Pharm I Autonomic Nervous System General Cholinergics

Front 1

Match the following catagories of drugs with their mneumonic :
(a) Ganglion blocker & AchE regenerator,
Ach-Inhibitor,
Anticholinergic Drugs,
Cholinergic Drugs…

(b) MeTH-Pee,
MEN PeePeePEE,
Piss BOAT,
PBs oN MAC

Back 1

Ganglion blocker & AchE regenerator: MeTH Pee,

Ach-Inhibitor: MEN PeePeePee,

Anticholinergic Drugs: Piss BOAT,

Cholinergic Drugs: PBs oN MAC…

Hint 1

None

Front 2

Name the 4-catagories of cholinergic drugs

Back 2

(1) Cholinomimetics
(2) Indirect Cholinergic Agonist (AchE Inhibitor)
(3) Anticholinergic
(4) Ganglion Blocker & AchE regenerator

Front 3

Name the 6 cholinergic drugs. (hint?)

Back 3

pilocarpine, behtanechol, nicotine, methacholine, Ach, and carbamylcholine

Hint 3

( PBs on MAC)

Front 4

Name the 3 Ganglion Blockers and the 1-AchE-Regenerator. (hint?)

Back 4

Ganglion Blockers: Mecamylamine, Trimethaphan, Hexamethonium… AchE-Regenerator: Pralidoxime

Hint 4

MeTH-Pee

Front 5

Name the 8 Anticholinergic drugs. (hint?)

Back 5

pancuronium, ipratropium, succinylcholine, scopolamine, benztropine, oxybutynin, atropine, tropicamide.

Hint 5

(Hint: PISS BOAT)

Front 6

which 2 of the cholinergics are direct M agonist?

Back 6

Bethanechol and Pilocarpine

Front 7

Which 3 of the the cholinergics have both M an N afinity? Which of the 3 has a M>N affinity?

Back 7

(1) methachoine, Ach, Carbamylcholine…(2) methacholine is M>N

Hint 7

(hint: MAC)

Front 8

Name the 6 AchE-Inhibitors. (hint?)

Back 8

malathion, edrophonium, Neostigmine, physostigmine, pyrodostigmine, Parathion

Hint 8

MEN PeePeePee

Front 9

Which of the cholinergics causes desensitization after prolonged use?

Back 9

Nicotine

Front 10

Which 3 of the cholinergics is potent at GI, GU and eye? Which of these two is not so potent on CV?

Back 10

Bethanechol, Pilocarpine, (Carbamylcholine)… Bethanecol is not so potent on CV

Hint 10

None

Front 11

Which of the cholinergics is potent at the CV and used to diagnose bronchial hypersensitivity?

Back 11

Methacholine

Front 12

(1) Which 3 of the cholinergics is used to treat Glaucoma? (Hint?)

(2) which one of these is especially for chronic glaucoma/acute angle closure?

Back 12

(1) Carbamylcholine, Ach, Pilocarpine …

(NOTE: Bethanecol also has an effect on the MAch-eye)

(2) :Pilocarpine

Hint 12

(hint: Baseball CAP)

Front 13

Which of the cholinergics is used to Tx dry mouth and Sjøgren's syndrome?

Back 13

Pilocarpine

Front 14

Which of the cholinergics is used for post operative GI and for non-obstructive urinary retention?

Back 14

Bethanechol

Front 15

Of the 8 Anticholinergics, which are not M antagonists? Atropine, succinylcholine, ipratropium, tropicamide, pancuronium, scopolamine, oxybutynin, benztropine.

Back 15

Pancuronium and succinylcholine... they are Nicotinic antagonists

Hint 15

They should be at the back of the bus

Front 16

Match the following nicotinic neuromuscular and neuronal receptor with (alpha, gamma, alpha, beta, delta… or alpha, beta, alpha, beta beta)

Back 16

neuromuscular: alpha, gamma, alpha, beta, delta... and neuronal receptor: alpha, beta, alpha, beta beta)

Front 17

Which cholinergic is short acting? And which is long lasting?

Back 17

Ach: short… Long=Bethanecol

Front 18

Cholinergic agonists are dose dependent: what are the low/high does effects of cholinergic agonist on the vasculature: constriction vs. dilation?

