Pharm1E1 Cholinergic Antagonists & NM Drugs

Question 1

atropine has high affinity for ? receptors and little to no affinity for ?

Answer 1

muscarinic- NONSELECTIVE for M1-M5

nicotine» little to no effect at ganglia

Question 2

tissues most sensitive to atropine? 3

Answer 2

salivary
bronchial
sweat

Question 3

? is 5 times more selective for M1 over ? receptors

Answer 3

pirenzepine

M2

Question 4

common s/e of musc. ant

Answer 4

dry mouth

Question 5

sites with little cholinergic control i.e. ? wont respond significantly

Answer 5

blood vessels

Question 6

antimuscarinics that enter the CNS can cause ? and ?

Answer 6

drowsiness

amnesia

Question 7

treats motion sickness; s/e include dry mouth & ?

Answer 7

scopolamine

sedation

Question 8

high doses of atropine results in?

Answer 8

tachycardia

Question 9

low doses of atropine.. initially causes ? b/c
the ? receptors aka ? on the ? terminals are blocked; these receptors normally reduce synaptic release of ? so when they are blocked more Ach is released, resulting in bradycardia

Answer 9

bradycardia
presynaptic muscarinic
autoreceptors
vagal nerve
Ach

Question 10

blockade of atrial muscle M2 receptors = no clinical significance except in ? or ?

Answer 10

atrial flutter, fibrillation

Question 11

overall antimuscarinic effects on heart not dramatic: ? and little to no change in ?

Answer 11

tachycardia, blood pressure

Question 12

atropine - respiratory - bronchodilation and reduction in?

Answer 12

bronchial secretions

Question 13

in RS primary use is ? and ?

Answer 13

reduce secretions and prevent laryngospasm (inhalation anesthesia)

Question 14

elevation of body temperature in infants aka?

Answer 14

atropine fever

Question 15

antimuscarinics reduce ? but have little effect on ?

Answer 15

tremor, bradykinesia

Question 16

drugs for PD? 3

Answer 16

cogentin
artane
norflex
aka CAN

Question 17

topical app- eye

aids in measurement of ? and facilitates ?

Answer 17

refractive error

eye exam of retina

Question 18

antimuscarinics for the eye? PACS TH

Answer 18

paremyd- combo of antimusc & sym-mimetic
atropine
cyclopentoate
scopolamine
tropicamide
homatropine

Question 19

? is the longest acting on the eye

Answer 19

atropine

Question 20

? is best for eye exams; shortest acting

Answer 20

tropicamide

Question 21

respiratory- inhibit airway secretions & cause bronchodilation (5)

Answer 21

atropine
hyoscyamine
ipratropium
combivent
tiotropium

Question 22

best for asthma?

Answer 22

combivent- activates B2!

Question 23

1st line for COPD

Answer 23

ipratropium

Question 24

GI- peptic ulcer 3

rarely used- PPIs more common

Answer 24

atropine
anaSPAZ
rubinol

Question 25

Diarrhea drug- additive to ? to discourage abuse

Answer 25

lomotil, opioid

Question 26

antispasmodics - 2 | treats IBS & spastic colon

Answer 26

atropine | bentyl

Question 27

only one for heart? low dose =? high dose=?

Answer 27

atropine bradycardia (presynaptic inhibition) tachycardia (may extend an infarct)

