Term
| give an example of the difference between the direct and indirect cholinergic? |
|
Definition
| a indirect cholinergic will cause AcH to be made or released while a direct cholinergic will be AcH or act like AcH. |
|
|
Term
| If you stimulate the PNS what will it do to the lungs? 2x thigns |
|
Definition
| bronchoconstriction and increase secretions |
|
|
Term
| does the PNS increase or decrease sweat glands? |
|
Definition
|
|
Term
| What does the PNS do to the pancreas |
|
Definition
| increase insulin (PNS IS EATING/POOPING/PEEING so you need insulin to help with digestion). |
|
|
Term
| What does the PNS do to the endothelium? Via what molecule? |
|
Definition
| causes smooth muscle dilation via NO release |
|
|
Term
| How many domains does a G protein have? |
|
Definition
|
|
Term
| Which M receptors use phospholipase C and that stimulation results in? |
|
Definition
| M1,3,5 stimulates phospholipase C which results in increase Ca movement. |
|
|
Term
| M2 and M4 receptors do what? |
|
Definition
| inhibit adenylcyclase, K loss, and decrease in cAMP. |
|
|
Term
| What type of enzyme is acetylcholinesterase? |
|
Definition
| a type b carboxylesterase enzyme |
|
|
Term
| Describe the anatomy of an acetylcholinesterase enzyme and how is does its job of hydrolyzing AcH |
|
Definition
| Acetylcholinesterase enzyme is made up of two subunits one is known as anionic site and the other esteric site. The anionic site binds cations such as the amine part of AcH. At the esteric site the enzyme binds to the ester part of AcH and does the work to hydrolyze it. |
|
|
Term
| what part of the acetylcholinesterase enzyme does our anticholinesterases bind to to inhibit? |
|
Definition
| they bind to the esteric spot b/c it binds to the ester part of AcH and does the hydrolyzing. |
|
|
Term
| To treat glaucoma do we want more AcH or less? |
|
Definition
| We want more! So we treat with anticholinergics |
|
|
Term
| where are true acetylcholinesterase found?? 3x |
|
Definition
1. RBCs
2. NMJ
3. Neuronal synapses |
|
|
Term
| Does pseudocholinesterase or true cholinesterase deactivate M and N Receptors? |
|
Definition
| TRUE!! Plasma (pseudo) cholinesterase does even hang out near the junction. |
|
|
Term
| What is sjogren's syndrome? How do we treat it? |
|
Definition
| an auto immune disease that attacks your exocrine glands so you can sweat or produce tears. We treat with parasympathometic drugs which act on muscarnic receptors to help produce tears and saliva. |
|
|
Term
| Which acetylcholinesterase inhibitor is reversible and acts on anionic and esteric site |
|
Definition
| edrophonium acts on the anionic and esteric site and is reversible. |
|
|
Term
| what acetylcholinesterase inhibitor is not reversible? |
|
Definition
|
|
Term
| max dose of neostigmine is |
|
Definition
|
|
Term
| cholinergic stimulation results in the following sx |
|
Definition
| 1. diarrhea, 2. urination 3. miosis 4. bradycardia 5. bronchospasms 6. emesis 7. lacrimation 8. emesis 9. salivartion/secretion/sweating |
|
|
Term
| why at large doses does an AcHe inhibitor cause a neuromuscular block?> |
|
Definition
| at high doses it causes excess AcH buildup which desensitizes the receptors on the motor end plate and can cause a block in itself or contribute to a channel block |
|
|
Term
| which AcHe Inibitor crosses the blood borne barrier? Where is its primary metabolism? |
|
Definition
| physostigmine, 90% metabolized by liver. can help with postop shivering and angalgeia similar to demerol. |
|
|
Term
Describe neostigmine.
peak, DOA, contraindications, clearance, metabolized, what anticholinergic do you give with? |
|
Definition
| does not cross BBB, peaks in 5-10 minutes, 80% cleared by kidneys, metabolized in liver, helps with post op shivering, contraindicted for pts with mechanical intestinal or urinary obstructions and peritonitis. Couples with glycopyrrolate. treats true cholinesterase |
|
|
Term
Describe Pyridostigmine
peak, DOA, contraindications, clearance, metabolized, what anticholinergic do you give with? |
|
Definition
| does not cross BBB, 75% renal clearance, depresses True cholinesterase, contraindicated with pts who have intestinal or urinary obstruction, |
|
|
Term
describe edrophonium
peak, DOA, contraindications, clearance, metabolized, what anticholinergic do you give with? |
|
Definition
| Fastest onset with 1-2 minutes, couple with atropine, 75% renal clearance, DOES NOT DEPRESS plasma cholinesterase, does not cross BBB, does not treat anticholinergic syndrome, most commond to be associated with arrythmias |
|
|
Term
| which AcHe inhibitor is most often associated with arrhythmias |
|
Definition
|
|
Term
| which AcHe Inhibitor is used to differenitiate between MG and anticholinesterase OD |
|
Definition
|
|
Term
By giving Edrophonium what will happen to the following patients:
