Neuro Pharm (Kruse)

Question 1

Methacholine

Answer 1

cholinergic agonist (used to diagnose bronchial airway hyperreactivity)

Question 2

Carbachol

Answer 2

cholinergic agonist (used to treat glaucoma or produce miosis)

Question 3

Bethanechol

Answer 3

cholinergic agonist (used to treat urinary retention and heartburn)f

Question 4

Cevimeline

Answer 4

cholinergic agonist (used to treat xerostomia)
metabolized via P450 >> excreted in urine

Question 5

Pilocarpine

Answer 5

cholinergic agonist (used to treat head/neck cancer, glaucoma and produces miosis and salivation)

Question 6

Varenicline

Answer 6

cholinergic partial agonist (used for smoking cessation and binds nicotinic receptors)

Question 7

What are the 3 groups of AChE inhibitors and which ones can be used therapeutically (reversible)?

Answer 7

1) alcohols *
2) carbamic acid esters *
3) organophosphates

Question 8

What is commonly used in a drug overdose and what is it combined with?

Answer 8

atropine (cholinergic antagonist) in conjunction with pralidoxime because it pulls organophosphates that are covalent/irreversible away from atropine

Question 9

What are some CNS disorders that anticholinergics can treat?

Answer 9

1) Parkinson (benztropine, trihexyphenidyl and procyclidine)
2) motion sickness (scopolamine)
3) anesthesia (atropine, glycopyrrolate are paired with neostigmine)

Question 10

Benztropine

Answer 10

anticholinergic (to treat Parkinson Disease)

Question 11

Trihexyphenidyl

Answer 11

anticholinergic (to treat Parkinson Disease)

Question 12

Procyclidine

Answer 12

anticholinergic (to treat Parkinson Disease)

Question 13

Scopolamine

Answer 13

anticholinergic (to treat motion sickness)

Question 14

What 2 drugs can treat uveitis and iritis?

ophthamologic disorders

Answer 14

homatropine and atropine (anticholinergics)

Question 15

Homatropine

Answer 15

anticholinergic (to prevent synechia formation in uveitis and iritis)

Question 16

What 2 drugs can be used to treat COPD?

Answer 16

ipratropium and tiotropium

Question 17

What anticholinergic is used to treat common traveler’s diarrhea and what is it combined with?

Answer 17

diphenoxylate and atropine (added to reduce risk of abuse since diphenoxylate is an opiate)

Question 18

What anticholinergic is used for GU disorders but has profound side effects?

Answer 18

oxybutynin

Question 19

What anticholinergics are preferred for GU disorders because of their minimal side effects?

Answer 19

darifenacin, solifenacin, tolterodine

Question 20

What are 3 contraindications for anticholinergics?

Answer 20

glaucoma, prostatic hyperplasia, acid peptic disease

Question 21

What is glycopyrrolate and how does it work?

Answer 21

antimuscarinic in GI disorders and after anesthesia as it stimulate skeletal muscle by increasing the levels of ACh in the body

Question 22

What are some charged AChE inhibitors?

Answer 22

neostigmine, edrophonium, pyridostigmine, echothiophate, ambenonium

Question 23

What are some neutral AChE inhibitors and what can they do that charged ones cannot?

Answer 23

physostigmine, donepezil, galantamine, rivastigmine, tacrine –> they can cross the BBB

Question 24

Major NT of sympathetic nervous system

Answer 24

norepinephrine

Question 25

Contraindication for varenicline use

Answer 25

suicidal ideation or changes in mood

Question 26

What are 3 big uses of direct-acting cholinergic agonists?

Answer 26

glaucoma, accommodative esotropia, GI/GU disorders

Question 27

Contraindications for muscarinic stimulants?

Answer 27

asthma, hyperthyroidism, coronary insufficiency, acid peptic disease

Question 28

Compare alpha adrenergic receptor agonists with mAChR antagonists in treatment of ophthalmologic disorders

Answer 28

alpha adrenergic agonists are shorter acting and produce less adverse effects, while mAChR antagonists are used when cycloplegia or prolonged mydriasis is required (LASIK)

Question 29

What can cause cholinergic poisoning?

Answer 29

cholinesterase inhibitor insecticides, wild mushrooms, chemical warfare nerve gases

Question 30

What are some acute symptoms of nicotinic agonist toxicity?

Answer 30

CNS stimulation, respiratory paralysis, HTN, cardiac arrhythmias

Question 31

How do you treat acute toxicity from nicotinic stimulants?

Answer 31

Atropine (for excess muscarinic stim) and diazepam (for CNS stimulation)