Cholinergic Drugs

Question 1

A direct acting agonist belonging to choline esters that is a prototype. It is used as eye drops to constrict the pupil. Use of this drug leads to negative chronotropy and decreased blood pressure

Answer 1

Acetylcholine

Question 2

A direct acting agonist belonging to choline esters that is used for increasing intestinal motility and for benign prostatic hyperplasia. It is not hydrolyzed by AChE

Answer 2

Bethanechol

Question 3

A direct acting agonist belonging to choline esters that is used for glaucoma. It is not hydrolyzed by AChE

Answer 3

Carbachol

Question 4

A direct acting agonist belonging to choline esters that is used to diagnose asthma in the past

Answer 4

Methacholine

Question 5

A direct acting agonist belonging to alkaloids that is from Pilocarpus jaborandi. It is a prodrug used as the drug of choice for emergency lowering of intraocular pressure or opthalmologic emergency and for glaucoma. Being a tertiary amine, it is stable to hydrolysis of AChE

Answer 5

Pilocarpine

Question 6

A direct acting agonist belonging to alkaloids that is from Areca catechu (betel nut)

Answer 6

Arecoline

Question 7

A direct acting agonist belonging to alkaloids that is from Amanita muscaria

Answer 7

Muscarine

Question 8

An indirect and short acting agonist belonging to quaternary amines that is used to diagnose myasthenia gravis. it is the prototype for short acting AChE inhibitors. It binds reversibly to the active center of AChE, preventing its hydrolysis. It is also usually given IV or IM

Answer 8

Edrophonium (Tensilon)

Question 9

An indirect acting agonist from carbamates with intermediate duration of action. This is also known as eserine, from the Calabar or ordeal bean (Physostigma venenosum), and is used for intestinal and bowel atony, glaucoma, and as an antidote for organophosphate poisoning like atropine, phenothiazine, and TCAs

Answer 9

Physostigmine

Question 10

An indirect acting agonist from carbamates with intermediate duration of action. It is used for the treatment for myasthenia gravis and as an antidote for tubocurarine poisoning

Answer 10

Neostigmine

Question 11

An indirect acting agonist from carbamates with intermediate duration of action. It is used for the treatment for myasthenia gravis

Answer 11

Pyridostigmine

Question 12

They are indirect acting agonists from carbamates with intermediate duration of action. They are known as carbamate insecticides

Answer 12

Carbaryl
Methylcarbamate

Question 13

They are indirect and long acting agonists that are organophosphates used for glaucoma

Answer 13

Isofluorophate
Echothiopate

Question 14

They are indirect and long acting agonists that are organophosphates used as pesticides

Answer 14

Malathion
Parathion

Question 15

They are indirect and long acting agonists that are organophosphates used for chemical warfare

Answer 15

Tabun
Sarin
Soman

Question 16

The prototype muscarinic blocker, which has an active isomer of L-hyoscyamine, responsible for GI antispasmodic activity. This is extracted in alkaloids like the deadly nightshade (Atropa belladonna) and jimsonweed (Datura stramonium). It is used for ophthalmoscopic examination, as organophosphate poisoning antidote, and for bradycardia.

Answer 16

Atropine

Question 17

This is a muscarinic blocker also known as hyoscine, an alkaloid from henbane (Hyoscyamus niger). It is used to prevent motion sickness, administered via transdermal patches

Answer 17

Scopolamine

Question 18

These are muscarinic blockers that are atropine analogs used in ophthalmoscopic examination with less systemic effects than atropine

Answer 18

Homatropine, Cyclopentolate, Tropicamide

Question 19

These are muscarinic blockers, specifically of M3 receptors for bronchodilation. They are quaternary derivative of atropine and has a more peripheral effect on the lungs and is thereby used for asthma

Answer 19

Ipratropium and tiotropium

Question 20

This is a muscarinic blocker used as a treatment for peptic ulcer

Answer 20

Pirenzepine

Question 21

These are muscarinic blockers used for Parkinson’s disease

Answer 21

Benztropine, Trihexyphenidyl, Biperiden

Question 22

These are muscarinic blockers used for overactive bladder, wherein the patient frequently urinates

Answer 22

Darifenacin, Fesoterodine, Oxybutynin (specifically), Solifenacin, Tolterodine, Trospium Chloride

Question 23

These are other drugs used that block muscarinic receptors

Answer 23

Antihistamines
Antipsychotics
TCAs (imipramine and clomipramine)

Question 24

A ganglionic blocker from Nicotiana tabacum that initially stimulates then blocks ganglia

Answer 24

Nicotine

Question 25

Ganglionic blockers that block the ganglia without prior stimulation. These are used to treat hypertension before, but is no longer used due to lack of selectivity

Answer 25

Hexamethoium, Mecamylamine, Trimethaphan

Question 26

A ganglionic blocker from Indian tobacco (Lobelia inflata) that initially stimulates then blocks ganglia

Answer 26

Lobeline

Question 27

These are non-depolorazing, competitive, and reversible neuromuscular blockers that have isoquinoline in their structure. At a low dose, they competitively block ACh at the receptor without stimulating it. At high doses, they block the ion channels, which are no longer reversed by AChE inhibitors

Answer 27

Atracurium
Tubocurarine

Question 29

These are non-depolorazing, competitive, and reversible neuromuscular blockers that have steroids in their structure. At a low dose, they competitively block ACh at the receptor without stimulating it. At high doses, they block the ion channels, which are no longer reversed by AChE inhibitors

Answer 29

Pancuronium
Rocuronium

Question 30

It is a depolorazing, non-competitive, and irreversible neuromuscular blocker that depolarizes (seen as transient fasciculations) then repolarizes (seen as flaccid paralysis) and is more resistant AChE. It facilitates intubation for mechanical ventilation and as a muscle relaxant during surgery. It is very notorious for causing malignant hyperthermia (Type B ADR) with anesthetic agents

Answer 30

Succinylcholine/ Suxamethonium

Question 31

This is a drug used to inhibit the storage of ACh

Answer 31

Vesamicol

Question 32

This drug is used to inhibit the release of ACh

Answer 32

Botulinum toxin

Question 33

This causes the excessive release of ACh

Answer 33

Spider venom

Question 34

This drug is used to inhibit the uptake of choline in the cell

Answer 34

Hemicholinium