Back 18

Cholinergic agonist: low dose = dilation… high dose=constriction of BV

This makes sense if you consider that at lower dose M parasympathetice predominates... as opposed to at high dose it's mixed sympathetic and parasympathetic

Hint 18

None

Front 19

What is the adverse effect of cholinergic agonist on atrial rhythm?

Back 19

ADR of cholinergic agonists: among others is atrial tachyarrhythmias (especially in hyperthyroid patients)...

Others are expected:
Asthma
Cardiac ischemia (due to low HR and low BP
Peptic ulcer (due to enhanched secretion)
Abdominal cramping

Hint 19

None

Front 20

What can be used to treat organophasphate poisoining? What is the time consideration?

Back 20

Pralidoxine can be used to attach the phosphate, but it must be used before the aging has occurred

Front 21

What effect on the BP can Indirect cholinergic agonist have? Why?

Back 21

small decrease in BP due to opposing pregangionic symp and para effects

Front 22

What is seen in skeletal muscle with indirect cholinergic agonists?

Back 22

increased contractility, fasciculation, paralysis

Front 23

What effect do direct cholinergic antagonist have on the CNS?

Back 23

sedation, reduced Parkinsonian rigidity

Front 24

What is the effect of Atropine on HR as dose is increased?

Back 24

low=decrease HR… med =small increase… high high increase in HR

Front 25

(1) Which type of drug causes pupil dilation, but must be used with care because it can cause acute angle closure glaucoma in predisposed individuals

(2) Which drug in this class would be a good choice for people with glaucoma? why?

Back 25

(1) Anticholinergics are used to dilate the eye, but can cause acute angle closure glaucoma in predisposed patients.

(2) Tropicamide is short acting

Hint 25

None

Front 26

Which anticholinergic drug can be used for Athma and COPD?

Back 26

Ipratropium

Hint 26

None

Front 27

What drug can be used for overactive bladder, paraplegia and enuresis?

Back 27

Oxybutynin

Front 28

What drug can be used for actue treatment of bradycardia?

Back 28

atropine

Front 29

What drug can be used for Parkinson's disease?

Back 29

Benztropine

Front 30

What drug can be used for motion sickness

Back 30

scopolamine

Front 31

what drug can be used for acute AV heart block?

Back 31

atropine

Front 32

what drug can be used for organophosphate poisoning?

Back 32

large doses of atropine... also: pralodoxine to regenerate AchE, and pyridostigmine (which is an AchE inhibitor, but can be used as a prophylaxis.)

Hint 32

None

Front 33

What drug can be used to diagnose Myasthenia Gravis? Which drugs can be used for tx of Myasthemia gravis? (hint?)

Back 33

Diag: edrophonium… Tx: pyridostigmine, neostigmine,

Hint 33

hint: Pyne treat

Front 34

what drug can be used for paralytic ileus?

Back 34

neostigmine

Hint 34

None

Front 35

what drug can be used for atonic bladder?

Back 35

neostigmine

Front 36

What drug can be used as a prophylaxis for organophosphate poisoning?

Back 36

pyridostigmine

Front 37

What drug can be used to regenerate enzymes in organophosphate poisoining?

Back 37

pralidoxine… large dose of atropine for poisoining

Front 38

What drug can be used for anticholinergic poisoining?

Back 38

physostigmine

Front 39

Which is faster, NAchR or MAchR… why?

Back 39

NAchR= ligand gated very fast… MAchR = G=protein slower

Front 40

What are the 3 types of Ach deactivation from fast to slow?

Back 40

Fastest: AchE (seconds) > Desensitization (min-hrs)> Down reg (hours -days)

Front 41

How does AcH open NAchR?

Back 41

(1) ligand gated non selective Na/K… (2) binding of 2 Ach moleules open channel --> EPSP

Front 42

What is Sarin Gas?

Back 42

Sarin: a nerve gas with indirect cholinergic agonist effects (organophosphate)

Front 43

What type of receptors are seen in muscarinic receptors?

Back 43

G coupled proteins

Front 44

T/F, both N and M receptors can undergo desensitization?

Back 44

TRUE

Front 45

Where are the two sites of activity for the Anticholinergics?

Back 45

M (antagonists) and Na channel R blockers

Front 46

T/F: Atropine works on all M receptors?

Back 46

TRUE

Front 47

What effect does Botulinum Toxin have on Ach release?

Back 47

Inhibition

Front 48

Name the two short acting anticholinergics

Back 48

Atropine and Tropicamide