Term
| Aqueous humor outflow is constantly subnormal because of degenerative process in the trabecular meshwork. |
|
Definition
|
|
Term
| No abnormal resistance to aqueous humor outflow, typically Medical emergency with acute onset |
|
Definition
|
|
Term
| Drugs used to Treat Glaucoma include _______, _______, _______, _______, and _______. |
|
Definition
| Alpha 2 adrenergic agonists, topical carbonic anhydrase inhibitors, beta blockers, Prostaglandin analogs, Cholinergic agonists (direct, indirect-anticholinesterase agents, sympathomimetics) |
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|
Term
| Postganglionic nerves contain both sympathetic and parasympathetic _______ receptors. |
|
Definition
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|
Term
| _______ receptors are located in the gut and activate HCl secretion. |
|
Definition
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|
Term
| _______ receptors are located on cardiac and certain smooth muscle and cause bradycardia and Smooth muscle inhibition. |
|
Definition
|
|
Term
| These receptors are located on exocrine glands, and Smooth Muscle cells and cause Secretion and Contraction. |
|
Definition
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|
Term
| The exception to the rule in the Sympathetic Nervous system is that Sweat Glands contain _______ receptors |
|
Definition
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|
Term
| _______ blocks muscarinic receptors, and is very effective against M2 and M3 subtypes, but is virtually ineffective against M1 subtypes. |
|
Definition
|
|
Term
| Parasympathetic effects in the eye are _______ and _______. |
|
Definition
| Miosis; Contraction of the Ciliary Muscle |
|
|
Term
| The Parasympathetic Affect in the Heart is _______, when _______ receptors are stimulated. |
|
Definition
|
|
Term
| The Direct effects of cholinergic agents in the heart are _______ and _______. |
|
Definition
| Decreased Cardiac Output; reduced peripheral resistance |
|
|
Term
| Parasympathetic effects in the respiratory system are _______ and _______. |
|
Definition
| Contraction of Bronchial Smooth muscle; increased secretory activity |
|
|
Term
| There are _______ receptors in the ventricles and arteries which are noninnervated, therefore giving drugs which activates these receptors causes bradycardia and decreased peripheral vascular resistance. |
|
Definition
|
|
Term
| The parasympathetic effects in the GI system are _______ and _______, and _______. |
|
Definition
| Increase peristalsis; relax sphincters; Increase secretory activity (salivary and gastric) |
|
|
Term
| Parasympathetic effects in the Genitourinary system are _______ and _______. |
|
Definition
| detrusor contraction; sphincter relaxation |
|
|
Term
| What is the action of Cholinergic Agonists? |
|
Definition
| Act on receptors that are activated by acetylcholine |
|
|
Term
| Cholinergic Agonists can be _______ or _______. |
|
Definition
| Direct acting (resemble acetylcholine); Indirect acting (Inhibit acetylcholinesterase) |
|
|
Term
| The Majour therapeutic uses of Cholinergic Agonists are _______, _______ and _______ stimulation, _______, and _______. |
|
Definition
| Glaucoma; GI and Urinary tract; Neuromuscular junction (myasthenia gravis; curare-induced neuromuscular paralysis); anticholinergic overdose |
|
|
Term
| What are the general toxic effects of Direct Acting cholinergic agonists? (10) |
|
Definition
| Flushing, sweating, bradycardia, Bronchoconstriction, GI distress, belching, nausea and vomiting, diarrhea, salivation, sensation of tightness of the urinary bladder (due to contraction) |
|
|
Term
| Signs of acute intoxication of Anticholinesterases are _______, _______, _______, _______, _______, _______, and _______, |
|
Definition
| Miosis (reduction in pupil size); salivation; sweating; bronchial constriction; vomiting and diarrhea, convulsions; coma |
|
|
Term
| Direct Acting Cholinergic Agents include _______, _______, _______ and _______. |
|
Definition
| Acetylcholine; Bethanechol; Carbachol; Pilocarpine |
|
|
Term
| Acetylcholine, Bethanechol, and Carbachol are all _______, while Pilocarpine is _______. |
|
Definition
| Quaternary ammonium compounds; a Tertiary ammonium |
|
|
Term
| Direct Cholinergic Agonists are also called _______. |
