Chapter 9: Cholinergics Flashcards Preview

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Flashcards in Chapter 9: Cholinergics Deck (45)
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1

Hemicholinium 3 MOA?

Blocks the high affinity choline transporter --> this prevents the uptake of choline needed for Ach synthesis

2

Vesamicol MOA?

Blocks the Ach H+ antiporter that is used to transport Ach into vesicles

3

What drug is used to treat disorders related to increased mm tone (i.e. focal dystonias, torticollis, achalasia, pain syndromes, etc)

Botulinum toxin

4

How does botulinum toxin work?

degrades synaptobrevin and so prevents synaptic vesicle fusion w the axon terminal

5

Which AChE inhibitor is used to diagnose myasthenia gravis, eaton lambert syndrome, and disorders resulting in mm weakness?

Edrophonium

edroPHONEium...receive DIAGNOSIS over the PHONE

6

What is physostigmine used to tx?

Reversal of anticholinergic toxicity or induced paralysis in surgery

When you are paralyzed you can't move your PHYSO....send out an SOS!

7

Is edrophonium short or long acting?

Short...2-10 min...which is why it is useful for diagnosis

8

Topical application of AchE inhibitors to the cornea of the eye decreased intraocular pressure by facilitating outflow of vitreous humor...which drugs are used to tx glaucoma, chronic myasthenia gravis, and GI motility issues?

NeoSTIGmine
Ambenonium
PyridoSTIGmine

9

Diisopropyl fluoro phosphate - everything you know about it, GO!

Used in chemical warface - often mixed with mustard gas!

Can cause respiratory paralysis

Used to be used in ophthalmology

10

Why is tacrine rarely used?

Can cause serious hepatoxicity

11

Which AchE inhibitor can be used to treat Parkinsonian symptoms?

Rivastigmine

Down to the RIVA(stigmine) by the PARK(inson)

12

Donepezil MOA?

AchE inhibitor

13

What is the clinical application of donepezil?

Treat symptoms of dementia and alzheimer's

14

Methacholine MOA?

M - Muscarinic receptor agonist

15

What is methacholine used for? Why only that?

to diagnose asthma

unpredictable response in cardiovascular muscarinic cholinergic receptors (so dont even want to use in pts with recent heart problems)

16

Carbachol MOA and clinical app?

Under a lot of pressure and want to eat CARBS
--> glaucoma

muscarinic agonist (topical)

17

Which muscarinic agonist would you use to help make a patient pee?

bethanechol ... is a urinary tract motility agent

18

Which muscarinic agonists would you use to tx xerostomia in Sjogren's syndrome? What receptors do these drugs agonize specifically?

cevimeline & pilocarpine
(piloCARPine --fish---dry mouth)

M1, M3

19

What kind of glaucome do you use carbachol to treat, open or closed angle?

open angle!!!

narrow angle/angle closure glaucoma is a CONTRAINDICATION

20

Succinylcholine MOA?

Nicotinic receptor agonist --> produces depolarization of the cell membrane --> persists at NMJ and activates receptors continuously

= inactivation of voltage gated NA channels so they cant support further APs!
= DEPOLARIZING BLOCKADE

21

What is the drug of choice for paralysis during intubation? Bc of its short duration of action

succinylcholine

SUCCINCT duration of action

22

What does succinylcholine DO??

Induces mm paralysis

23

What is a contraindication/potential adverse effect of succinylcholine?

malignant hyperthermia

family or personal hx of malignant hyperthermia

24

What kind of glaucome do you use carbachol to treat, open or closed angle?

open angle!!!

narrow angle/angle closure glaucoma is a CONTRAINDICATION

25

Succinylcholine MOA?

Nicotinic receptor agonist --> produces depolarization of the cell membrane --> persists at NMJ and activates receptors continuously

= inactivation of voltage gated NA channels so they cant support further APs!
= DEPOLARIZING BLOCKADE

26

What is the drug of choice for paralysis during intubation? Bc of its short duration of action

succinylcholine

SUCCINCT duration of action

27

What does succinylcholine DO??

Induces mm paralysis

28

What is a contraindication/potential adverse effect of succinylcholine?

malignant hyperthermia

family or personal hx of malignant hyperthermia

29

What drug is used to tx acute, symptomatic bradycardia and excessive salivation/mucus during surgery?

atropine

30

Atropine MOA?

muscarinic receptor antagonist

31

What type of pts should you avoid giving atropine?

elderly or cognitively impaired

32

What are the common and serious adverse side effects of atropine?

HOT as a hare
Dry as a bone (xerostomia)
Red as a beet
Blind as a bat (raised intraocular pressure)
Mad as a hatter (coma??)

33

Scopolamine clinical app and adverse effects?

Michael scoffield - if you look at him you will not experience nausea and vomiting, but might alter your heart rate, psychosis, and blurred vision!

Clinical app: motion sickness, nausea, vomit
Adverse: alter heart rate, blurred vision, psychosis

34

Glycopyrrolate MOA and clinical app?

musc receptor antagonist

tx surgically or vagally induced bradycardia

35

IpratrOpium and TiotrOpium MOA and clinical app?

musc receptor antagonist

tx COPD and asthma

"if you smoke OPIUM youll get asthma and COPD"

36

Oxybutynin MOA

musc receptor antag

37

When would you prescribe oxybutynin?

For a pt with overactive or hyperreflexic bladder

"OXes really pee a lot"

38

Nicotinic receptor antagonists - they all end in what?

CURonium or CURium or CURarine

39

What agents cause non depolarizing blockade and can thus be used to induce neuromuscular blockade in surgery?

nic recept antagonists...the CURs

40

What agents would you prescribe for hypertension in pts with acute aortic dissection?...cause ganglionic block

trimethaphan
mecamylamine

41

Which drug will cause a dilated pupil that is unresponsive to light?

atropine

42

What DON'T you want to do with respect to the pupil in a patient with closed (narrow) angle glaucoma?

Don't Dilate!

So dont give an antimuscarinic without first checking the intraocular pressure!

43

What drug can be used to reverse anticholinergic activity? i.e. if a patient ingested tons of nightshade and presented with hallucinations, thirst, etc...

physostigmine

44

A patient with a paralytic ileus requires tx - what would you prescribe as the DRUG OF CHOICE

neostigmine

Neo trying to get into the paralytic ileus (matrix)

45

Tx for nerve gas exposure includes what 2 agents?

atropine + pralidoxime