Cholinomimetic Agents

Front 1

Bethanechol

Back 1

Activates Bowel and Bladder smooth muscle
Resistant to AChE
Clinical App: postoperative and neurogenic ilieus and urinary retention

Front 2

Carbachol

Back 2

Glaucoma
pupillary constriction
release of intraocular pressure

Front 3

Pilocarpine

Back 3

Pile on the tears, sweat and saliva
Contracts ciliary muscle of eye
(open angle)
acts on pupillary sphincter
(wide angle)
Resistant to AChE

Front 4

Methacholine

Back 4

Used in CHALLENGE TEST for Diagnosis of ASTHMA!
-Stimulates muscarinic receptors in airway when inhaled

Front 5

Cholinomimetic Agents
(Muscarinic Receptor Agonists)
Name 4

Back 5

Bethanechol
Carbachol
Pilocarpine
Methacholine

Front 6

Name 5 Indirect Agonists of Muscarinic Receptors

Back 6

Neostigmine
Pyridostigmine
Edrophonium
Physostigmine
Echothiophate

Front 7

Neostigmine

Back 7

Post op and neurogenic ILEUS and URINARY RETENTION

MYASTHENIA GRAVIS, reversal of neuromuscular junction blockade-postop

Front 8

Does Neostigmine penetrate the CNS?

Back 8

NO.
NEO CNS = NO CNS

Front 9

Pyridostigmine

Back 9

Treatment for Myasthenia Gravis
Long acting

Front 10

Does Pyridostigmine penetrate the CNS?

Back 10

NO. Pyrido does not stimulate CNS

Front 11

Edrophonium

Back 11

To diagnose Myasthenia Gravis
(extremely short acting)

Front 12

Physostigmine

Back 12

-Glaucoma
PHYS is for eyes!
-Atropine overdose

Front 13

Does Physostigmine penetrate the CNS?

Back 13

YES. PHYS FOR EYES crosses the blood brain barrier!

Front 14

Echothiophate

Back 14

Glaucoma...echossssss:)

Front 15

What drug is used for ATROPINE overdose?

Back 15

-----Physostigmine
crosses the CNS, Tertiary Amine

Front 16

what happens when a patient takes too much of an acetylcholinesterase inhibitor such as Edrophonium, Physostigmine, neostigmine, Donepezil, or an Organophosphate?

Back 16

DUMBBELSS!
D-Diarrhea
U-Urination
M-Miosis
B-Bradycardia
B-Bronchoconstriction
E-Excitation
L-Lacrimation
S-Salvation
S-Sweating
These are MUSCARINIC effects

Front 17

What are the NICOTINIC EFFECTS of Acetylcholinesterase INhibitors?

Back 17

Not DUMBBELSS but....
S
C

S-Skeletal Muscle excitation followed by paralysis
C-CNS stimulation

Front 18

Edrophonium diagnosis' MG.
What does it differentiate?

Back 18

Myastinia from a cholinergic crisis in other words, overdose of a acetylcholinesterase drug

Front 19

How do we manage a cholinesterase inhibitor overdose/toxicity?

Back 19

For the
1. Muscarinic Effects: Use Atropine

2. Regeneration of AChE: pralidoxime (2-PAM)
Time dependent aging requires use of 2-PAM As soon as possible

Front 20

Donepezil (Tacrine)

Back 20

Acetylcholinesterase Inhibitor
Lipid Soluble
NO CNS ENTRY
Clinical Use: Alzheimers

Front 21

Name 2 AchE-In.
One that is a Tertiary Amine

One that is a Quarternary Amine

Back 21

1. Physostigmine
(Tertiary Amine) PHYS-3

2. Neostigmine or Pyridostigmine
(Quarternary Amine)
NEmO ate 4 PYes

Front 22

What Drug helps in the early stages of Alzheimers?

Back 22

Achetycholinesterase Inhibitor

-Done-pez-il

Front 23

Organophosphates are Acetylcholinesterase Inhibitors.

Name 4 properties

Back 23

Organophosphates are:
-Lipid Soluble
-are IRREVERSIBLE Inhibitors
-TREAT GLAUCOMA
-Used as insecticides and as Nerve gas

Front 24

Insecticides (AChE-In)
Name 2, Quickly!

