

A 
Glycopyrrolate = charged
Atropine = uncharged
33
Q

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

A

Cyclopentolate

Tropicamide - shortest acting option!

34
Q

Drug for motion sickness

A

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

35
Q

3 contraindications for muscarinic antagonists

A

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

36
Q

Symptoms of mushroom poisoning. treatment?

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

P&T Block 1 (43 decks)

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