|
Definition
|
|
Term
| _______ Cannot cross membranes and is quickly destroyed by acetylcholinesterase so it has limited clinical use. |
|
Definition
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|
Term
| _______ has a Short duration of action, and is only used during Cataract surgery. |
|
Definition
|
|
Term
| Bethanechols Duration of action is _______. |
|
Definition
|
|
Term
| Bethanechol is designed to _______. |
|
Definition
| NOT be destroyed by acetylcholinesterase |
|
|
Term
| What is Bethanechol's mechanism of Action? |
|
Definition
| Contraction of bladder detrusor and relaxation of sphincter. |
|
|
Term
| Bethanechol's indication is _______ and _______. |
|
Definition
| Urinary retention after surgery; Postpartum |
|
|
Term
| The adverse Affects of Bethanechol are _______, _______, _______, _______, _______, _______, _______ and _______. |
|
Definition
| sweating; salivation; flushing, decreased blood pressure; nausea, abdominal pain; diarrhea; bronchospasm |
|
|
Term
| Physical Obstruction, Asthma, and Peptic Ulcers are all _______ of Bethanechol. |
|
Definition
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|
Term
| _______ is Considered a third-line agent when other agents are not effective. |
|
Definition
|
|
Term
| This drug is only used topically as a miotic to decrease IOP and has Dangerous cardiovascular side effects. |
|
Definition
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|
Term
| Carbachol is ______ resistant to cholinesterase than Pilocarpine. |
|
Definition
|
|
Term
| Carbachol can stimulate _______ and _______ receptors. |
|
Definition
| BOTH Muscarinic; Nicotinic |
|
|
Term
| Carbachol can _______ release of epinephrine from the Adrenal Medulla. |
|
Definition
|
|
Term
| Contraction of the ciliary muscle attached to the trabecular meshwork to enhance aqueous humor outflow is the Mechanism of action of _______. |
|
Definition
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|
Term
| The Primary adverse reaction Pilocarpine is _______. Other adverse reactions include _______ and _______. |
|
Definition
| Brow Arches;CNS Disturbances; Miosis with decreased vision |
|
|
Term
| This is the Drug of Choice for EMERGENCY lowering of both wide and narrow angle Glaucoma. |
|
Definition
|
|
Term
| Reversible Cholinesterase Inhibitors (Anticholinesterases) are called _______. |
|
Definition
| Indirect Cholinergic Agents |
|
|
Term
| Reversible Cholinesterase Inhibitors (Anticholinesterases) cause _______ and _______. |
|
Definition
| Muscarinic; Nicotinic receptor stimulation |
|
|
Term
| What is the Mechanism of Action of Edrophonium? |
|
Definition
| Prolongs duration of acetylcholine by binding with acetylcholinesterase. |
|
|
Term
| The Clinical indication of Edrophonium is _______. |
|
Definition
| Diagnosis of Myasthenia Gravis |
|
|
Term
| Edrophonium is a _______ compound. |
|
Definition
| Quaternary Ammonium Compound |
|
|
Term
| Edrophonium has a _______ and is more _______ than Neostigmine. |
|
Definition
| Shorter duration of Action; Rapidly absorbed |
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|
Term
| Physostigmine is a _______ that enters the CNS. |
|
Definition
|
|
Term
| What is the Mechanism of Action of Physostigmine? |
|
Definition
| Prolongs duration of acetylcholine by binding with acetylcholinesterase |
|
|
Term
| What are the indications of Physostigmine? |
|
Definition
| Atony (Increases intestinal and bladder motility); Treatment for anticholinergic overdose (atropine, tricyclics and phenothiazines); glaucoma |
|
|
Term
| An Adverse Reaction of Physostigmine is that it can enter the CNS and may cause _______ in high doses. |
|
Definition
|
|
Term
| What adverse reactions, in addition to causing convulsion in high doses, can Physostigmine cause? |
|
Definition
| vomiting, salivation, bradycardia and respiratory arrest from systemic use; miosis and allergic irritation from ophthalmic use |
|
|
Term
| Reversible Cholinesterase inhibitors include _______, _______, _______, and _______. |
|
Definition
| Edrophonium; Physostigmine; Neostigmine; Pyridostigmine |
|
|
Term
| What makes Physostigmine a unique Reversible cholinesterase inhibitor? |
|
Definition
| It is a tertiary amine, therefore it can enter the CNS |
|
|
Term
