Parasympathetic Inhibition (Anticholinergics)

Question 1

6 symptoms of parasympathetic, cholinergic blockade

Answer 1

1. Hot as a hare–> hyperthermia
2. Red as a beet–> flushing
3. Blind as a bat–> cycloplegia, mydriasis
4. Dry as a bone–> lack of salivation
5. Mad as a hatter–> confusion, delirium
6. Bloated as a toad–> constipation, urinary retention
7. Tachycardia

Question 2

4 anticholinergics used in tx of urge-type urinary incontinence (“on the darn toilet”)

Answer 2

1. Oxybutynin
2. Tolterodine
3. Darifinacin (and solifinacin)
4. Trospium

Question 3

What are 5 pt populations that atropine is contraindicated?

Answer 3

1. BPH
2. Hyperthermia
3. ** Acute angle glaucoma
4. Elderly (exacerbate/ cause delirium)
5. G.I. obstruction or ileus

Question 4

What are 4 other drugs/drug classes that have anticholinergic effects? *classic board Q to have an elderly person come into the ER with delirium due to these or mixing them

Answer 4

1. H1 blocking antihistamin (diphenyhydramine, doxylamine, chlorpheniramine)
2. Neuroleptics
3. TCA (often cause dry mouth)
4. Amantadine

Question 5

4 drugs used topically to dilate pupils

Answer 5

1. atropine
2. homatropine
3. tropicamide
4. cyclopentolate

Question 6

used in Parkinson’s and used with antipsychotics to decrease side effects

Answer 6

Benzotropine (CNS)

Question 7

motion sickness and also to decrease respiratory secretions in pts on respirator

Answer 7

Scopolamine

Question 8

used in COPD and asthma

Answer 8

1. ipratropium

2. tiotropium

Question 9

used preoperatively to reduce airway secretions

Answer 9

glycopyrrolate

Question 10

reduces urgency in mild cystitis and reduces bladder spasms

Answer 10

oxybutynin

Question 11

2 muscarinic antagonists that act in the CNS

Answer 11

1. benztropine

2. scopolamine