Part 2.3.2 - Autonomic Drugs - Parasympatholytics

Proverbs 16:3

c. Cholinergic

Parasympatholytics are also known as ________ antagonists.

a. Adrenergic
b. Dopaminergic
c. Cholinergic
d. Histaminergic

c. both

Parasympatholytics classifications

a. Antimuscarinics

b. Antinicotinics

c. both

b. Anticholinergics

[ANTIMUSCARINICS]

Antimuscarinics are also known as ________.

a. Adrenergics
b. Anticholinergics
c. Sympathomimetics
d. Cholinomimetics

b. Atropine

[ANTIMUSCARINICS]

Drug that is a prototype antimuscarinic

a. Scopolamine
b. Atropine
c. Benztropine
d. Ipratropium

b. Gastric

[ANTIMUSCARINICS]

Blocking M1 receptors by atropine inhibits ________ secretion.

a. Salivary
b. Gastric
c. Bronchial
d. Lacrimal

b. Tachycardia

[ANTIMUSCARINICS]

Blocking M2 receptors by atropine causes ________.

a. Bradycardia
b. Tachycardia
c. Bronchodilation
d. Ileus

a. Secretion

Blocks M3: Inhibits secretion & Smooth Muscles

[ANTIMUSCARINICS]

Blocking M3 receptors by atropine inhibits ________.

a. Secretion
b. Lipolysis
c. Dopamine release
d. Peristalsis only

• Dry mouth

• Anhidrosis (no sweating)

• Cutaneous vasodilation (widening of skin blood vessels)

• Erythema (skin redness)

[ANTIMUSCARINICS]

Blocks M3 by atropine: Inhibits secretion may lead to

• Salivation / wet mouth or Dry mouth?

• Anhidrosis (no sweating) or Sweating / diaphoresis?

• Cutaneous vasodilation (widening of skin blood vessels) or Cutaneous vasoconstriction?

• Pallor (pale skin) or Erythema (skin redness)?

• Mydriasis

• Cycloplegia

• Bronchodilation

• Ileus

• Urinary retention

[ANTIMUSCARINICS]

Blocks M3 by atropine: Smooth Muscles may lead to

• Miosis or Mydriasis?

• Cycloplegia or Accommodation / normal focusing?

• Bronchodilation or Bronchoconstriction?

• Normal bowel movement / peristalsis or Ileus?

• Urination or Urinary retention?

All

CNS / mental confusion symptoms

• Acute Psychosis → abnormal thinking/perception

• Confusion → cannot think clearly

• Agitation → restless or disturbed behavior

• Disorientation → confused about place, time, or person

[ANTIMUSCARINICS]

CNS Effects of blocking muscarinic receptors by atropine

I. Acute Psychosis

II. Confusion

III. Agitation

IV. Disorientation

All

[ANTIMUSCARINICS]

Other Anticholinergics for CNS

I. Scopolamine

II. Trihexyphenidyl

III. Benztropine

IV. Biperiden

All

[ANTIMUSCARINICS]

Other Anticholinergics for Eyes

I. Homatropine

II. Anistropine

III. Cyclopentolate

All

[ANTIMUSCARINICS]

Other Anticholinergics for Bronchi

I. Ipratropium

II. Tiotropium

III. Oxytropium

Both

[ANTIMUSCARINICS]

Other Anticholinergics for Gastric Gland

I. Pirenzepine

II. Telenzepine

All

[ANTIMUSCARINICS]

Other Anticholinergics for GIT and Urinary Bladder:

Methscopolamine, Glycopyrrolate, Hyoscine, Dicycloverine, Oxybutinin, Scopolamine

d. Atropine

[ANTIMUSCARINICS]

For Symptomatic Bradycardia

a. Trihexyphenidyl

b. Scopolamine

c. Biperiden

d. Atropine

d. Atropine

[ANTIMUSCARINICS]

Treatment of Cholinomimetic Poisoning

a. Trihexyphenidyl

b. Scopolamine

c. Biperiden

d. Atropine

d. Atropine

[ANTIMUSCARINICS]

