Parasympathetic drugs - Parasympatholytics

Synonymous with Anticholinergics

a. Anti muscarinic

b. Anti nicotinic

c. Both

d. None

a. Anti muscarinic

Ganglionic blockers

a. Nn

b. Nm

a. Nn

Neuromuscular blockers, also known as Skeletal Muscle relaxants

a. Nn

b. Nm

b. Nm

Muscarinic antagonist classification except:

a. Alkaloids

b. Synthetic-tertiary compounds

c. Synthetic-quaternary compounds

d. Tricyclic antidepressants

e. Ganglionic blockers

f. None

e. Ganglionic blockers

Alkaloid muscarinic antagonist except

a. Atropine

b. Scopolamine

c. Homatropine

d. Dicyclomine

e. None

d. Dicyclomine - this is Synthetic-tertiary compounds

Synthetic-tertiary compounds muscarinic antagonist except:

Dicyclomine

Oxybutynin

Flavoxate

Tolterodine

Trihexylphenidate

Biperiden

Benztropine

Glycopyrrolate

a. Glycopyrrolate

b. Trihexylphenidate

c. Benztropine

d. Biperiden

e. None

a. Glycopyrrolate - this is Synthetic-quaternary compounds

Synthetic-quaternary compounds except

Propantheline

Methscopolamine

Clidinium bromide

Mepenzolate

Methantheline

Glycopyrrolate

Tolterodine

a. Glycopyrrolate

b. Clidinium bromide

c. Mepenzolate

d. Tolterodine

e. None

d. Tolterodine - this is Synthetic-tertiary compounds

Tricyclic antidepressant:

a. Homatropine

b. Glycopyrrolate

c. Clidinium bromide

d. Oxybutynin

e. Tolterodine

f. Pirenzepine

f. Pirenzepine

Prototype anti-cholinergic drug.

a. Homatropine

b. Glycopyrrolate

c. Atropine

d. Oxybutynin

e. Tolterodine

f. Benztropine

c. Atropine

Pharmacologic effects of muscarinic blockers:

I. Cycloplegia (blurred vision) and mydriasis (dilation of pupils)

II. Increased Heart Rhythm (Tachycardia)

III. Reduced peristalsis; Ileus (loss of peristalsis); constipation

IV. Decreased salivation

V. Bronchodilation

VI. Retention of urine

VII. Anhidrosis

VIII. Hypothermia which visual manifestation is erythema/flushing (redness)

a. III, IV, V, VI, VII

b. II, III, IV, V

c. I, II, III, IV, V

d. V, VI, VII, VIII

e. I, II, III, IV, V, VI, VII, VIII

f. I, II, III, IV, V, VI, VII

f. I, II, III, IV, V, VI, VII

HYPERTHERMIA which visual manifestation is erythema/flushing (redness)

For refractive measurements and for ophthalmoscopic examination for better view of the posterior eye.

a. Homatropine

b. Cyclopentolate

c. Tropicamide

d. a and b

e. b and c

f. All

f. All

For symptomatic bradycardia.

a. Homatropine

b. Cyclopentolate

c. Tropicamide

d. Atropine

e. Oxybutinin

f. Benztropine

d. Atropine

For symptomatic relief of urinary urgency.

a. Homatropine

b. Cyclopentolate

c. Tropicamide

d. Atropine

e. Oxybutinin

f. Benztropine

e. Oxybutinin

Used for Parkinsonism and extrapyramidal side effects (EPS)

a. Benztropine

b. Biperiden

c. Trihexyphenidyl

d. a and b

e. b and c

f. All

f. All

For suppression of bronchial secretions during surgical and spinal anesthesia.

a. Atropine

b. Scopolamine

c. Oxytropium

d. a and b

e. b and c

f. All

d. a and b

For bronchial asthma and COPD.

a. Ipratropium

b. Tiotropium

c. Oxytropium

d. a and b

e. b and c

f. All

f. All

For cholinomimetic poisoning.

a. Homatropine

b. Cyclopentolate

c. Tropicamide

d. Atropine

e. Oxybutinin

f. Benztropine

d. Atropine

Nicotinic antagonist.

a. Ganglionic Blockers

b. Neuromuscular Blockers

c. Both

d. None

c. Both

Obsolete drugs for HTN; not being used now a days due to unwanted effects.

a. Ganglionic Blockers

b. Neuromuscular Blockers

c. Both

d. None

a. Ganglionic Blockers

Ganglionic blockers.

a. Rarely to obsolete used in clinical setting

b. Vasodilation and anticholinergic effects

c. Include Hexamethonium, Trimethaphan, Mecamylamine

d. a and b

e. b and c

f. All

f. All

Ganglionic blockers except:

a. Hexamethonium

b. Trimethaphan

c. Mecamylamine

d. Tubocurarine

e. None

d. Tubocurarine - this is NEUROMUSCULAR BLOCKERS

Neuromuscular Blockers except:

a. Also known as skeletal muscle relaxants = effects softens the muscle

b. Structurally similar to Ach

c. Contain one or two tertiary nitrogens that limits their entry into the CNS.

d. Classified as either Non-depolarizing and depolarizing types.

c.

