Lecture 7-8 Notes

Question 1

What are the main categories of cholinoceptor drugs?

Answer 1

• Cholinomimetic
• Anti-muscarinic
• Anti-nicotinic

Question 2

What type of receptors are muscarinic receptors associated with?

Answer 2

Effector cells (heart, glands, smooth muscle)

Question 3

What type of receptors are nicotinic receptors associated with?

Answer 3

Autonomic ganglia and neuromuscular junction

Question 4

Name the two main classifications of direct-acting cholinomimetics.

Answer 4

• Esters of Choline
• Plant-Based Alkaloids

Question 5

List four examples of esters of choline.

Answer 5

• Acetylcholine
• Methacholine
• Carbachol
• Bethanechol

Question 6

What is a characteristic of esters of choline?

Answer 6

Quaternary ammonium groups (highly charged)

Question 7

Fill in the blank: Acetylcholine is used for _______.

Answer 7

Pupillary constriction, eye surgery

Question 8

What are the effects of muscarine?

Answer 8

• Exaggerated parasympathetic response
• Increased salivation, tears, sweat
• Nausea, vomiting, diarrhea
• Bronchospasm
• Headache, visual disturbances

Question 9

What is the treatment for muscarine toxicity?

Answer 9

Atropine (1-2 mg intramuscular)

Question 10

What is the mechanism of open-angle glaucoma?

Answer 10

Excess aqueous humor production

Question 11

What is the contraindication for treating closed-angle glaucoma?

Answer 11

Atropine is contraindicated (can worsen condition)

Question 12

Name the three categories of indirect-acting cholinomimetics.

Answer 12

• Simple Alcohols
• Carbamic Acid Esters
• Organophosphates

Question 13

What is an example of a simple alcohol used as an indirect-acting cholinomimetic?

Answer 13

Edrophonium

Question 14

What is the duration of action for organophosphates?

Answer 14

Long-acting (hours to days)

Question 15

What is the mechanism of organophosphate poisoning?

Answer 15

Covalent bond formation with acetylcholinesterase

Question 16

What is the treatment for organophosphate poisoning?

Answer 16

• Atropine (for muscarinic effects)
• Pralidoxime (2-PAM) (breaks organophosphate off enzyme)

Question 17

What is myasthenia gravis?

Answer 17

Autoimmune disease: Antibodies against acetylcholine receptors

Question 18

What is the characteristic symptom of myasthenia gravis?

Answer 18

Weakness, fatigue (worsens with exercise)

Question 19

What does SLUDGE-BM stand for in muscarinic toxidrome?

Answer 19

• Salivation
• Lacrimation
• Urination
• Defecation
• GI motility
• Emesis
• Bronchial constriction
• Miosis

Question 20

What is the source of atropine?

Answer 20

Atropa belladonna (deadly nightshade)

Question 21

List three clinical uses of atropine.

Answer 21

• Bradycardia: IV atropine
• Eye examinations: Tropicamide
• COPD/Asthma: Ipratropium bromide

Question 22

What is the classic presentation of anticholinergic toxidrome?

Answer 22

• Hot as a hare
• Blind as a bat
• Dry as a bone
• Red as a beet
• Mad as a hatter

Question 23

What is the mechanism of succinylcholine?

Answer 23

ACh receptor agonist, not broken down by AChE

Question 24

What are the side effects of succinylcholine?

Answer 24

• Hyperkalemia
• Muscle pain
• Malignant hyperthermia

Question 25

Name the categories of non-depolarizing muscle relaxants by duration.

Answer 25

* Long-acting: Pancuronium * Intermediate-acting: Vecuronium, rocuronium * Short-acting: Mivacurium

Question 26

What is the method used to assess neuromuscular blockade?

Answer 26

Train of Four (electrical stimulation)

Question 27

What is the reversal agent for neuromuscular blockade?

Answer 27

* Neostigmine (general reversal) * Sugammadex (specific for rocuronium/vecuronium)

Question 28

True or False: Atropine is contraindicated in closed-angle glaucoma.

Answer 28

True

Question 29

What is the long-term treatment for myasthenia gravis?

Answer 29

Neostigmine, physostigmine

Question 30

What is the key clinical pearl regarding organophosphate poisoning?

Answer 30

Atropine + Pralidoxime