Pharm Block 1 (PNS - Anticholinergic Agents)

Question 1

Function of Anticholinergics Agents

Answer 1

• block ACh’s interaction w/ either a muscarinic or nicotinic receptor
• Effects are opposite of cholinergic stimulation (DUMBBELLS)

Question 2

Three types of receptor antagonist (Anticholinergic Agents)

Answer 2

M - antimuscarinic
Nn - ganglionic blocker
Nm - neuromuscular (or skeletal) muscle blocking agent

Question 3

Eye

Answer 3

Dry eyes, cyloplegia

Question 4

Cardiovascular

Answer 4

Increase chronotrope/inotrope

Facial vasodilation

Question 5

Respiratory

Answer 5

Bronchodilation

Decrease secretions

Question 6

GI

Answer 6

Decrease

• Secretions (Saliva & gastric, dry mouth)
• peristalsis
• sphincter constriction (constipation)

Question 7

Secretary glands

Answer 7

Decrease salivation, sweating, lacrimation

Question 8

Major Therapeutic Uses of Anti-Muscarinic Agents

Answer 8

• Reduce glandular and bronchiole secretions (atropine, glycopyrrolate)
• Induce sedation (scopolamine)
• Alleviate motion sickness (scopolamine)
• Reduce vagal stimulation of the myocardium (atropine)
• Reduce GI smooth muscle spasms
• Parkinson’s Disease (adjunct therapy to decrease ACh lvs)
• Treat bronchospasm

Question 9

Contraindications & Warnings

Eye

Answer 9

Do NOT use in narrow angle glaucoma

Question 10

Contraindications & Warnings

Cardiovascular

CNS

Answer 10

Cardiovascular: caution in angina (where increased HR exacerbates disease)

CNS: Minimize ‘anticholinergic load’ in px w/ Alzheimer’s Disease; coma

Question 11

Contraindications & Warnings

Respiratory

GI

GU

Answer 11

Respiratory: do NOT use atropine for asthma (effects not constrained to lungs)

GI: do NOT sue for chronic diarrhea, gastroparesis, GI obstructions

GU: caution in px w/ Benign Prostatic Hyperplasia (BPH), GU obstructions

Question 12

Contraindications & Warnings

Secretary glands

Neuromuscular

Answer 12

Secretary Glands - may increase heart injuries due to decrease thermoregulatory sweating

Neuromuscular - avoid in px w/ myasthenia gravis (unless treating AChE inhibitor side effects)

Question 13

What is useful anticholinergic drug for Parkinson’s Disease?

Answer 13

Benztropine (Cogentin)

Trihexyphenidyl (Artane) - another one

Question 14

Ganglionic Blockers are __________________ receptors blockers

Answer 14

Non-specific Nn (nicotinic neural)

No longer used therapeutically

Question 15

Neuromuscular Blocking Agents (NMBA)

Answer 15

it’s agents that

Block ACh at the Nm (nicotinic muscle) at the neuromuscular junction at the SKELETAL muscle

Order of paralysis (peripheral to central)
-face/eyes; fingers; limbs; neck; trunk muscles; intercostal muscles; diaphragm

Question 16

How does Curare induces neuromuscular paralysis?

Answer 16

Blocks the ability of ACh or similar agonist to activate Nm (nicotinic muscle) receptor at the neuromuscular junction at the skeletal muscle

Question 17

How is NMBA used for clinically?

Answer 17

For procedures that require muscle relaxation/paralysis

Ex)

• facilitate endotracheal intubation
• Paralyze mechanically ventilated px
• relax skeletal muscles during surgery after general anesthesia has been induced

DO NOT effect consciousness or pain threshold

Question 18

NMBA’s are structural analogs of ACh and act as either in what?

Answer 18

• Nondepolarizing (competitive inhibition)

- Depolarizing (Prolonged occupation and persistent binding)

Question 19

Ganglionic Blockers

Answer 19

Non-specific Nn (nicotinic neural) receptors blockers

NO longer used therapeutically