[PCOL] Part 2.3.2 - Autonomic Drugs - Parasympathetic drugs - Parasympatholytics

a. Anti muscarinic

Synonymous with Anticholinergics

a. Anti muscarinic

b. Anti nicotinic

c. Both

d. None

a. Nn

Ganglionic blockers

a. Nn

b. Nm

b. Nm

Neuromuscular blockers, also known as Skeletal Muscle relaxants

a. Nn

b. Nm

e. Ganglionic blockers → nicotinic antagonist

Muscarinic antagonist classification except:

a. Alkaloids

b. Synthetic-tertiary compounds

c. Synthetic-quaternary compounds

d. Tricyclic antidepressants

e. Ganglionic blockers

f. None

d. Dicyclomine - this is Synthetic-tertiary compounds

Alkaloid muscarinic antagonist except

a. Atropine

b. Scopolamine

c. Homatropine

d. Dicyclomine

e. None

a. Glycopyrrolate - this is Synthetic-quaternary 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

d. Tolterodine - this is Synthetic-tertiary compounds

Synthetic-quaternary compounds except

Propantheline

Methscopolamine

Clidinium bromide

Mepenzolate

Methantheline

Glycopyrrolate

Tolterodine

a. Glycopyrrolate

b. Clidinium bromide

c. Mepenzolate

d. Tolterodine

e. None

f. Pirenzepine

Tricyclic antidepressant:

a. Homatropine

b. Glycopyrrolate

c. Clidinium bromide

d. Oxybutynin

e. Tolterodine

f. Pirenzepine

c. Atropine

Prototype anti-cholinergic drug.

a. Homatropine

b. Glycopyrrolate

c. Atropine

d. Oxybutynin

e. Tolterodine

f. Benztropine

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

HYPERTHERMIA which visual manifestation is erythema/flushing (redness)

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

CHAT

Cyclopentolate

Homatropine

Atropine

Tropicamide

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

Atropine

1st line against symptomatic bradycardia.

e. Oxybutinin

For symptomatic relief of urinary urgency.

a. Homatropine

b. Cyclopentolate

c. Tropicamide

d. Atropine

e. Oxybutinin

f. Benztropine

BeBOT

Benztropine

Biperiden

Orphenadrine

Trihexyphenidyl

Used for Parkinsonism and extrapyramidal side effects (EPS)

d. a and b

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

f. All

Ipratropium - SAMA

Tiotropium - LAMA

Oxitropium - SAMA

For bronchial asthma and COPD.

a. Ipratropium

b. Tiotropium

c. Oxitropium

d. a and b

e. b and c

f. All

d. Atropine

For cholinomimetic poisoning.

a. Homatropine

b. Cyclopentolate

c. Tropicamide

d. Atropine

e. Oxybutinin

f. Benztropine

c. Both

Nicotinic antagonist.

a. Ganglionic Blockers

b. Neuromuscular Blockers

c. Both

d. None

a. Ganglionic Blockers

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

a. Ganglionic Blockers

b. Neuromuscular Blockers

c. Both

d. None

f. All

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

Hexamethonium

Mecamylamine

Trimethaphan

Ganglionic blockers.

c.

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

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. ACh

Neuromuscular Blockers is structurally similar to

a. NE

b. EPI

c. ACh

d. DA

e. All

e. None

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

a. -curiums

Isoquinolines

a. -curiums

b. -curoniums

b. -curoniums

Steroidal

a. -curiums

b. -curoniums

Succinylcholine

Depolarizing neuromuscular blockers.

a. Phase I

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

c. Na

Succinylcholine binding at NM receptors opens what channel?

a. Ca

b. K

c. Na

d. Cl

b. Phase II

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

c. Both

spastic cerebral palsy → stiff, tight muscles

Uses of neuromuscular blockers.

a. Treatment of spastic cerebral palsy

b. To induce paralysis in short surgical procedures

c. Both

d. None

f. All

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

b. Hypotension

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

c. Tachycardia

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

f. All

Treatment for the deadly respiratory diaphragmatic paralysis.

a. Edrophonium

b. Neostigmine

c. Mechanical ventilator

d. a and b

e. b and c

f. All

a. Atracurium - as an isoquinoline derivative

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

a. Atracurium

b. Pancuronium

c. Mecamylamine

d. Hexamethonium

a. Isoflurane - General Anesthetics in general but especially Isoflurane

→ isoflurane potentiates the effects of non-depolarizing agents

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

e. Amikacin - generally aminoglycosides

Potentiate the effect of non-depolarizing and depolarizing NMBs.

a. Isoflurane

b. Tensilon

c. Echothiopate

d. Succinylcholine

e. Amikacin

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

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

a. Dantrolene

Treatment for malignant hyperthermia.

a. Dantrolene

b. Mannitol

c. Naltrexone

d. Dapsone

e. Chloramphenicol

A. Decreased gastric acid secretion

What is the physiological effect of Atropine at M1 muscarinic receptors?

