Cholinesterase Inhibitors & Anticholinergics

Question 1

Why is there no IV or IM form of cholinergic agonists

Answer 1

Rapid breakdown and rapid actions

Question 2

Where are cholinergic agonists metabolized

Answer 2

At the muscarinic & nicotinic receptor sites in the plasma and liver

Question 3

When do you use cholinergic agonists?

Answer 3

Urinary retention d/t weak or atomic bladder
Lack of bowel movements especially post op
Glaucoma to reduce intraocular pressure
Salivary gland hypofunction

Question 4

Can cross BBB

Answer 4

Acetylcholinesterase inhibitors, anticholinergics

Question 5

How are AChE inhibitors metabolized and excreted?

Answer 5

Enzymes in plasma/ kidneys

Question 6

Interrupt parasympathetic nerve impulses in the central and autonomic nervous systems

Answer 6

Anticholinergics

Question 7

All cholinergic blocking agents relax smooth muscle of?

Answer 7

GI and urinary bladder

Question 8

Drug interactions with cholinergic blockers

Answer 8

Tricyclic and tetracyclic antidepressants

Question 9

Antidote/tx for cholinergic blockers

Answer 9

Physostygmine

Question 10

Naturally occurring tertiary amine belladonna alkaloids

Answer 10

Atropine & Scopolamine

Question 11

Semisynthetic quarternary ammonium derivative

Answer 11

Glycopyrrolate

Question 12

Why do semisynthetic quaternary ammonium derivatives have no CNS effects?

Answer 12

Poor penetration to the brain

Question 13

Atropine & Scopolamine:

Answer 13

Naturally occurring drugs formed into esters
Resemble cocaine structurally
Equal parts dextrorotatory & levorotatory isomers
Anticholinergic effects d/t levorotatory form

Question 14

Anticholinergic drug with muscarinic receptors results in?

Answer 14

NO cell membrane change

Question 15

How can effects of anticholinergics be overcome?

Answer 15

Increased concentration of ACh in area of muscarinic receptors

Question 16

M1

Answer 16

CNS & stomach

Question 17

M2

Answer 17

Lungs, heart, & eyes

Question 18

M3

Answer 18

CNS, airway smooth muscle & glandular tissue

Question 19

M4 & M5

Answer 19

CNS

Question 20

All muscarinic cholinergic receptors are _______ depending on second messenger coupling

Answer 20

G-protein coupled receptors

Question 21

Scopolamine has _________ antisialagogue (decreased production of saliva) & ocular affects than atropine

Answer 21

Greater

Question 22

_________ has greater anticholinergic effects on the heart, bronchial smooth muscle, & GI tract than ________

Answer 22

Atropine; scopolamine

Question 23

_______ increased metabolic O2 consumption, ________ has no effect, & ________ has a decreased effect

Answer 23

Glycopyrrolate; atropine; scopolamine

Question 24

_____ & ______ can penetrate the BBB but _______ cannot

Answer 24

Atropine; scopolamine; glycopyrrolate

Question 25

Order for causing mydriasis

Answer 25

Scopolamine > atropine > glycopyrrolate

Question 26

Scopolamine is _____ times more potent than atropine in decreasing activity of RAS

Answer 26

100

Question 27

favored combo when a reliable sedative is needed in pre-op

Answer 27

Morphine + scopolamine

Question 28

Depresses the cerebral cortex and effects other areas of the brain causing amnesia

Answer 28

Scopolamine

Question 29

Has been associated with increased incidence of memory deficit after anesthesia

Answer 29

Atropine

Question 30

Inhaled anesthetics can ________ the effects of anticholinergic drugs on the CNS which could lead to increased post-op restlessness

Answer 30

Potentiate

Question 31

Effective in the reversal of restlessness/somnolence d/t CNS effects of tertiary amine anticholinergics

Answer 31

Physostigmine

Question 32

Which drug is more potent as an antisialagogue?

Answer 32

Scopolamine is 3x more potent than atropine as an antisialagogue

Question 33

What drug would you choose when an antisialagogue and sedation are needed?

Answer 33

Scopolamine

Question 34

Which drug is selected for absence of sedative effects when an antisialagogue is needed?

Answer 34

Glycopyrrolate (2x more potent than atropine and duration is longer)

Question 35

How do anticholinergics increase HR

Answer 35

By blocking effects of ACh on SA node (shortening the PR interval)

Question 36

How does great vagal tone in young adults influence atropine

Answer 36

Influence of atropine is enhanced

Question 37

During anesthesia, where a volatile drug is used, the does of atropine needed may increase d/t?

Answer 37

Depression of vagal centers

Question 38

what is the advantage of aerosols

Answer 38

Absences of adverse CV side effects

Question 39

Prevents & treats bronchospasm d/t beta blockers or psychogenic stimuli

Answer 39

Ipratropium (Atrovent)

Question 40

Which receptor does Ipratropium block

Answer 40

M3

Question 41

Which is more effective for chronic bronchitis or emphysema

Answer 41

Ipratropium

Question 42

Atropine decreases the tone of the smooth muscles of?

Answer 42

Biliary tract & ureter

Question 43

Atropine may not be able to reverse opioid-induced spasm of?

Answer 43

Sphincter of Oddi

Question 44

Tx for renal colic

Answer 44

Morphine + atropine

Question 45

How is glaucoma affected by mydriasis?

Answer 45

Mydriasis obstructs passage of intraocular fluid in venous circulation, causing hazardous increase IOP

Question 46

When should scopolamine be applied?

Answer 46

4 hrs before noxious stimulus

Question 47

Motion sickness is caused by? How does scopolamine help?

Answer 47

Stimulation of vestibular apparatus; | Scopolamine blocks transmission to the medulla of impulses from overstimulation

Question 48

Tx for anticholinergic overdose

Answer 48

Physostigmine 15-60 mcg/kg IV