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Flashcards in Cholinergics Deck (60):
1

onset/duration of tropicamide?

fast, short duration

2

rate of hydrolysis of physotigmine and neostigmine?

slow (hours)

3

which NMJ blockers have CV effects?

atracurium (minimum)

pancuronium (increase heart rate & BP)

3

which AChase inhibitor can enter CNS?

physostigmine

5

does it enter the CNS?

succinylcholine

no

5

how is pancuronium degraded?

kidney

5

side effects of oxybutynin?

high incidence of anti-muscarinic side effects

  • xerostomia
  • blurred vision
  • GI
  • CNS (drowsiness, confusion)

5

choline esters

acetylcholine, bethanechol

6

side effects of neuromuscular blocking agents

prolonged apnea

cardiovascular collapse (rare - histamine release)

anaphylaxis (rare)

6

administration of edrophonium?

IV

6

use of neostigmine

  • treats myasthenia gravis (oral)
  • prevents and treats post-operative atony of gut and bladder (oral)
  • reversal of paralysis by competitive NMJ blockers (IV)

7

what to use glycopyrrolate for?

block parasympathomimetic effects during reversal of NM blockade with anticholinesterase agents

8

which drug is used to treat anticholinesterase or muscarinic toxicity

atropine

9

administration of bethanechol?

oral, subcutaneous

10

administration of pilocarpine

orally, ophthalmic

11

therapeutic uses of physotigmine

glaucoma wide angle

toxicity by antimuscarinic drug poisoning

12

administration of physotigmine?

ophthalmic (glaucoma)

IV (antimuscarinic drug poisoning)

13

how is atracurium degraded?

Hofmann hydrolysis, spontaneously degrades in plasma to inactive metabolytes, and by plasma esterases

14

uses of atropine?

  • ophthalmic (mydriasis, cycloplegia)
  • anesthesia (block vagal reflexes)
  • anticholinesterase toxicity

15

how to treat muscarinic receptor antagonist poisoning?

physostigmine

15

administration of scopoloamine

transdermal patch

16

which of the musc. agonists can enter the CNS?

pilocarpine (tertiary amine)

17

therpeutic use of bethanechol?

urinary retention in the absence of obstruction

19

side effects of muscarinic antagonists

  • hot as a hare
  • dry as a bone
  • red as a beet
  • blind as a bat
  • drowsiness

no sweating, dry mouth, hot skin, mydriasis, cycloplegia, CNS action

20

with AChase inhibitors, what are the toxic side effects outside the SLUDGE?

  • medullary respiratory center depression, muscle paralysis
  • death due to respiratory failure

21

use of scopolamine?

motion sickness, vestibular disease

22

how is rocuronium degraded?

liver metabolism

22

which drug is commonly given to block responses to vagal reflexes induced by surgical manipulation of visceral organs?

atropine

23

onset/duration of edrophonium?

rapid, short

24

therapeutic use of pilocarpine?

  • xerostomia
  • ophthalmically for wide angle glaucoma
  • emergency narrow angle glaucoma

25

which NMJ blockers release histamine?

atracurium

pancuronium

26

how does succinylcholine work?

agonist of nicotinic receptors at NMJ, cause opening of cation channel

28

adminstration of ipratropium?

inhalation

28

alkaloids

atropine, scopolamine

29

function of tropicamide?

ophthalmic solution to produce mydriasis and cyloplegia

30

which drugs should be avoiding in patients with hyperthyoidism?

bethanechol, pilocarpine (musc agonists)

32

which of the naturally occurring alkaloids has greater CNS penetration

scopolamine

(more CNS penetration and prominent effects than atropine)

34

use of oxybutynin?

treats overactive bladder and incontinence

35

musc agonists should be used with caution in which patients?

  • asthma/COPD
  • urinary, GI obstruction and peptic ulcer
  • CV disease (bradycardia, hypotension, hyperthyroidism)

36

how do NMJs work?

compete fwith ACh for unoccupied end-plate nicotinic receptors without activating the channel

37

uses of edrophonium

  • diagnosis of myasthenia gravis
  • distinguish cholinergic crisis from myasthenic crisis
  • reverse paralysis

39

how do you treat competitive NMJ toxicity?

nestogimine or edrophonium

combine with glycopyrrolate to reduce muscarinic actions (bradycardia, GI/GU secretions/motility)

40

toxic effects of muscarinic antagonists

mad as a hatter (ataxia, restlessness, excitement, hallucinations, delirium, coma)

40

does glycopyrrolate penetrate the CNS?

no

42

pralidoxime

reactivates AChase peripherally, treat quickly because no longer effective after enzyme has aged

43

administration of neostigmine?

oral, IV

45

therapeutic use of rocuronium?

faciliate endotracheal intubation

46

long acting NMJ blocker

pancuronium

47

therapeutic use of NMJ blockers?

adjusvant in surgical anesthesia to obtain relaxation of skel muscle (mainly abdominal wall)

allows for much lighter level of anesthesia

49

use of ipratropium

COPD

rhinorrhea associated with common cold or rhinitis

50

SLUDGE

salivation, lacrimation, urination, defecation, GI, emisis (vomiting)

51

therapeutic use of succinylcholine?

muscle paralysis

53

effects of muscarinic antagonists

  • mydriasis and cycloplegia (paralysis of accommodation)
  • relax non-vascular smooth muscle (airways, GI, urinary bladder)
  • inhibit exocrin egland secretion (sweat, salivary, etc.)
  • increase HR
  • CNS effects (low - sedation, high - delirium)

54

how is vecuronium degraded?

liver

55

you should use muscarninic antagonists with caution in which patients?

  • glaucoma
  • prostatic hypertophy - difficulty voiding
  • tachycardia

56

side effects of succinylcholine

  • prolonged apnea
  • hyperthermia
  • muscle pain (fasciculation)
  • hyperkalemia

57

why aren't muscarinic agonists administered IV?

will cause hypotension due to activation of muscarinic receptors of vascular endothelium

58

does ipratropium cross into CNS?

no, quaternary amine

59

administration of tropicamide?

ophthalmic solution

60

aminosteroid

rocuronium

atracurium

vecuronium

pancuronium