| Irreversible Anticholinesterases (Cholinesterase Inhibitors) include _______, _______, _______ and _______. |
|
Definition
| Toxins; poisons; Nerve Agents; insecticides |
|
|
Term
| The Antidote for Irreversible Anticholinesterases are _______ and _______. |
|
Definition
| Pralidoxime (which will reactivate cholinesterase if used before aging); Atropine (for muscarinic effects: bronchoconstriction,vomiting, bradycardia, miosis, incontinence) |
|
|
Term
| What are the actions of Echothiophate? |
|
Definition
| miosis; muscle paralysis, respiratory arrest; convulsions |
|
|
Term
| What is the Clinical indication of Echothiophate? |
|
Definition
| Irreversible anticholinesterases used to treat glaucoma. ONLY used Locally |
|
|
Term
| Donepezil (Aricept) and Tacrine (Cognex) are other agents used to treat Alzheimer's Disease, what is their Mechanism of Action? |
|
Definition
| Increase cerebral concentrations of acetylcholine by inhibiting acethlcholinesterase |
|
|
Term
| Tacrine (Cognex) was the first agent approved for treatment of Alzheimer's Disease, but can cause _______. |
|
Definition
| elevation in serum alanine aminotransferse (ALT) levels |
|
|
Term
| Cholinergic antagonists block activity at _______. |
|
Definition
| Both nicotinic and muscarinic receptors. |
|
|
Term
| Cholinergic Antagonists are also called _______ or _______ drugs. |
|
Definition
| cholinergic blockers; anticholinergic |
|
|
Term
| The subcategories of Cholinergic Antagonists are _______, _______ and _______. |
|
Definition
| Antimuscarinic; Ganglionic Blockers; Neuromuscular blockers |
|
|
Term
| Muscarinic Antagonists _______ all parasympathetic activity. |
|
Definition
|
|
Term
| Ganglionic Blockers are _______ receptor blockers. |
|
Definition
|
|
Term
| What is the Mechanism of Action of Antimuscarinic Agents? |
|
Definition
| Block muscarinic receptors on the effector organs of the parasympathetic nervous system and on the sweat glands (exception from sympathetic system) |
|
|
Term
| What is the key reason for the usefulness of Antimuscarinic Agents? |
|
Definition
| Their specificity for muscarinic receptors (because they have little effect at the skeletal neuromuscular junction or autonomic ganglia) |
|
|
Term
| What are the general pharmacological effects of Atropine sulfate? |
|
Definition
| A belladonna alkaloid competitively blocks muscarinic receptors from acetylcholine. It has the ability to cross the CNS |
|
|
Term
| Atropine is used as an antidote for _______. |
|
Definition
| Cholinergic Agonists (Organophosphate overdoses) |
|
|
Term
| The Adverse Reactions of Atropine are: _______, _______, _______, _______ (CNS) _______, _______, and _______. |
|
Definition
| (autonomic)-dry mouth, blurred vision, tachycardia, and constipation; (CNS) - restlessness, confusion, and hallucinations |
|
|
Term
| What are the Indications for Atropine Sulfate? |
|
Definition
| Eye - Diagnostic use only - Causes mydriasis (pupil dilation) and cycloplegia (inability to focus). Increases intraocular pressure in patients with glaucoma; GI - Antispasmodic agent for GI track and bladder - Reduces motility but not hydrochloric acid; Antidote for cholinergic agonists - organophosphate overdoses |
|
|
Term
| Atropine is used in _______. |
|
Definition
|
|
Term
| Atropine Improves Sinus Node and AV Node conduction by _______ vagal activity. |
|
Definition
|
|
Term
| Atropine gets rid of the _______ in the heart, therefore the sympathetic system is able to take over. |
|
Definition
| Parasympathetic effects (M2) |
|
|
Term
| Anticholinergic contraindications are _______, _______, _______, _______, _______, and _______. |
|
Definition
| Narrow angle glaucoma, Tachycardia, GI or GU Obstructive disease, Myasthenia gravis , Asthma (Atropine only) |
|
|
Term
| What are the Anticholinergic Warnings? |
|
Definition
| Heat prostration - due to decreased sweating; Diarrhea; Gastric ulcers - These will delay gastric emptying time |
|
|
Term
| Scopolamine is indicated for _______. |
|
Definition
|
|
Term
| Why might Scopolamine be used in surgery? |
|
Definition
| To block short-term memory |
|
|
Term
| Both _______ and _______ are used to reduce the flow of saliva (antisialagogue) in surgery. |
|
Definition
|
|
Term
| Scoploamine is a _______ antimuscarinic Blocker. |
