Lecture 13 - Cholinergic Antagonists Flashcards Preview

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Flashcards in Lecture 13 - Cholinergic Antagonists Deck (71):
1

What are the muscarinic antagonists? (six)

Atropine
Scopolamine
Glycopyrrolate
Oxybutynin
Ipratropium
Tropicamide

2

What are the non-depolarizing NMJ blocking agents? (five)

D-tubocurarine
Pancuronium
Vecuronium
Cisatracurium
Atracurium

3

What are the depolarizing NMJ blocking agents? (one)

Succinylcholine

4

What does atropine come from?

Belladona/nightshade

5

What does scopolamine come from?

angels trumpet

6

What is the general distribution of atropine?

Only gets into CNS with very high doses
Mostly peripheral effects

7

About how long does atropine last in dogs?

30 min

8

What is the general distribution of scopolamine?

CNS!

9

What effects do you see with scopolamine?

Euphoria + Sedation + Amnesia

10

What determines the effects of atropine at a certain organ?

Dose
Prevailing tone
Distribution of M receptors

11

How do rabbits react to atropine?

Resistant, have special enzyme to metabolize quickly

12

How do goats, cattle, and horses react to atropine?

Can eat the plant, but injected atropine can be VERY toxic

13

How do swine react to atropine?

very sensitive, can't even eat it

14

What are the general CNS effects of atropine?

Confusion + Coma

15

What are the toxic CNS effects of scopolamine?

Hallucinations + Delirium + Coma

16

What is the normal state of the eye?

PNS - slightly rounded lens + slightly constricted pupil

17

What does muscarinic antagonist do to the eye?

PNS decreased
Pupil dilated - via circular muscle
Lens flattens - via ciliary muscle

18

What is mydriasis?

Dilation

19

What is miosis?

Constriction

20

What side effects do you see with muscarinic blocked in the eye?

Photophobia + Blurry vision + Dry eyes

21

What type of muscarinic receptor is on the heart?

M2

22

What does M2 do at the heart?

ACh stimulates M2 on the heart at SA node
Pre-synaptic M2 decreases NE
Both decrease heart rate

23

What does muscarinic blockade due to the heart?

Tachycardia

24

When is atropine used in relation to the heart?

Cardiac arrest

25

What do cholinergic antagonists do to respiration?

Reverse bronchoconstriction
--or--
Bronchodilation

26

When is a cholinergic antagonist used in regards to respiration?

RAO or Heaves

27

What cholinergic antagonist is used for heaves?

Ipratropium

28

What does muscarinic blockade do in the GI tract?

Decrease motility + secretions
Decrease tone of bile duct

29

What does muscarinic blockade do to the bladder?

Decrease bladder motility
Decrease tone of ureter

30

What does muscarinic blockade do to the uterus?

Depress hypertonicity

31

What is a cholinergic antagonists used for during surgery?

Decrease secretions

32

What is a common side effect with cholinergic antagonists?

Dry mouth

33

What is the general effect of cholinergic antagonist in regards to secretions?

Dry eyes + Lack of sweating

34

What is used to reverse bradycardia in sx?

Atropine

35

What is used to prevent/treat post-operative bradycardia ?

Glycopyrrolate

36

What is something you have to watch out for with Glycopyrrolate?

Colic in horses

37

What is used for decreasing GI hypermotility + spasms?

Glycopyrrolate + Propantheline

38

What is used to decrease bladder activity + incontinence?

Oxybutynin

39

What is used to treat anterior uveitis?

Atropine

40

What is used in corneal ulceration treatment to decrease pain?

Atropine

41

What is used to cause mydriasis for intraocular exam?

tropicamide

42

How does tropicamide act differently in horses?

lasts for up to 12 hours

43

What is used to decrease respiratory secretions in surgery?

Atropine + Glycopyrrolate

44

What is used in treatment of organophosphate poisoning?

Atropine

45

What are the common side effects with cholinergic antagonists?

Dry mouth
Decrease secretions
Tachycardia with possible arrhythmias
Mydriasis + Cycloplegia
Decreased GI motility

46

What is the phrase for atropine overdose?

Dry as a bone
Blind as a bat
Mad as a hatter

47

What do you see with atropine overdose specifically?

Hot + Dry
Constipated + Urinary retention
Dilated pupils + blurred vision
Tachycardia
Aggitation + Delirum
Cardiovascular + respiratory collapse

48

What is used to treat atropine overdose?

AChE inhibitors
Physostigmine to increase CNS ACh

49

What are the two types of Neuromuscular blockers?

Depolarizing
-- and --
Non-depolarizing

50

What do the depolarizing NM blockers do?

Stimulate a muscular contraction before blocking the receptor

51

What do the non-depolarizing NM blockers do?

Competive antagonists
Direct blockade of channel occurs with no contractions

52

What are NM blockers used for?

paralysis with surgery

53

What is the onset of action for non-depolarizing NM blockers?

1 to 6 minutes

54

What is the distribution of non-depolarizing NM blockers in the CNS? Why?

Not able to get to CNS
Highly ionized

55

What can reverse non-depolarizing NM blockers?

Cholinesterase inhibitors to increase ACh levels enough to overcome blocker

56

What is the most common non-depolarizing NM blocker to use?

Atracurium

57

What is atracurium broken down by?

Plasma cholinesterase

58

How does cisatracurium compare to atracurium?

More potent
Less likely to cause histamine release

59

What are the long acting non-depolarizing drugs?

d-tubocurarine
pancuronium

60

What are the intermediate non-depolarizing drugs?

Vecuronium
Atracurium
Cisatracurium

61

What is the duration of the long action non-depolarizing drugs?

2 to 3 hours

62

What is the duration of the intermediate non-depolarizing drugs?

30 to 90 minutes

63

What is the progression of paralysis with the non-depolarizing drugs?

Small muscles
Larger muscles
Deglutition + Laryngeal + Abdominal intercostal muscles
Respiratory muscles

64

How long does succinylcholine last?

5 ot 10 minutes

65

What is succinylcholine used for?

Short procedures

66

What animals are resistant to succinylcholine?

Horse + Pigs

67

What ion is important to watch out for with use of succinylcholine?

K+

68

What does succinylcholine do in regards to K+?

Increases release of K+, leading to hyperkalemia in dogs who are already sick = cardiac arrest

69

What effect does tetracylines + aminoglycosides have on ACh release?

Decreased
reverse with Ca but NOT neostigmine

70

What effect does Polymixins have on ACh?

Decrease post-synaptic sensitivity

71

What effect does clindamycin have on muscle?

Inhibits, cannot be reverse with Ca or neostigmine