1. MG
2. AcH crisis patient
3. Lambert Eaton Myasthenic syndrome |
|
Definition
1. MG: Will make their Sx better. Less muscle weakness
2. AcH crisis: Makes it worse by adding more AcH and causing desensitization and possible depolariztion / block.
3. Lambert Eaton: No change. |
|
|
Term
| Which AcHe inhibitor is an organophosphate |
|
Definition
|
|
Term
| Which AcHe Inhibtor causes severe plasma cholinesterase inhibition |
|
Definition
|
|
Term
| what is the dose of edrophonium |
|
Definition
|
|
Term
|
Definition
| When the inhibotor is cleared faster than the NDMB then a reblock occurs. |
|
|
Term
| What structure of AcHe inhibitors contributes to their ability to cross the BBB |
|
Definition
|
|
Term
| for renal failure patients which drug is the wrose because it is least cleared by the liver? |
|
Definition
|
|
Term
| what is the dose of glycopyrrolate? |
|
Definition
|
|
Term
| generally contraindications for AcHe Inhibitors is? 4x |
|
Definition
1. gastric obstruction
2. urinary tract obstruction
3. asthma
4. peptic ulcers. |
|
|
Term
| what muscle is responsible for enlarging the airway..it is greatly weakened by blockers. |
|
Definition
|
|
Term
list in order which muscle recovers first from a block..
adductor policis, diagphram and facial muscle |
|
Definition
| Facial muscle first, then diagphram then adductor policis. |
|
|
Term
| cholinergic crisis results from? Describe Sx, |
|
Definition
| from large amounts of AcH, results in ANS control, weakness to paralysis at muscles b/c of desensitziation from excess AcH, also CNS effects of dysphoria, confusion, ataxia, coma |
|
|
Term
| Treatment for cholinergic crisis |
|
Definition
| atropine b/c you need to give something that can cross the BBB, diazpam for seizures related to excess AcH in brain, and pralidoxime which reactivates acetylcholinesterase. |
|
|
Term
| which Muscle relaxant is not as effective with myasthenia gravis. Why |
|
Definition
| Sux, b/c there are less receptors due to T-cells killing nicotinic receptors. |
|
|
Term
| what is the drug used to diagnose Myastehnia gravis |
|
Definition
|
|
Term
| name the drug used to deferentiate myasthenia gravis from cholinergic crisis |
|
Definition
|
|
Term
| name two drugs to treat myastehnia gravis |
|
Definition
| neostigmine and pyridostimgine. neither cross BBB. Both are anti-cholinesterase. means more AcH and more parasympathetic. |
|
|
Term
| "Fixo-stigmine" is another nick name for? used for? |
|
Definition
| name for physostigmine, used to treat atropine overdose. Crosses BBB. |
|
|
Term
| echoth I ophate treats? What kind of drug is it? |
|
Definition
| glaucoma!! STRESS THE "I" = eye. Its a anticholinesterase |
|
|
Term
| Drug for alzheimers b/c I DONT remember anything..what kind of drug is it? |
|
Definition
| Don-epezil. An anticholinesterase. I "DONT" remember anhything |
|
|
Term
| Which M receptor is primary brain |
|
Definition
| M1. #1 most important organ = brain. so 1. Also M1 does enteric nervous system. |
|
|
Term
| which m receptor is heart |
|
Definition
| M2. B/c after your brain the #2 most important organ = heart = 2. |
|
|
Term
| What M receptor for bladder constriction exocrine, gut motility accommodation and bronchoconstriction? |
|
Definition
| M3. M3 is everything else in the body. M4 and M5 aren't that important. |
|
|
Term
| you treat parkinsons disease with what class of drug |
|
Definition
| anti-cholinergic. PARK YOUR "BENZ". Benztropine. |
|
|
Term
| i pray i breath... what drug does this pertain to? what type of drug? |
|
Definition
| ipratropium. I-PRA-Tropium. An anticholinergic. Safe to give to a asthmatic and COPD pt to bronchodilate without a lot of secretions. |
|
|
