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35 Cards in this Set
- Front
- Back
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What is the effect of direct-acting muscarinic agonists on skeletal muscle?
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There is no effect because these use nicotinic receptors.
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How do you want to administer these drugs?
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Never IV, only subq, orally, topically bc can cause massive vasodilation in vessels
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Where are they CIed?
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Asthma, bradycardia/hypotension/CAD, peptic ulcer dz (bc stimulate acid sec), hyperthyroidism, weak bladder/GIT or obstruction
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Where do you use acetylcholine?
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Glaucoma topically, not systemic bc rapidly hydrolyzed by pseudocholinesterase
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Where do you use carbachol?
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Glaucoma (topically). Cars have tires no both sides, so nicotinic and muscarinic, resistant to hydrolysis by cholinesterases bc has coating on car
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Where do you use methacholine?
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Pulmonary function testing in asthma bc meth causes coughing??
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Where do you use betanechol?
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Bethroom -- GI motility and urinary retention tx (GI paresis for post-op)
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Where do you use pilocarpine?
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Glaucoma, xerostomia (pile on sweat and tears)
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What is the effect of cholinesterase inhibitors on skeletal muscle?
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Makes more Ach available so works at this level
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What are the toxicities of cholinesterase inhibitors?
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SLUDGE (salivation, lacrimation, urination, defecation, GI, emesis), paralysis from skeletal muscles, hypotension, mioisis, CNS if cross BBB (nonquarternary salt)
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How do you treat cholinesterase inhibitor poisoning?
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With atropine (muscarinic receptor antagonist) or pralidoxime (binds phosphate, works with organophosphate poisoning not carbamyl)
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Where do you use edrophonium?
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short acting so used as tensilon test for MG muscle weakness (myasthenic versus cholinergic crisis)
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Where do you use neostigmine?
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long acting so tx or MG
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Where do you use pyridostigmine?
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tx MG and protect from chemical warfare (nerve agents) --your pyrid can't stig me???
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Where do you use physostigmine?
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Tx poisoning from atropine and antimuscarinics, can get into CNS bc nonquartenary (physo is physiological, so can get things back to normal by going into brain)
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What are parathion and malathion?
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Organophosphate insecticides. parasite, mal - bad, think cricket!! Irrev cholinesterase inhibitor, phosphorylate enzyme. can be absorbed through skin. tx is atropine and PRAlidoxime (PRActical)
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What is carbaryl?
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Carbamate insecticide, irrev, but not absorbed through skin. Use atropine.
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What are DFP and sarin?
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nerve gases, potent/toxic chemical warfare agents. irrev. Tx with atropine and pralidoxime.
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What 2 drugs are used for Alzheimers?
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rivstigmine and donepezil (reverse cholinergic deficit in brain)
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What are the toxicities of muscarinic antagonists? competitive antagonists at muscarinic receptors
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excessive anticholinergic action, including dry mouth, visual disturbammces and cycloplegia, CNS - sedation.confusion, amnesia
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Where are muscarinic antagonists contraindicated?
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Glaucoma, prostatic hyperplasia, cardiovascular instability, severe ulcerative colitis
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How do you tx acute poisoning with muscarinic antagonists?
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physostigmine (physiological), benzodiazepines (seizure tx)
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What is special about atropine? What is the version that doesn't penetrate the CNS?
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Initially have transient bradycardia (weird). Homatropine, homo so doesn't cross over
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Where is scopolamine used?
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Orally and patch form for motion-sickness and vertigo (crosses BBB) - your scope is out of whack
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Where do you use dycyclomine?
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GI (tx IBS, decrease motility). Nonquartnery so crosses CNS. DIE CYCLES!!
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Where do you use propantheline?
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GI. don't want to PROPel food
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Where do you use glycopyrrolate?
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Anesthesiology to dry resp secretions and inhibit vagal reflexes. Genl purpose antimuscarinic. Nonquarternary
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Where do you use ipratropium and tiatropium?
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Asthama tx. few systemic effects. tiatroprium has longer doa.
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Where do you use benztropine? Trihexyphenidyl?
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benz for parkinsons. trihex do cancel HEXes on the brain. nonquarternary, goes to CNS.
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Where do you use tolterodine, oxbutynin, and solfenacin?
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Urinary incontinence due to overactive bladder, The sole ox toltally peed.
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Where do you use tropicamide and cyclopentolate?
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Dilate pupil for ophtho. duh you should know this.
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What are the PDE-5 inhibitors and how do they work?
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Sildenafil, vardenafil and tadalafil -- Ach causes NO release from the corpus callosum, activates cGMP causing vasodilation, PDE-5 breaks down cGMP. so inhibits this and get more vasodilation.
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Where do you use this?
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Erectile dysfunction and pulmonary arterial hypertension.
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Where is it contraindicated?
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pre-existing cardiovascular dz, reflex tachycardia (already excited! uh oh!) Also causes visual disturbances (PDE-5 in retina), think pilots and runway lights
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What lasts longest?
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TADAlafil
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