Chapter 7-8: Indirect Acting Cholinomimetics

Question 1

Describe Indirect acting Cholinomimetics

Answer 1

block acetylcholinesterase

Question 2

Name the 3 types of Indirect acting Cholinomimetics

Answer 2

1. Simple Alcohols: Edrophonium
2. Carbamic acid esters of alcohol: Carbamates and -stigmine
3. Organic derivatives of phosphoric acid: organophosphate

Question 3

T/F: Simple acids lasts for a long time

Answer 3

F

Short time

Question 4

Describe Organophosphates

Answer 4

Last for long time
can form covalent bonds

Question 5

What medication is used for MG Dx testing?
What is the DOA?

Answer 5

Edrophonium (Simple alcohol)

5-15 mins

Question 6

What 2 drugs treat MG? What is the DOA?

Answer 6

Neostigmine - 0.5-2 hrs
Pyridostigmine - 3-6 hrs

Question 7

What is the Tx for Glaucoma? DOA? Classification?

Answer 7

Echothiophate

100 hours

Organophosphate

Question 8

How fast do Indirect acting Cholinomimetics work?

Answer 8

150 mircoseconds

Question 9

Organophosphate form _______ bonds in the active site with _______

Answer 9

Covalent

Phosphorous

Question 10

What drug can break the covalent bond with organophosphates?

Answer 10

Pralidoxime

If given within the 1st few hours

Question 11

Explain the MG diagnostic testing process

Answer 11

2mg IV Edrophonium - watch for negative side effect

8mg IV - watch for improvement to see if other Indirect acting Cholinomimetics will work

Question 12

What are side effects of direct acting muscarinic overdose?

Answer 12

(-ine, choline esters, colorful mushrooms)

SLUDGEM!!!!!!

Question 13

What is SLUDGEM

Answer 13

Salivation
Lacrimation
Urination
Defication
GI motility
Emesis
Miosis

Question 14

What is the Tx for direct acting muscarinic SLUDGEM symptoms?

Answer 14

ATROPINE

or Pralidoxime

Question 15

Describe Toxicity in direct acting nicotinic stimulants

Answer 15

40mg is fatal
Want to induce vomiting
usually child eating cigarettes
S/S: HA, N/V, Dizziness, Breathlessness, Collapse, LOC

Question 16

What is a Cholinoceptor Blocking agent?

Answer 16

Cholinergic receptor blockers:

Antimuscarinic/Antinicotinic

or muscarinic/nicotinic antagonist

Blocks effects of natural ligands of the SNS and PNS at these receptors

Question 17

What is the Amanita phalloides?

Answer 17

“Deadly nightcap”

Noncolorful mushroom
inhibits mRNA synthesis
causes death within 4-7 days

Question 18

What is the antimuscarinic prototype?

Answer 18

Atropine

Question 19

Describe Atropine

Answer 19

Antimuscarinic
Plant based alkaloid
Racemic mixture of D and L

Question 20

In racemic atropine, the L isomer is ______ times more potent than the D isomer

Answer 20

100x

Question 21

What does belladonna mean?

Answer 21

Beautiful woman

Question 22

What does atropine or another plant based alkaloid do to the pupils?

Answer 22

dilate

Question 23

Describe Scopolamine

Answer 23

Antimuscarinic

Tx of motion sickness
very lipid soluble (patch)

Similar to atropine but shorter DOA

Question 24

Indications for antimuscarinics

Answer 24

block overproduction of PNS

Question 25

What is Atrovent

Answer 25

inhalant antimuscarinic -- bronchodilating effects Tx of asthma/COPD bronchospasms

Question 26

What is Cycloplegia?

Answer 26

Happens when you take a med that dilates your pupils Paralysis of ciliary muscle attaches to ciliary cords that hold lense in place and cant switch from near/far vision (accommodation) Dont drive

Question 27

What drug is used by the eye doctor to dilate the pupils? DOA?

Answer 27

Tropicamide 4-6 hrs

Question 28

Summary of atropine effects: urine, HR, Eye, Salivation

Answer 28

Urine: decrease HR: increase Eye accommodation: decrease Salivation: decrease

Question 29

Contraindications for antimuscarinics

Answer 29

Glaucoma (open/closed) Elderly men (d/t BPH)

Question 30

Muscle relaxants =

Answer 30

Neuromuscular blocking drugs

Question 31

Where and how do muscle relaxants work?

Answer 31

Block nAch-R at the NMJ skeletal muscle end plate

Question 32

describe ion flow in nAch-R

Answer 32

Na+ floods in Ca++ slowly comes in K+ comes out

Question 33

What is Succinylcholine?

Answer 33

Depolarizing muscle relaxant contracts onces, then relaxes and stays there wont repolarize

Question 34

Nondepolarizing muscle relaxants are ________derivatives

Answer 34

curare

Question 35

How does non depolarizing muscle relaxants work?

Answer 35

by outcompeting Ach and blocking the actual channel 1 alpha subunit only needs to be blocked

Question 36

Depolarizing muscle relaxant clinical use and name:

Answer 36

Succs Intubation

Question 37

Succs side effects (important ones only)

Answer 37

Hyperkalemia MH Apnea

Question 38

Name a few nondepolarizing muscle relaxants

Answer 38

Pancuronium - long acting Atracurium - intermediate Mivacurium - short

Question 39

Name 2 neuromuscular blockers reversals

Answer 39

Sugammadex Neostigmine