Autonomics II: Cholinomimetics

Question 1

Bethanecol: Class, clinical apps, and action

Answer 1

direct-acting agonist. postop and neurogenic ileus, urinary retention. activates bowl and bladder sm muscle.

Question 2

Pilocarpine: Class, clinical apps and action

Answer 2

direct-acting agonist. glaucoma. activates papillary sphincter and ciliary muscles of eye.

Question 3

Cevimeline: Class, clinical apps and action

Answer 3

direct-acting agonist. dry mouth in Sjogren’s, post-radiation therapy. increases salivation

Question 4

Nicotine (NRT): Class, clinical apps and action

Answer 4

direct-acting agonist. cessation of smoking. reduces cravings.

Question 5

Neostigmine: Class, clinical apps and action

Answer 5

indirect-acting agonist, carbamate. postop and neurogenic ileus, urinary retention; MG; reversal of paralyzing neuromuscular blockade. amplifies endog ACh, increasing skel muscle strength. 0.5-2hr duration

Question 6

Edrophonium: Class, clinical apps and action

Answer 6

indirect-acting agonist, alcohol. MG; reversal of paralyzing neuromuscular blockade. amplifies endog ACh, increasing skel muscle strength. Used for dosing of neostigmine and testing for MG. 5-15min duration.

Question 7

Physostigmine: Class, clinical apps and action

Answer 7

indirect-acting agonist, carbamate. glaucoma. amplifies effects of ACh. 0.5-2hr duration.

Question 8

Echothiophate: Class, clinical apps and action

Answer 8

indrect-acting agonist, organophosphate. glaucoma. amplifies effects of ACh. 100 hours.

Question 9

Donepezil: Class, clinical apps and action

Answer 9

indirect-acting agonist. Alzheimer’s. amplifies endog ACh in brain.

Question 10

Overdose of these agents lead to what series of symptoms? Antidote that blocks these affects?

Answer 10

miosis, n/v/d, salivation, sweating, cutn vasodilation, bronchial constriction (SLUDGE) Atropine.

Question 11

What organophosphate cholinesterase inhibitor is a very potent, volatile nerve gas that can result in death?

Answer 11

Sarin

Question 12

In addition to SLUDGE, what more serious symptoms can one experience as toxicity of cholinesterase inhibitors? As with nerve gases, what rapid tx should be initiated?

Answer 12

Resp collapse from CNS effects, skel muscle paralysis and bronchospasm. Atropine and pralidoxime (regen’s AChE)..