Contain one or two QUATERNARY nitrogens that limits their entry into the CNS.

Neuromuscular Blockers is structurally similar to

a. NE

b. EPI

c. ACh

d. DA

e. All

c. ACh

Non-depolarizing agent except:

a. Stops depolarization right away

b. Effects include relaxation

c. Drug competitively blocks binding of Acetylcholine to NM receptors

d. Include the curare derivatives; -curiums and -curoniums

e. None

e. None

Isoquinolines

a. -curiums

b. -curoniums

a. -curiums

Steroidal

a. -curiums

b. -curoniums

b. -curoniums

Depolarizing neuromuscular blockers

a. Tubocurarine

b. Succinylcholine

c. Mecamylamine

d. Hexamethonium

b. Succinylcholine

Depolarizing phase; muscles are stimulated → contract

a. Phase I

b. Phase II

a. Phase I

Transient fasciculations followed by flaccid paralysis.

a. Phase I

b. Phase II

a. Phase I

Succinylcholine binds at NM causing opening of sodium channel causing entry of sodium thus increase sodium inside leading to depolarization.

a. Phase I

b. Phase II

a. Phase I

Succinylcholine binding at NM receptors opens what channel?

a. Ca

b. K

c. Na

d. Cl

c. Na

Desensitizing phase

a. Phase I

b. Phase II

b. Phase II

Membrane repolarizes but receptor is desensitized to effect of acetylcholine.

a. Phase I

b. Phase II

b. Phase II

→ Succinylcholine is prolonged tending receptors to become numb thus desensitized

→ Sodium channels do not open = ↓ Sodium inside = (-) charge inside = hyperpolaeized = relaxed

a. Phase I

b. Phase II

b. Phase II

Uses of neuromuscular blockers.

a. Treatment of spastic cerebral palsy

b. To induce paralysis in short surgical procedures

c. Both

d. None

c. Both

Adverse effects of non-depolarizing neuromuscular blockers.

a. Respiratory Diaphragmatic Paralysis

b. Hypotension

c. Tachycardia

d. a and b

e. b and c

f. All

f. All

Adverse effect of isoquinoline derivatives non-depolarizing neuromuscular blockers.

a. Respiratory Diaphragmatic Paralysis

b. Hypotension

c. Tachycardia

d. a and b

e. b and c

f. All

b. Hypotension

Adverse effect of steroidal derivatives non-depolarizing neuromuscular blockers.

a. Respiratory Diaphragmatic Paralysis

b. Hypotension

c. Tachycardia

d. a and b

e. b and c

f. All

c. Tachycardia

Treatment for the deadly respiratory diaphragmatic paralysis.

a. Edrophonium

b. Neostigmine

c. Mechanical ventilator

d. a and b

e. b and c

f. All

f. All

Contraindicated to asthmatic patients and patients with history of anaphylactic reactions.

a. Atracurium

b. Pancuronium

c. Mecamylamine

d. Hexamethonium

a. Atracurium - as an isoquinoline derivative

Non-depolarizing agent has drug interaction with this leading to increased NMB action of non-depolarizing agents.

a. Isoflurane

b. Tensilon

c. Echothiopate

d. Succinylcholine

e. Amikacin

a. Isoflurane - General Anesthetics in general but especially Isoflurane

Potentiate the effect of non-depolarizing and depolarizing NMBs.

a. Isoflurane

b. Tensilon

c. Echothiopate

d. Succinylcholine

e. Amikacin

e. Amikacin - generally aminoglycosides

Adverse effects of succinylcholine

I. Postoperative muscle pain at higher doses

II. Hyperkalemia → due to Rhabdomyolysis

III. Malignant Hyperthermia

IV. Bradycardia

V. Increase in IOP

VI. Prolonged paralysis

a. I, II

b. II, III, IV

c. I, II, III, IV, V, VI

d. II, III, IV, V

e. II, III, IV, V, VI

f. I, III, IV, V, VI

c. I, II, III, IV, V, VI

Treatment for malignant hyperthermia.

a. Dantrolene

b. Mannitol

c. Naltrexone

d. Dapsone

e. Chloramphenicol

a. Dantrolene