Carbachol in the Treatment of Atonic Bladder Side Effects Quiz

Cholinergic Agents

• Ipratropium: a quaternary derivative of atropine, used to treat asthma and chronic obstructive pulmonary disease, with a positive charge that prevents its entry into circulation and the CNS.

Anticholinergic Agents

• D-Tropicamide and Cyclopentolate: used as eye solutions to induce mydriasis and cycloplegia, with durations of 6 and 24 hours, respectively.

Ganglionic Blockers

• A-Nicotine: a component of cigarettes, with no therapeutic benefit, and deleterious to health; available as patches, lozenges, and gums, absorbed via skin, and reduces craving for nicotine in those who want to quit smoking.

Refractive Errors

• Refractive errors: a type of vision problem that makes it hard to see clearly, occurring when the shape of the eye keeps light from focusing correctly on the retina.

Delirium and Muscle Spasms

• Delirium: a serious change in mental abilities.
• Muscle spasms: sudden, involuntary movements in one or more muscles, also known as a charley horse, muscle cramp, or twitch.

Kinetics

• Quaternary compounds: not used orally due to minimal absorption and presence of quaternary amines in their structure, making them orally ineffective; most are excreted unchanged in urine.

Urinary Incontinence and Electroconvulsive Therapy

• Urinary incontinence (enuresis): the medical term for bedwetting.
• Electroconvulsive therapy (ECT): a treatment that involves sending an electric current through the brain.

Apnea and Fever

• Apnea: when someone stops breathing while asleep or has almost no airflow.
• Fever: occurs when endogenous or exogenous pyrogens cause an elevation in the body's thermoregulatory set-point.

Atracurium and Carbachol

• Atracurium: metabolized by a combination of spontaneous degradation in plasma and ester hydrolysis, used to treat atonic bladder postpartum and postoperative non-obstructive retention.
• Carbachol: has both muscarinic and nicotinic actions, causes miosis like acetylcholine, and releases epinephrine from the adrenal medulla by its nicotinic action.

Pilocarpine and Cevimeline

• Pilocarpine: a tertiary amine, stable to hydrolyze by acetylcholinesterase, used for eye application, causing rapid miosis and not able to focus (spasm of accommodation).
• Cevimeline: another non-specific cholinergic agent like pilocarpine.

Anticholinesterase (Reversible)

• Acetylcholinesterase enzyme: cleaves acetylcholine to acetate and choline, located in pre- and post-synaptic terminals.
• Inhibition of acetylcholinesterase: prolongs the lifetime of acetylcholine and accumulates in synaptic space, introducing a response at muscarinic and nicotinic receptors.

Physostigmine and Alzheimer's

• Physostigmine: an alkaloid and a tertiary amine, a substrate for acetylcholinesterase, and forms a relatively stable enzyme-substrate intermediate that reversibly inactivates acetylcholinesterase.
• Alzheimer's: treated with acetylcholinesterase inhibitors.

Reactivation of Acetylcholinesterase

• Pralidoxime: able to reactivate the enzyme if used at a time before aging of acetylcholinesterase, not crossing into the CNS, and acts by displacing a phosphate group from organophosphate and regenerating the enzyme.

Cholinergic Antagonists

• Competitive and non-competitive inhibitors: bind to the active site and prevent substrate binding, or bind to a different site, causing changes in the enzyme.

Cataracts and Accommodative Esotropia

• Cataracts: a cloudy area in the lens of the eye, common in older adults.
• Accommodative esotropia: an inward turning of one or both eyes that occurs with activation of the accommodative reflex.