A. Decreased gastric acid secretion

B. Increased salivary gland secretion

C. Smooth muscle contraction in the stomach

D. Increased gastrointestinal motility

A. Vagolytic effect increasing heart rate, used as first-line agent for symptomatic bradycardia

What is the cardiac effect of Atropine at M2 receptors, and what is its primary clinical indication?

A. Vagolytic effect increasing heart rate, used as first-line agent for symptomatic bradycardia

B. Vagotonic effect decreasing heart rate, used for tachyarrhythmias

C. Direct beta-1 activation, used for acute heart failure

D. Alpha-1 constriction, used for neurogenic shock

C. To prevent abuse and lower addiction potential of the opioid

Why is Atropine co-formulated with Diphenoxylate in antidiarrheal medications?

A. To enhance diphenoxylate absorption in the gut

B. To reduce gastrointestinal cramping through synergistic M3 activation

C. To prevent abuse and lower addiction potential of the opioid

D. To counteract diphenoxylate induced respiratory depression

B. Mydriasis with blurring of vision

In the Alice in Wonderland effect of atropine toxicity, what symptom corresponds to blind as a bat?

A. Severe miosis with loss of night vision

B. Mydriasis with blurring of vision

C. Retinal detachment with loss of color vision

D. Cortical blindness with intact pupil reflexes

B. They paralyze the ciliary muscle, blocking accommodation and adjusting focus

How do mydriatic anticholinergic agents affect the eye to facilitate diagnostic eye exams?

A. They contract the ciliary muscle to improve near-vision focus

B. They paralyze the ciliary muscle, blocking accommodation and adjusting focus

C. They constrict the sphincter pupillae to lower intraocular pressure

D. They increase trabecular meshwork outflow of aqueous humor

A. Cyclopentolate, Homatropine, Atropine, Tropicamide

Which list correctly contains mydriatic and cycloplegic antimuscarinic agents?

A. Cyclopentolate, Homatropine, Atropine, Tropicamide

B. Ipratropium, Oxitropium, Tiotropium, Aclidinium

C. Biperiden, Benztropine, Trihexyphenidyl, Scopolamine

D. Pirenzepine, Telenzepine, Hyoscine, Glycopyrronium

C. Ipratropium and Oxitropium

Which bronchodilators are classified as Short-Acting Muscarinic Antagonists?

A. Umeclidinium and Glycopyrronium

B. Aclidinium and Tiotropium

C. Ipratropium and Oxitropium

D. Salmeterol and Formoterol

B. Umeclidinium, Glycopyrronium, Aclidinium, Tiotropium

Which bronchodilators are classified as Long-Acting Muscarinic Antagonists for maintenance therapy?

A. Ipratropium and Oxitropium

B. Umeclidinium, Glycopyrronium, Aclidinium, Tiotropium

C. Biperiden, Benztropine, Trihexyphenidyl, Scopolamine

D. Pirenzepine, Telenzepine, Hyoscine, Tropicamide

A. Pirenzepine and Telenzepine

Which selective M1 receptor antagonists decrease gastric acid secretion in gastrointestinal disorders?

A. Pirenzepine and Telenzepine

B. Ipratropium and Tiotropium

C. Cyclopentolate and Tropicamide

D. Biperiden and Benztropine

A. M3 antagonist antispasmodic that relaxes smooth muscle and may promote cervical dilation

What is the primary action and indication for Hyoscine N-butylbromide?

A. M3 antagonist antispasmodic that relaxes smooth muscle and may promote cervical dilation

B. M1 agonist used to stimulate gastric motility post-operatively

C. Selective Nn blocker used to control severe hypertensive emergencies

D. Centrally acting acetylcholinesterase inhibitor used for vascular dementia

B. Laudanosine, causing central nervous system stimulation and seizures

What toxic metabolite is formed during the breakdown of Atracurium, and what adverse effect can it cause?

A. Acrolein, causing hemorrhagic cystitis

B. Laudanosine, causing central nervous system stimulation and seizures

C. Formic acid, causing optic nerve damage

D. Thiocyanate, causing metabolic acidosis

A. Sugammadex

What agent is used as a fast-acting selective reversal agent for curare toxicity?

A. Sugammadex

B. Dantrolene

C. Pralidoxime

D. Atropine

A. Diaphragmatic paralysis, malignant hyperthermia, and rhabdomyolysis

What are three major life-threatening adverse effects associated with Succinylcholine administration?

A. Diaphragmatic paralysis, malignant hyperthermia, and rhabdomyolysis

B. Severe hypertension, liver failure, and nephrotic syndrome

C. Aplastic anemia, bronchospasm, and hyperthyroidism

D. Paralytic ileus, corneal ulceration, and ventricular hypertrophy