Anti-Muscarinics

Question 1

Anticholinergics include

Answer 1

anti-muscarinics and ganglionic blockers

Question 2

Atropine

Answer 2

• Reverse muscarine or ACh inhibition poisoning
• long lasting pupil dilation (for ophth exams)
• anti-diarrheal (mixed with opiod) = lomotil
• prevent M side effects in patient receiving ChE inh for myesthenia gravis.
• intestinal spasms/pain
• reduction of GI secretions
• alt for amblyopia (pharmacological patch)
• 3 amine so CNS effects

Question 3

Scopolamine

Answer 3

• motion sickness
• cause drowsiness
• patch
• 3 amine so CNS effects

Question 4

Tropicamide

Answer 4

• short acting
• pupil dilation
• cyclopentolate and homatropine are similar

Question 5

Cyclopentolate

Answer 5

-Similar to homatropine and tropicamide

Question 6

Homatropine

Answer 6

-Similar to tropicamide and cyclopentolate

Question 7

Ipratropium

Answer 7

• quart amine
• administered by inhalation
• COPD – bronchodilation
• tiotropium is similar but longer lasting

Question 8

Tiotropium

Answer 8

similar to Ipratropium but longer lasting

Question 9

Tolterodine

Answer 9

• Antag at bladder mAChRs

- Overactive bladder, nocturia and incontinence

Question 10

Dicyclomine

Answer 10

• GI mAChRs – so relaxes the intestinal smooth muscle

- Overactive bowel

Question 11

Glycopyrrolate

Answer 11

• used preop to inh secretion
• inh sweating
• inh M overshoot after ChE inhibition (prevent M side effects for patient on neostigmine)

Question 12

Benztropine

Answer 12

• lipid soluble

- relieves extrapyramidal effects in Parkinson’s patients or antipsychotic patients

Question 13

What side effects to they block

Answer 13

DUMBELS and SLUD

salivation, lacrimation, urination, defecation

Question 14

effects of increasing doses of atropine

Answer 14

0.5- dry mouth and decreased sweating
1- incr HR, very dry mouth and thirst
2- blurred vision, tachycardia and palpitations
5- urinary retention, hot and dry skin, restlessness and fatigue
10- rapid and weak pulse, ataxia, hallucinations, delirium and coma

Question 15

affects of atropine overdose

Answer 15

hot as a hare (decr sweating, incr temp)
mad as a hatter (confusion, delirium)
red as a beet (flushed face, tachycardia)
dry as a bone (decr secretions, thirsty)
blind as a bat (pupil dilation)

Question 16

contraindications

Answer 16

glaucoma

Question 17

classes of other drugs with anti M activity

Answer 17

• sedating antihistamines
• tricyclic antidepressants
• phenothiazine antipsychotics
• older NMB
• Quinidine
• Meperidine

Question 18

Anti-muscarinics

Answer 18

so they have symp because allows symp influence to become predominant.
Often distinguished by the duration of action and lack of CNS penetrance

Question 19

ocular effects of atropine

Answer 19

• mydriasis - relaxes the iris sphincter, which allows symp tons to predominate on radial muscle.
• blocks accommodation- relaxes/paralyzes the ciliary muscle, which increases tension on the ligaments, thereby flattening the lens.
• inhibits lacrimation

Question 20

cardiac effects of atropine

Answer 20

• standard doses may incr HR and antrioventricular conduction
• very low doses may initially decrease HR by first blocking presyn Rs

Question 21

respiratory effects of atropine

Answer 21

• bronchodilation

- inhibit secretions

Question 22

GI and urinary tract effects of atropine

Answer 22

• relaxes gastrointestinal tone, (not sphincters) prolonging intestinal transit time.
• inh gastric acid secretion
• relaxes detrusor muscle of bladder causing urinary retention.

Question 23

CNS affects of atropine

Answer 23

• first causes stimulation, followed by a sedating effect

- high doses can cause confusion and/or hallucinations

Question 24

other effects of atropine

Answer 24

inh sweating, possible leading to hyperthermia

Question 25

short acting mydriatic agents

Answer 25

Tropicamide, cyclopenolate, homatropine

Question 26

antiM adverse effects

Answer 26

Dry mouth (xerostomia), blurred vision, hot/flushed skin, constipation, difficulty urinating, tachycardia, confusion, sedation

Question 27

diphenhydramine

Answer 27

Antihistamine with anti-muscarinic activity

Question 28

tricyclic anti-depressants

Answer 28

Class of drug with anti-muscarinic activity

Question 29

chlorpromazine

Answer 29

Antipsychotic with anti-muscarinic activity

Question 30

amblyopia

Answer 30

Atropine is an alternate treatment to the eye patch

Question 31

low doses of atropine

Answer 31

Produce dry mouth and decreased sweating

Question 32

mod doses of atropine

Answer 32

Produces increased heart rate, blurred vision, possible urinary retention

Question 33

high doses of atropine

Answer 33

Produces rapid and weak pulse, ataxia, hallucinations, delirium and coma

Question 34

The effect of Atropine on bradycardia

Answer 34

Blocks M2 receptors allowing B1 receptors to predominate at the cardiomyocyte

Question 35

SLUD

Answer 35

Mnemonic for adverse actions of antimuscarinics; blocks salivation, lacrimation, urination, defecation

Question 36

DUMBELS

Answer 36

Mnemonic for Diarrhea, Decreased blood pressure, Urination, Miosis, Bronchoconstriction and Bradycardia, Excitation of skeletal muscle, Lacrimation, and Salivation and Sweating

Question 37

oxybutinin

Answer 37

Antimuscarinic used for overactive bladder; main side effects are dry mouth and constipation; contraindicated for narrow-angle glaucoma.