Pharma Week 3

Question 1

Mention drugs to treat parkinsonism , blocker in eye , treat peptic ulcer

Treat bronchial asthma, spasmolytic

Answer 1

Parkinsonism : benztropine, trihexiphenydil

On eye : homatropine , cyclopentolate , tropicamide

For PUD : pirenzepine , telenzepine

For bronchial asthma : ipratropium , tiotropium

On GIT for spasmolytic : propantheline , Hyoscine N butyl bromide ( Buscopan)

Question 2

Pharmacological action of atropine (therapeutic dose (3) , moderate, toxic)

Answer 2

1- therapeutic dose :
1- stimulation of medullary center
2- stimulation of Vagal center : bradycardia later on tachycardia due to the peripheral antimuscarinic effect

3- stimulation of respiratory centre: increase rate and depth of respiration

2- Moderate dose :
Decrease parkinsonism ( tremor , rigidity )

3- Toxic dose :
CNS stimulation ( excitation, insomnia , hallucinations , convulsions)
Followed by depression and death due to medullary paralysis

Question 3

4 effects of atropine on eye

Answer 3

1- paralysis of dilator pupillae muscle lead to passive mydriasis and photophobia
2- paralysis of ciliary muscle lead to cycloplegia

3- increase IOP which is danger for narrow angle glaucoma , but no significant effect on the IOP of normal patients

4- decrease lacrimation ( sandy eye)

Question 4

3 effects of atropine on blood vessels

Answer 4

1- Atropine has no significant effect on blood vessels and blood pressure

2- It counteracts the action of choline esters

3- toxic effects ( normal dose in hyperactive persons) cause cutaneous VD and atropine flush

Question 5

Atropine is less effective in treat biliary spasm caused by what and 2 drugs are effective

Answer 5

Biliary spasm caused by morphine
And treated by nitrates and theophylline

Question 6

6 classes of drug has antimuscarinic pharmacology

Answer 6

1- Antihistamines
2- quinidine
3- Amantadine
4- tricyclic antidepressants
5- antipsychotics
6- Meperidine

Question 7

What is function of Oxybutynin and Tolterodine

Answer 7

Urge incontinence -> relax detrusor smooth muscle, decrease overactivity

Question 8

What is the treatment of antimuscarinic activity (2)

Answer 8

1- symptomatic treatments is the best ( fever - convulsion )
2- physostigmine used in small doses

Question 9

Contraindications of antimuscarinic (5)

Answer 9

1- Glucoma
2- gastric ulcer
3- tachycardia
4- BPH
5- children

Question 10

Scopolamine differs from atropine in (4)

Answer 10

1- has CNS depressent effects
2- stronger effects on eye and stronger antisecretoty effects
3- weaker effects on vagus tone , intestinal and bronchial
4- Effective in motion sickness

Question 11

Ganglionic stimulants and ganglionic blockers

Answer 11

1- nicotine in small does
2- dimethyl phenyl piperazinium DMPP

1- trimethaphan ( last choice)
2- hexamethonium
3- large does of nicotine

Question 12

Therapeutic uses of atropine

Answer 12

1- preanethetic medications

Decrease the bronchial and salivary secretions which are increased by anesthetic agent , or during endotracheal and intubation

Protect against reflex, vagal stimulation (due to an anesthetic agent )which may cause severe bradycardia and heart block
انت عندك المادة المخدرة دي وحشة وليها عيبين اول حاجة بتزود الافراز بتاع الbronchus فده وحش بالذات اثناء العملية من المريض يختنق ويموت تاني حاجة بتعمل reflex vagal stimulation يعني العصب الحائر يستثار وده هيجري علطول يعملك bradycardia فاحنا بندي atropine علشان الحوارين دول

2- cholinergic poisoning : due to reversible or irreversible choline esterase inhibitors

3- Myasthenia gravis with neostigmine

4- CVS

  A-V block 

Severe bradycardia and syncope caused by hypersensitive carotid sinus syndrome or digoxin toxicity

Some cases of Graves’ disease (hyperthyroidism), dilated cardiomyopathy, and chagas disease caused by trypansoma

5- GIT uses

Anti-spasmodic : atropine and scopolamine

reducing excessive salivation : as drug induced salvation and with heavy metal poisoning and parkinsonism