Back 24

Malathion (Insecticide)
Parathion (Insecticide)

Insects will NOT end up finishing the triathalon! :)

Front 25

Nerve Gas (Sarin)

Back 25

Organophosphate
Lipid Soluble
irriversible inhibitor

Front 26

Patient comes into the ER sweating, can't breath well, has abdominal cramping, diarrhea, and keeps going to urinate to the toilet.You notice he is salvating and his eyes are tearing. He has Bradycardia. what should you suspect?

Back 26

Organophosphate intake.

AChE-Inhibitor
TREATMENT: ATROPINE (muscarinic antagonist)
and Pralidoxime (used to chemically antagonize and regenerate active cholinesterase)

Front 27

Name 4 Muscarinic Antagonists and what organ system they work on.

Back 27

1. Atropine = Eye
2. Benztropine =CNS
3. Ipratropium = Respiratory
4. Scopolamine = CNS

Front 28

Atropine

Back 28

EYE
Produces Mydriasis (dilation)
and
Cycloplegia

Front 29

Benztropine

Back 29

Park my Benz
CNS Drug
--->Parkinsons' Disease

Front 30

Ipratropium

Back 30

Asthma, COPD

I PRAY I can breath soon!

Front 31

Oxybutynin

Back 31

Genitourinary System
MUSCARINIC ANTAGONIST
-Reduces urgency in mild cystitis and reduces bladder spasms

Front 32

Atropine
Homatropine
Tropicamide
Benztropine
Scopolamide
Ipratropium
Oxybutynin
Methscopolamine
Pirenzepine
Propantheline

Back 32

Muscarinic ANTAGONISTS

Front 33

Patient has urgency to urinate, mild cystitis. What can we consider as treatment, out of the Muscarinic Antagonists?

Back 33

Oxybutynin
or
Glycopyrrolate

Front 34

Patient has Peptic Ulcers.

What Muscarinic Antagonist, to stop secretion from GI can we use?

Back 34

Methscopolamine

or
Pirenzepine
or
Propantheline

Front 35

Atropine Side Effects.

Think Mad Hatter, in Alice in Wonderland.

Back 35

Hot as a Hare
Dry as a bone
Red as a beat
Blind as a bat
Mad as a Hatter

Front 36

Atropine
Muscarinic Agonist or Antagonist?

Back 36

Muscarinic Antagonist

Front 37

Elderly guy comes to ER, has increased body temp, acute angle closure glaucoma, dry skin, and isn't urinating often and has prostatic hyperplasia after USG results come in.

Back 37

ATROPINE TOXICITY

Front 38

Name 2 Ganglionic Blockers

Back 38

Hexamethonium

Mecamylamine

Front 39

What is the primary actions of
Hexamethonium
&
Mecamylamine?

Back 39

Ganglionic Blockade
Reduce automonic tone, vagal tone
prevents barorepector reflex changes in heart rate
no longer available clinically due to toxicities!

Front 40

Ganglionic Blockade.
Think Botulism Toxin.
What happens to:
1. Arterioles (SANS)
2. Veins (SANS)
3. Heart (PANS)

Back 40

Ganglionic Blockade will cause
1. Arterioles to Dilate, hypotension
2. Veins to dilate and decreased Venous return and decreased COutput
3. Heart will have tachycardia

Front 41

Ganglionic Blockade.
Think Botulism Toxin.
What happens to:

1, Iris (PANS)
2. Cilliary Mus (PANS)
3. GI Tract (PANS)
4. Bladder (PANS)
5. Salivary Glands (PANS)
6. Sweat Glands (SANS)

Back 41

ganglionic blockade with cause
1. Iris =to dilate
2. cilliary muscle to create blurred vision, or cycloplegia
3. GI tract =decreased tone, constipation
4. Gladder = urinary retention
5. salivary glands =xerostomia
6. Sweat glands = anhhydrosis, no sweating

Front 42

prior to eye exam, patient given a drug that causes mydriasis but has no effect on accommodation. what is the most likely identity of the drug?

Back 42

Tropicamide -- Muscarinic Antagonist!

~Atropine