Question 28

atropine can reverse ? in the heart and ? attacks aka ? can be blocked

Answer 28

bradycardia | vaso-vagal, syncope

Question 29

GU- relieve urinary urgency/incontinence s/e include ? and ? name 6

Answer 29

``` ditropan XL detrol LA sanctura toviaz enablex vesicare **last two are M3 selective-detrusor muscle- overactive bladder ```

Question 30

atropine very safe but CI in ? and ?

Answer 30

GLC, especially narrow angle closure | BPH- can precipitate urinary retention

Question 31

ganglionic blockade- all ganglia blocked bc all are ?, so the ? in ANS is prevented; drug?

Answer 31

nicotinic reflex activity inversine- DOES access the CNS

Question 32

effect of inversine is opposite to the ? | all tone is PNS except for ?

Answer 32

dominant ANS tone | arterioles (S), veins (S), sweat glands (S), and G/U (both)

Question 33

bv are dominant via SNS vasoconstrictor actions so mecamylamine (inversine) results in ? bc ?

Answer 33

postural/orthostatic hypotension | the postural reflexes that prevent venous pooling are blocked

Question 34

on heart vagal tone dominates so ganglionic blockade >> ?

Answer 34

moderate tachycardia

Question 35

mecamylamine (inversine) indicated for moderate to severe ? and is an orphan drug by FDA for ?

Answer 35

Htn Tourette's *also used for ADHD, drug withdrawal, reducing bleeding during surgery

Question 36

inversine rarely used by can lower BP in emergency cases of ?

Answer 36

acute dissecting aortic aneurysm

Question 37

NM blocking drugs are used as adjuncts to ?

Answer 37

general anesthesia

Question 38

nicotinic receptor antagonists are ? agents

Answer 38

nondepolarizing

Question 39

depolarizing agents activate ? i.e. ?

Answer 39

nicotinic receptors, succinylcholine

Question 40

non depolarizing are given either ? or ? but are inactive if given?

Answer 40

IM, IV, orally

Question 41

longer actings non depolarizing blockade drugs? | **difficult to reverse blockade!

Answer 41

tubocurarine (80-120hrs) | PANcuronium (120-180hrs)- pan = all so it needs a long time!

Question 42

shorter acting non depolarizing blockade drugs?

Answer 42

atracurium (30-60 min), mivacurium (12-18 min)

Question 43

rapid onset, low potency, intermediate duration?

Answer 43

rocuronium

Question 44

nondepolarizing blocking drugs produce flaccid paralysis of muscle by inhibiting the ?

Answer 44

binding of ACh to nAChRs on muscle fibers

Question 45

? can slightly block ganglionic neuronal nicotinic Ach receptors

Answer 45

tubocurarine

Question 46

used in patients w/ multi system organ failure b/c their metabolism is independent of renal and hepatic function

Answer 46

atricurium, cisatracurium

Question 47

has the fastest onset and is a useful alternative to succinylcholine for tracheal intubation?

Answer 47

rocuronium

Question 48

tubocurarine produces ? due to stimulation of ? release and at high concentrations ganglionic blockade

Answer 48

hypotension | histamine

Question 49

has a moderate increase in HR and CO due to blockade of cardiac muscarinic receptors?

Answer 49

pancuronium

Question 50

? and ? can be used to ANTAGONIZE NM blockade

Answer 50

neoSTIGmine | pyridoSTIGmine

Question 51

drugs: | ? and ? can increase NM blockade

Answer 51

Ca channel blockers, anesthetics i.e. isoflurane

Question 52

two molecules of Ach bind to the receptors a ? in the receptor results in the opening of an ion channel which allows the passage of ? into the cell causing membrane depolarization

Answer 52

conformational change | sodium ions

Question 53

in succinylcholine initially the muscles display disorganized ? which is followed by ?

Answer 53

contractions | flaccid paralysis

Question 54

despite repolarization the membrane cannot be ? as long as succinylcholine is present- resembles ? of the nAChRs

Answer 54

depolarized | sensitization

Question 55

With succinylcholine, ? results if a second dose is given ? minutes after the first

Answer 55

bradycardia | five

Question 56

during prolonged muscle depolarization, excessive ? is lost and significant Na, Cl, and Ca are gained by the muscle. excessive damage to the soft tissue the K released can cause significant ? occasionally causing cardiac arrest

Answer 56

potassium | hyperkalemia

Question 57

halothane followed by administration of ? results in ?

Answer 57

malignant hyperthermia