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43 Cards in this Set
- Front
- Back
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Where are mu-2 receptors present?
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The heart
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Where are mu-3 receptors present?
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CNS, salivary glands, airway
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What is the mechanism of action of the Mu1, 3, 5 receptors?
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Phospholipase C -> calcium mobilization
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What is the mechanism of action of the Mu2, 4 receptors?
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Gi inhibit adenyl cyclase -> inhibition of voltage-gated calcium channels
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Which anticholinesterase drug has the greatest antisialagogue effect?
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Scopalamine
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Which anticholinesterase drug causes the greatest increase in IOP?
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Scopalamine
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Which anticholinesterase drug has the greatest effect on heart rate?
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Atropine
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Which anticholinesterase drug has the greatest effect on bronchodilation?
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Atropine
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Does atropine work in a patient with a transplated heart?
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No
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What is the onset of atropine?
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1 minute
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What is the duration of action of atropine?
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30-60 minutes
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What is the onset of glycopyrrolate?
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2-3 minutes
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What is the duration of glycopyrrolate?
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30-60 minutes
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How is glycopyrolate eliminated?
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80% unchanged in the urine
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To which patients should scopalamine not be given?
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Patients with glaucoma
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Which anticholinesterase drug should be used with glaucoma?
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Glycopyrrolate
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How does scopalamine cause sedation?
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Inhibition of the RAS
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Does scopalamine cause amnesia?
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Yes
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What potentiates scopalamine-induced sedation?
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inhaled anesthesics
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What is the treatment for central anticholinergic syndrome?
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Physostigmine 15-60 mcg/kg Q 1-2 hours
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What is the potency of glycopyrolate relative to atropine as an antisialagogue?
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2x more potent
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What is the dose of atropine for bradycardia?
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15-70 mcg/kg IV
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At what age is atropine more effective? Less effective?
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More effective with young adults, due to higher vagal tone, less effective with infants/geriatrics
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What is the influence of general anesthesia on atropine?
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Less atropine needed for same effect due to depression of vagal centers
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What anticholinesterase drug is prefered in patients at risk for CV complications?
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Glycopyrrolate (less risk of dysrhythmias than atropine, shorter duration)
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Where are Mu-3 receptors located in the airway?
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In the medium and large airways
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What is the effect of bronchodilating anticholinergic drugs on dead space?
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Increased
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What is the advantage of nebulizing anticholinergic drugs for bronchodilation?
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More local, less systemic effects (No CV effects)
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What is the nebulized dose of atropine?
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1-2 mg in 3ml saline
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What is the nebulized dose of ipratropium?
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0.25-0.5 mg
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When is ipratropium most effective?
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Beta-blocker induced bronchospasm, psychogenic stimuli, COPD
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When is ipratropium least effective?
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Asthma (Beta agonists better here)
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What is a potential adverse side effect of ipratropium?
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Initial bronchoconstriction due to blockade of Mu-2 receptors
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What is an effective treatment for bronchospasm secondary to intubation?
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Ipratropium
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What are the systemic effects of ipratropium?
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No HR, ocular SEs, minimal systemic absorption (some swallowed, not absorbed)
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What GI procedures would atropine be used for?
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Possibly spasm of sphincter of odi, renal colic, due to smooth-muscle relaxant properties
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What are the effects of anticholinergics on intraocular pressure? Mechanism?
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Relaxation of the cilliary muscle -> obstruction of the angular space and deceased outflow of intraocular fluid
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What anticholinesterase drugs are OK to use in patients with glaucoma?
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Glycopyrrolate, atropine
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Which anticholinesterase drug may protect against PONV? How is it administered? When?
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Scopalamine, transdermal patch adminstered before the induction of anesthesia (Ideally 4 hours before)
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What is a potential cause of anisocoria in a patient on transdermal scopalamine?
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Transfer of scopalamine from the patch to the eye by manipulation of the patch and touching the eye
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Why are anticholinergics included in over-the-counter cold remedies?
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Because they reduce upper airway secretions
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What is a potential treatment for hiccups?
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Atropine 0.5mg IV
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What is the effect of anticholinergics on LES tone?
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Decreases LES pressure
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