Pharm Flashcards
What reverses the central vs peripheral effects of anticholinesterase toxicity?
Atropine treats central
Pralidoxime treats peripheral
Symptoms of anti-muscarinic toxicity?
Blind as a bat (from mydriasis and lack of accom)
Dry as a desert (dry eyes/ mouth)
Hot as hell (from lack of being able to sweat)
Red as a beet (from above hyperthermia)
Mad as a hatter (confusion/agitation sx)
Full as a flask (from lack of being able to pee)
Symptoms of muscarinic agonist toxicity?
SLUDGE and Killer B’s
S- salivation L- lacrimation U- urinatino D -diaphoresis G- GI stuff E- emesis
Bronochoconstriction, bronchospasm, bradycardia
Symptoms of anti-cholinesterase toxicity?
SLUDGE and Killer B’s
muscarinic agonist?
pilocarpine!
nicotinic agonist?
varenicline
cholinergic agonists (direct)
varenicline and pilocarpine
Muscarinic antagonists?
atropine and scopalamine
Nicotinic antagonists? (3-4)
Tubcurarine (curares and pancuronium)
Succinylcholine
Macamylamine
BOTOX
Cholinesterase inhibitors
Quaternary alcohols (edrophonium) Carbamates (neo/physo/pyridostimine, and donepazil/galantamine/rivostigmine) Organophosphates (ectothiophates and nerve agents)
What drug class can exacerbate athsma or copd?
cholinergic agonists
Side effects of what drug class can cause acute angle-closure glaucoma?
antimuscarinics bc they dilate pupil and dry out eye decreasing outflow, thus increase IOP
Preferred MG tx?
pyridostigmine, which is an anticholinesterASE
what can TREAT open-angle glaucoma?
pilocarpine bc it increases aqueous humor outflow
which carbamates (anticholinesterases) penetrate the bbb?
the 3 alzheimer’s drugs + physostigmine
what do organophosphates do?
irreversibly bind to acetylcholinesterase and age the bond, unless pralidoxime breaks the bond first
what do antimuscarinics do to bronchiole airways and lung secretions?
they dilate bronchiole airways (for fight/flight) and reduce secretions
which cholinergic receptors are found on the NMJ vs effector organs?
nicotinic- nmj
muscarinic- effector organs
what do antimuscarinics do to sweating and why?
antimuscarinics cause hyperthermia due to inhibition of sweat glands, since muscarinic agonists cause sweating
what drug can treat atropine overdose?
physostigmine
What drug class is flaccid paralysis from NMJ block due to? What drug do you give to reverse it? What drug do you combine with it to prevent side effects from overcompensation?
Anti-nicotinics can cause NMJ block flaccid paralysis (lack of parasymp ACh). You can give neostigmine (an anticholinesterase) to reverse it (increasing ACh parasymp and thus some muscle mvmt). But you must give it with atropine/glyco so that you don’t get ACh cholinergic toxicity (SLUDGE BBB, prevent too much parasymp). Neo also treats post-up urinary retention.
Physostigmine is also a anticholinergic toxicity antidote.
Which nerve agent organophosphate is the most volatile, and which has rapid aging? What drug can you give to prevent damage from the latter? What drug would you give otherwise?
Sarin- most volatile
Soman- camphor odor, rapid aging, thus use pyridostigmine to prevent damage (since oxime cant be fast enough)
What antidote (cumulative) can be given in mild, moderate, and severe organophosphate toxicity?
mild- atropine to block muscarinic effects (CNS, BBB)
moderate- add 2PAM (pralidoxime) (NIC/MUSC BOTH) to regen AChE
severe- add scopalamine or benzos to the mix
What does atropine do to pupil size, accomodation, and intraocular pressure/secretions?
it’s a muscarinic blocker so dilates pupils (mydriasis), prevents accommodation (fixed far vision, cycloplegia), and prevents secretions so increases IOP (glaucoma like effects, so don’t give if there’s narrow angle glaucoma bc fluid can’t leave when intraocular P increases since obstructed by angle)