Given with Diphenoxylate to minimize addiction with Diphenoxylate

a. Trihexyphenidyl

b. Scopolamine

c. Biperiden

d. Atropine

b. Scopolamine

[ANTIMUSCARINICS]

Management of Motion sickness

a. Trihexyphenidyl

b. Scopolamine

c. Biperiden

d. Atropine

II. Trihexyphenidyl

III. Benztropine

IV. Biperiden

[ANTIMUSCARINICS]

Management of EPS and Parkinsonism

I. Scopolamine

II. Trihexyphenidyl

III. Benztropine

IV. Biperiden

I. Homatropine

II. Anistropine

III. Cyclopentolate

[ANTIMUSCARINICS]

For Mydriatic Cycloplegics

I. Homatropine

II. Anistropine

III. Cyclopentolate

IV. Biperiden

I. Ipratropium

II. Tiotropium

III. Oxytropium

[ANTIMUSCARINICS]

For Bronchial and COPD

I. Ipratropium

II. Tiotropium

III. Oxytropium

IV. Cyclopentolate

II. Pirenzepine

IV. Telenzepine

[ANTIMUSCARINICS]

For Management of hyperacidity

I. Ipratropium

II. Pirenzepine

III. Oxytropium

IV. Telenzepine

All

[ANTIMUSCARINICS]

For Management of hypermotility D/O and urinary incontinence

I. Methscopolamine

II. Glycopyrrolate

III. Hyoscine

IV. Dicycloverine

V. Oxybutinin

VI. Scopolamine

b. Ganglionic Blockers

[ANTINICOTINIC]

_______ are Nn blockers.

a. Neuromuscular Blockers
b. Ganglionic Blockers
c. Muscarinic agonists
d. Bronchodilators

b. Skeletal muscle relaxants

[ANTINICOTINIC]

_______ are Neuromuscular blockers.

a. Ganglionic Blockers
b. Skeletal muscle relaxants
c. Bronchodilators
d. Antimuscarinic agents

a. Ganglionic Blockers

[ANTINICOTINIC]

Vasodilation and anticholinergic

a. Ganglionic Blockers

b. Neuromuscular Blockers

a. Ganglionic Blockers

[ANTINICOTINIC]

These agents are no longer clinically useful

a. Ganglionic Blockers

b. Neuromuscular Blockers

b. Neuromuscular Blockers

[ANTINICOTINIC]

Used for spastic disorders

a. Ganglionic Blockers

b. Neuromuscular Blockers

b. Neuromuscular Blockers

[ANTINICOTINIC]

Anesthetic adjuncts

a. Ganglionic Blockers

b. Neuromuscular Blockers

a. Ganglionic Blockers

[ANTINICOTINIC]

Hexamethonium

a. Ganglionic Blockers

b. Neuromuscular Blockers

a. Ganglionic Blockers

[ANTINICOTINIC]

Trimethaphan

a. Ganglionic Blockers

b. Neuromuscular Blockers

a. Ganglionic Blockers

[ANTINICOTINIC]

Mecamylamine

a. Ganglionic Blockers

b. Neuromuscular Blockers

b. Neuromuscular Blockers

[ANTINICOTINIC]

Classified as Depolarizing or Non-depolarizing

a. Ganglionic Blockers

b. Neuromuscular Blockers

a. Depolarizing NMB

[ANTINICOTINIC]

Succinylcholine

a. Depolarizing NMB

b. Non-depolarizing NMB

b. Non-depolarizing NMB

[ANTINICOTINIC]

Curare derivatives

a. Depolarizing NMB

b. Non-depolarizing NMB

b. Succinylcholine

[ANTINICOTINIC]

_______ is an anti-nicotinic agonist useful when rapid endotracheal intubation is required during induction of anesthesia.

a. Rocuronium
b. Succinylcholine
c. Atracurium
d. Neostigmine

a. Succinylcholine

[ANTINICOTINIC]

