Cholinergic and Adrenergics

Question 1

Nerve Gas/Insecticide Poisoning

Answer 1

Cholinergic Overdose –> DUMBBELS/SLUDGE BB

Tx w/ Atropine

Question 2

Edrophonium

Answer 2

Indirect Cholinergic Agonist –> short acting AChEI used to test for MG –> Tension Test

Question 3

Neostigmine

Answer 3

Indirect Cholinergic Agonist –> AChEI. Use to tx MG and Curare Poisioning

Question 4

Atropine

Answer 4

Cholinergic Antagoinist (Nonselective antimuscarinic) –> M 1-3 receptors only. Causes SNS like sx. Use to tx bradyarrhythmia, AV block, and a cholinergic/muscarinic overdose (i.e. from Nerve Gas)

Question 5

Anticholinergic Overdose

Answer 5

Anticholinergic = SNS like sx i.e. Atropine Overdose
Tachycardia –> blocks M2 in heart –> increase HR
Hot As a Hare - blocks M3 thermoreg receptor
Dry - Blocks M3 Salivation gland –> dry
Blind as Bat - blocks M3 in eye –> Cycloplegia = blurred vision
Mad as Hatter - blocks M1 in CNS –> AMS, confusion

Also: 
No See
No Pee
No Spit 
No Shit

Question 6

Cholinergic Overdose

Answer 6

Excessive PNS sx i.e. from Nerve Gas/organophosphate
DUMBBELS = Diarrhea, Urination, Miosis, Bradycardia, Bronchoconstriction, Emesis Lacrimation, Salivation
Tx: atropine for M receptor reversal and Pralidoxime for neuromuscular blockade

Question 7

Nicotinic Neuronal

Answer 7

Activates PNS and SNS via ganglionic Nn receptors
Peripheral Actions: sims release of EPI from adrenals –> SNS actions (increase BP, HR/B1, vasoconstriction/A1), increases GI motility
CNS actions: relaxation, euphoria, emetic chemoreceptor stim
SNS - Release of NE to act on Alpha 1, Alpha 2, and Beta 1 receptors - also get feedback inhibition via pre-synaptic Alpha 2 receptors that can decrease NE and SNS actions
PNS = release ACh to act on Muscarinic receptors

Question 8

Ganglionic Blocker

Answer 8

Blocks both SNS and PNS at ganglia, but since PNS controls majority of tone, will cause anti-PNS/anti-cholinergic effects –> SNS like sx (tachycardia, constipation, dry mouth…)
Differentiate with strict anti-cholinergic overdose due to presence of hypotension (SNS controls vessel tone, so blocking SNS upstream will cause vasodilation and reflex tachy)

Question 9

NE

Answer 9

Alpha 1, Alpha 2, and Beta 1 receptors

Question 10

EPI

Answer 10

Alpha 1, Alpha 2, Beta 1, and Beta 2 receptors