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26 Cards in this Set
- Front
- Back
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What is the goal of anticholinergics
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Block the muscurinic receptors
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What effects happen with anticholinergics
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Increased HR, decreased salivation, sedation/amnesia, bronchodilation, and reversal of cholinergic crisis.
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Which compounds of anticholinergics can cross the BBB, tertiary or quaternary?
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tertiary
Quaternary has an extra electronic charge that keeps it from crossing. |
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Where does atropine originate?
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From the belladonna plant
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M1 receptors
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Muscurinic
affect neurons and nerve endings |
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M2 receptors
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affect heart and neurons and nerve endings
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M3 receptors
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affect exocrine glands, smooth muscles, and neurons and nerve endings
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The way to remember Anticholinergic affects
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Dry as a bone
Mad as a hatter Red as a beat Blind as a bat |
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Atropine
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Anticholinergic
Combines with receptors reversibly Acts as a competitive antagonist at the receptor Acts quickly Primarily increases HR Relaxes smooth muscles - primarily bronchioles Treats Brady |
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Scopolamine
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Anticholinergic
CNS depressant Antisialagogue N/V Motion sickness Can be given as a patch Occasionally used in Trauma - amnesia |
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Antisialagogue
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Decrease salivation
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Glycopyrrolate
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Anticholinergic
Slower onset / longer duration Use with neostigmine for those reasons Often used as an antisialagogue Given with the NMB reversal to prevent ACh overload. |
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Less frequent uses of anticholinergics
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Bronchodilation
Biliary smooth muscle relaxation mydriasis cycloplegia - paralysis of the ciliary muscle of the eye motion sickness Cold remedies |
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Examples of direct acting muscarinics
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Methacoline - used to diagnose asthma (broncho constricts)
Pilocarpine - used to tx dry mouth in head and neck cx pt's. |
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An indirect acting muscarinic drug will have what effect on duration?
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Indirects act much longer
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Indirect acting parasympathomimetic AKA
What are they used for? |
anticholinesterases
NMB reversal Eg neostigmine |
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When are anticholinesterases given?
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When spontaneous recovery has begun and when youre ready to reverse.
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Neostigmine
Onset? Duration? Effects? |
Anticholinesterase
Onset 7-11 minutes (dose dependent) Duration 40-90 minutes Causes - Brady, NV, salivation, BM, bronchodconstriction |
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Edrophonium
Onset? Duration? Used to diagnose what? |
Anticholinesterase
Onset 1-2 minutes Duration 5-10 minutes Presynaptic effects Used to diagnose MG |
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Pyridostigmine
Onset? Duration? Used to treat what? What do you do on day of surgery? |
Anticholinesterase
Onset 10-20 minutes Duration 60-120 minutes Used to tx MG Take half the dose on the morning of surgery |
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Anticholinesterace AKA
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Acetylcholineesterase inhibitors
Remember we are trying to increase the amount of ACh at the receptors |
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Physostigmine
Reverses the effects of what? |
tertiary amine allows the cross of the BBB
Reverses the CNS effects of many things: atropine, opioids, benzos, volatiles, TCA, phenothiazides |
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parasympathomimetics
Irreversible examples? |
mimics the effects of the parasympathetic nervous system.
Irreversibles are examples of nerve gas. Organophosphate |
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Organophosphates
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Nerve gas
Binds up acetlycholinesterase Causes massive SLUDGEM response Tx with Atropine, diazepam, pralidoxime |
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SLUDGEM
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Salivation
Lacrimation Urination Defication GI motility Emesis Miosis |
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Echothiopate
Used to treat what? Also effects what? |
Topical irreversible anticholinesterase used to tx glaucoma.
Lasts 2-3 weeks Also effects pseudocholinesterase (watch out for SUCCs administration) |