_______ is used during electroconvulsive shock treatment.

a. Succinylcholine
b. Tubocurarine
c. Pancuronium
d. Rocuronium

a. Succinylcholine

[ANTINICOTINIC]

MOA of ________: irreversibly activates Nm receptor.

a. Succinylcholine
b. Atracurium
c. Pancuronium
d. Tubocurarine

a. Succinylcholine

[ANTINICOTINIC]

Initial phase of effect of ________ is skeletal muscle contraction, followed by final relaxation paralysis.

a. Succinylcholine
b. Rocuronium
c. Tubocurarine
d. Atracurium

a. Succinylcholine

[ANTINICOTINIC]

Respiratory paralysis caused by ________ may be treated with Endrophonium or Neostigmine.

a. Succinylcholine
b. Cyclopentolate
c. Pirenzepine
d. Ipratropium

b. Dantrolene

[ANTINICOTINIC]

Malignant hyperthermia caused by Succinylcholine is treated with ___.

a. Rocuronium
b. Dantrolene
c. Tubocurarine
d. Atracurium

a. Myalgia, Myositis, and Rhabdomyolysis

[ANTINICOTINIC]

Adverse effects of Succinylcholine include ________.

a. Myalgia, Myositis, and Rhabdomyolysis
b. Hyperacidity and diarrhea
c. Bronchospasm and cough
d. Mydriasis and cycloplegia

b. Block Nm receptor causing immediate paralysis

[ANTINICOTINIC]

MOA of curare derivatives: ________.

a. Irreversibly activate Nm receptor
b. Block Nm receptor causing immediate paralysis
c. Stimulate muscarinic receptor
d. Increase acetylcholine release

c. Acetylcholine (ACh)

[ANTINICOTINIC]

At low doses, curare derivatives competitively block ________ at nicotinic receptors, preventing depolarization and muscle contraction.

a. Dopamine
b. Epinephrine
c. Acetylcholine (ACh)
d. Serotonin

b. Ion channels

[ANTINICOTINIC]

At high doses, curare derivatives block ________ of the motor template, further weakening neuromuscular transmission.

a. Muscarinic receptors
b. Ion channels
c. Sodium pumps
d. Alpha receptors

a. Type I Non-depolarizing NMB

[ANTINICOTINIC]

Isoquinoline (-curium)

a. Type I Non-depolarizing NMB

b. Type II Non-depolarizing NMB

a. Type I Non-depolarizing NMB

[ANTINICOTINIC]

Atracurium

a. Type I Non-depolarizing NMB

b. Type II Non-depolarizing NMB

a. Type I Non-depolarizing NMB

[ANTINICOTINIC]

Tubocurarine

a. Type I Non-depolarizing NMB

b. Type II Non-depolarizing NMB

b. Type II Non-depolarizing NMB

[ANTINICOTINIC]

Steroidal (-curonium)

a. Type I Non-depolarizing NMB

b. Type II Non-depolarizing NMB

b. Type II Non-depolarizing NMB

[ANTINICOTINIC]

Pancuronium

a. Type I Non-depolarizing NMB

b. Type II Non-depolarizing NMB

b. Type II Non-depolarizing NMB

[ANTINICOTINIC]

Rocuronium

a. Type I Non-depolarizing NMB

b. Type II Non-depolarizing NMB

b. Neostigmine and Edrophonium

[ANTINICOTINIC]

Respiratory/diaphragmatic paralysis caused by non-depolarizing blockers is treated with ________.

a. Dantrolene and Epinephrine
b. Neostigmine and Edrophonium
c. Atropine and Dopamine
d. Tiotropium and Ipratropium

a. Epinephrine

[ANTINICOTINIC]

Tubocurarine may cause an anaphylactoid reaction treated with ________.

a. Epinephrine
b. Dantrolene
c. Neostigmine
d. Scopolamine

c. Tubocurarine

[ANTINICOTINIC]

May cause an anaphylactoid reaction

a. Epinephrine
b. Dantrolene
c. Tubocurarine
d. Scopolamine