Pharm Block 1 (Drug - PNS) Flashcards
Direct-acting Cholinergic Agonists(Agents) - 2
Pilocarpine
- Reduce IOP in px w/ Glaucoma
- Xerostomia (dry mouth)
Bethanechol
- Increase urination and defecation
- Treat acute post-op/postpartum non-obstructive urinary retention
Indirect-acting Cholinergic Agents (AChEI) - Competitive (Reversible)
Edrophonium
Physostigmine Salicylate
Neostigmine
Pyridostigmine Bromide
Edrophonium
Indirect-Acting Cholinergic Agents - Competitive (Reversible)
Plant-derived
Short acting: 30s to 60s after injection and last for 10 min
(Clinical)
Differential Diagnosis of myasthenia gravis
Reverse
Reverse the effects of non-depolarizing neuromuscular blocking agents
(Comment)
Not effective against Depolarizing neuromuscular agents
Physostigmine Salicylate
Indirect-acting Cholinergic Agents - Competitive (Reversible)
Plant-derived
(Clinical)
Only for severe, life-threatening event
Routine is NOT recommended
(Contraindication)
Respiratory distress & seizures
Neostigmine
Indirect - Competitive (Reversible)
Medium acting (Synthetic competitive)
(Clinical)
Treatment of Myasthenia gravis (Diagnosis w/ Edrophonium)
Pyridostigmine Bromide
Indirect - Competitive (Reversible)
Synthetic, Medium acting
(Clinical)
Served as Nerve Agent Pyridostigmine Pretreatment (NAPP) Dose
Indirect-acting Cholinergic Agents - Non-competitive (Irreversible)
Ecothiopate (Echothiophate Iodide) - eye drops for treatment of Glaucoma
Sarin - Warfare agent
Parathion - Insecticides
Pralidoxime - Antidote, Overdoses of anticholinesterase drugs
Pralidoxime
Indirect (Non-competitive - Irreversible)
(MOA)
Reactivate cholinesterase
Slows the “aging” process
(Clinical)
Antidote (Poisoning)
Overdoses of AChEI drugs for myasthenia gravis
(Adverse)
Anticholinergic Effects
Alzheimer’s Disease
Tacrine (Cognex) - Multiple Daily Dosing, Hepatotoxic
Donepezil (Aricept) - Daily dosing preferred
Galantamine (Razadyne)
Rivastigmine (Exelon) - Patch
Anticholinergics
Used for Eye (2)
Cyclopentolate
Tropicamide
Anticholinergics
Used for GI
Dicyclomine (IBS)
Belladonna Alkaloids (IBS)
Scopolamine
Anticholinergics
Used for Lungs
Ipratropium
Tiotropium
Anticholinergics
Belladonna alkaloids
Scopolamine
Anticholinergics
Used for or GU
Oxybutynin Darifenacin Solifenacin Tolterodine FEsoterodine Trospium
Anticholinergic
Used for Parkinson’s
Benztropine
Trihexyphenidyl
Atropine
(MOA)
Inhibits the muscarinic actions of ACh
Central and Peripheral Anticholinergic
(Pharmacodynamic Effects)
Respiratory
-Reduces secretions in the mouth
-Relieves constriction and spasm
(Clinical)
- Ophthalmic (Diagnostic agent - mydriatic)
- Bradycardic rhythm
(Monitoring)
HR, BP, and mental status
Anticholinergics for the Eye
Name & Time to recovery
Atropine (Longest)
Cyclopentolate (Medium - 24 hrs)
Tropicamide (Shortest - 1 - 6 hrs)
Anti-cholinergic agents
Used for GU
Oxybutynin (XL and Patch are more tolerable) Darifenacin (Selective M3 antagonist) Solifenacin (Minimal M3>M2 selectivity) Tolterodine Fesoterodine Trospium (Decrease CNS side effects)
Anticholinergics
Used for GI
Dicyclomine
- Caution w/ CNS effects
- Diarrhea (a sign of incomplete intestinal obstruction)
Belladonna Alkaloids
-Inhibit M actions of ACh
Scopolamine
Anticholinergics
Used for Lung
Ipratropium (Short Acting)
Tiotropium (Long acting)
Parkinson’s Disease
Benztropine (Useful in the control of extrapyramidal disorders)
Trihexyphenidyl
Succinylcholine
NMBA Depolarizing Agents
(Clinical)
choice for rapid sequence intubation
(Adverse)
- Malignant Hyperthermia
- Hyperkalemia
DO NOT give as a continuous infusion !!!
NMBA Nondepolarizing Agents
_____ —> Metabolized to laudanosine —> seizures
Atracurium
NMBA Non-Depolarizing Agents
Atracurium
Cisatracurium
Rocuronium
Vecuronium
Pancuronium (Long)
OnabotulinumtoxinA (Botox)
Clinical Use Non-Cosmetic (2)
Cosmetic Use (1)
Adverse Rxn
- Chronic migraines, Cervical dystopia and blepharospasm
- Wrinkles and browlift
- hypersensitivity (localize pain)