|
Definition
| Prototypical antimuscarinic (anticholinergic) blocker. |
|
|
Term
| Scopolamine has _______ CNS penetration and therefore _______ CNS affects than Atropine. |
|
Definition
|
|
Term
| Donnatal will cause _______ and _______. |
|
Definition
| drowsiness; anticholinergic side effects (dry mouth, urinary retention, constipation, and increased sensitivity to light) |
|
|
Term
| Donnatals indication is _______, Although it only relieves the symptoms and does nothing to correct the underlying problem. |
|
Definition
|
|
Term
| Dicyclomine (Bentyl) is an _______. |
|
Definition
| anticholinergic GI antispasmodic |
|
|
Term
| What is the indication of Dicyclomine (Bentyl)? |
|
Definition
| Treatment of functional bowel/irritable bowel syndrome. It can also be used to increase bladder capacity in patients with detrusor hyperreflexia |
|
|
Term
| Dicyclomine (Bentyl) is containdicated in _______. |
|
Definition
| Infants less than six months old |
|
|
Term
| Oxybutynin (Ditropan) targets _______ receptors. |
|
Definition
|
|
Term
| Oxybutynin (Ditropan) exerts _______ effects on smooth muscle. |
|
Definition
|
|
Term
| What are the indications for Oxybutynin (Ditropan)? |
|
Definition
| Bladder instability and overactive bladder |
|
|
Term
| This is the newest anticholinergic indicated for overactive bladder. |
|
Definition
|
|
Term
| Ipratropium (Atrovent) is indicated for _______ and _______. |
|
Definition
| Bronchospasm associated with COPD; Rhinorrhea |
|
|
Term
| Ipratropium (Atrovent) Acts on _______ receptors. |
|
Definition
|
|
Term
| Ipratropium (Atrovent) has both _______ and _______ effects. |
|
Definition
| Brochodilation (Effects are localized predominantly in the lungs); Anti-secretory |
|
|
Term
| Compared to Beta agonists (ie. Albuterol) Ipratropium is generally considered _______ in COPD patients but _______ in asthmatic patients. |
|
Definition
| Equal or superior; Not as Effective |
|
|
Term
| _______ is an Inhaler containing both ipratropium and albuterol |
|
Definition
|
|
Term
| Several anticholinergics are used to treat _______, where they serve to lower the amount of acetylcholine in the CNS to attempt to keep it in balance with dopamine. |
|
Definition
|
|
Term
| Anticholinergics used to treat Parkinsonism include _______ and _______. |
|
Definition
| Benztropine (Cogentin); Trihexyphenidyl (Artane) |
|
|
Term
| _______ drugs Benztropine (Cogentin) and Trihexyphenidyl (Artane) are both anticholinergic drugs used to treat parkinson’s disease. |
|
Definition
|
|
Term
| Ganglionic Blockers show _______ selectivity block receptors on _______ the parasympathetic and sympathetic ganglia |
|
Definition
|
|
Term
| Nicotine in _______ doses causes ganglionic stimulation causing euphoria and arousal. It also causes relaxation, and improves attention |
|
Definition
|
|
Term
| Nicotine in _______ doses creates a ganglionic blockade causing respiratory paralysis and hypotension |
|
Definition
|
|
Term
| Neuromuscular Blocking Drugs block _______ receptors on the neuromuscular skeletal muscle junctions. |
|
Definition
|
|
Term
| Nicotinic receptor Antagonists are _______, they sit on the receptor and shut them down. |
|
Definition
|
|
Term
| Nicotinic receptor Agonists are _______, they overstimulate the nicotinic receptor and desensitize them. |
|
Definition
|
|
Term
| Neuromuscular Blocking Drugs are indicated in _______. |
|
Definition
| Surgery to produce complete muscle relaxation |
|
|
Term
| Nondepolarizing blockers, such as Turbocurarine are _______, their action can be reversed by increasing concentration of acetylcholine with cholinesterase inhibitors (neostigmine, edrophonium and pyridostigmine) |
|
Definition
|
|
Term
| In Low Doses Nondepolarizing blockers _______ with receptor and prevent ACh binding. Action can be overcome by increasing concentration of _______. |
|
Definition
|
|
Term
| In High Doses of Nondepolarizing blockers the ability of cholinesterase reversal is _______ due to the blockage of the end plates |
|
Definition
|
|
Term
| This is an extremely rapidly acting Depolarizing Agent used for rapid intubation. |
|
Definition
|
|
Term
| The Primary adverse effect of Succinylcholine is _______. |
|
Definition
|
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