110 Questions
What is the primary action of bethanechol on the heart?
Slowing it down
Why is bethanechol described as a quaternary ammonium compound?
Because it has a positive charge
In which system does bethanechol increase tone and motility?
Gastrointestinal system
What is the primary effect of bethanechol on the smooth muscle in the lung?
Constriction of bronchi
What is the onset of action for bethanechol when administered orally?
30-60 minutes
What is the duration of action for bethanechol?
~1 hour
Why are cholinergic drugs not recommended in the elderly population?
They can worsen existing health conditions in the elderly
What is the role of cholinesterase inhibitors in preventing acetylcholine breakdown?
They prevent acetylcholine breakdown
What is the primary effect of muscarinic antagonists?
Blocking acetylcholine effects
Why should cholinergic drugs be used with caution in pregnant females?
They can affect fetal development
Why should cholinergic drugs not be used in lactating females?
They decrease milk production due to anticholinergic side effects
Which of the following is a therapeutic use of bethanechol?
Treatment of urinary retention
What are the adverse effects of bethanechol?
Hypotension, abdominal cramps, and diarrhea
What are the symptoms of muscarinic poisoning?
Profuse salivation, visual disturbances, and bradycardia
What is the main therapeutic use of pilocarpine?
Treatment of glaucoma
What are the alternative names for muscarinic antagonists?
Parasympatholytic drugs and anticholinergic drugs
What is the mnemonic used to remember the side effects of muscarinic poisoning?
SLUDGE
Why do certain drugs like anti-histamines need to be used with caution in patients receiving muscarinic antagonists?
They may exacerbate the adverse effects of muscarinic antagonists
What is the primary effect of cevimeline?
Treatment of dry mouth in Sjogren's syndrome
Acetylcholine is used for rapid miosis after delivery in which procedure?
Cataract surgery
What is the effect of direct-acting muscarinic agonists on cholinesterase inhibitors?
They potentiate the effects of cholinesterase inhibitors
Why is pilocarpine an exception among muscarinic agonists?
It can cross cell membranes easily.
What effect does atropine have on muscarinic receptors?
It desensitizes them.
Why should bethanechol be used with caution in lactating females?
It decreases milk production due to anticholinergic side effects
What is the primary effect of atropine on muscarinic receptors?
Inhibition
How does bethanechol affect the heart?
It slows it down
What is the primary therapeutic use of muscarinic antagonists?
Dilating the bronchi in the lung
What is the duration of action for bethanechol when administered orally?
30-60 minutes
Why are cholinergic drugs not recommended for the elderly population?
They affect receptors causing unwanted side effects
What is the main effect of bethanechol on smooth muscle in the lung?
Constriction of bronchi
What is the primary therapeutic use of bethanechol?
Treating urinary retention
What is the adverse effect of bethanechol that can result in exacerbation of asthma?
Increased motility of GI tract
Which structure is mentioned as an exception among muscarinic agonists due to its ability to cross membranes easily?
Pilocarpine
What is the mnemonic used to remember the side effects of muscarinic poisoning?
SLUDGE
What are the symptoms of muscarinic poisoning?
Visual disturbances, bronchospasm, and hypotension
What is the role of cholinesterase inhibitors in muscarinic poisoning?
Exacerbating muscarinic symptoms
Why should certain drugs like anti-histamines be used with caution in patients receiving muscarinic antagonists?
They may have prominent anti-muscarinic actions
What is the primary effect of cevimeline?
Treating dry mouth in Sjogren's syndrome
What are the pharmacologic effects of muscarinic receptor blockade caused by atropine?
Increases heart rate, decreases secretions in exocrine glands, relaxes smooth muscle in the bronchi, and decreases the tone of the urinary bladder detrusor
Which adverse effect is NOT associated with atropine use?
Sedation
In which conditions can atropine be used therapeutically?
Asthma and peptic ulcer disease
What is the primary use of AtroPen?
Cholinesterase inhibitor poisoning
What is the alternative term for overactive bladder?
Detrusor instability
Which symptom is NOT associated with overactive bladder?
Dysuria
What is the primary effect of atropine on the eyes?
Mydriasis
What is the route of administration for Atropine drops used in ophthalmology?
Topical
What effect does atropine have on the tone and motility of the GI tract?
Decreases tone and motility
What is an example of a therapeutic use of atropine?
Biliary colic
What adverse effect can result from atropine use?
Elevation of interocular pressure
Which formulation of oxybutynin provides the longest duration of action?
Transdermal patch
What is the main reason for the high incidence of dry mouth associated with oxybutynin use?
Blockade by oxybutynin itself
What is the unique feature of darifenacin that makes it well-tolerated?
M3 selectivity
Which drug interaction can alter oxybutynin blood levels?
Inhibition of CYP3A4
What is a prominent side effect of darifenacin and oxybutynin in the pediatric and geriatric populations?
Hallucinations and agitation
Which side effect is NOT associated with oxybutynin use?
Constipation
What is the most common side effect associated with darifenacin use?
Dry mouth
Which condition can be exacerbated by the side effects of oxybutynin and darifenacin?
Asthma
What can intensify the anticholinergic side effects when used in combination with oxybutynin?
SSRIs
What is the primary effect of darifenacin on muscarinic receptors?
M3 selectivity
Which muscarinic antagonist is a CYP2D6 and CYP3A4 substrate?
Fesoterodine
What is the mechanism of action of Mirabegron?
Activates adenylyl cyclase and forms cyclic adenosine monophosphate
Which muscarinic antagonist is a moderate inhibitor of CYP2D6 and a minor inhibitor of CYP3A4?
Solifenacin
Which muscarinic antagonist can cause QT prolongation and an increase in blood pressure?
Mirabegron
What is the main adverse effect associated with Trospium?
Constipation
What distinguishes Mirabegron from other drug classes in terms of producing a therapeutic effect?
It activates beta-3-adrenoreceptors by norepinephrine.
Which drugs have been evaluated as non-traditional therapies for overactive bladder?
Venlafaxine and duloxetine
What is the primary role of scopolamine?
Production of cycloplegia
Ipratropium bromide is used to treat which conditions?
Asthma, COPD, and rhinitis caused by allergies or the common cold.
What are the therapeutic uses of mydriatic-cycloplegics?
To produce mydriasis and cycloplegia for ophthalmic procedures.
What is the specific antidote to poisoning by the irreversible cholinesterase inhibitors?
Pralidoxime
What autoimmune process characterizes myasthenia gravis?
Antibodies attack the nicotinic m receptors on the skeletal muscle
Which drug does not cross the blood-brain barrier and will not reduce CNS effects?
Atropine
What is the primary effect of neostigmine during myasthenic crisis?
Cholinesterase inhibition
What is the distinguishing factor between a cholinergic crisis and a myasthenic crisis when challenged with edrophonium?
Increased muscle strength
What is the initial treatment for a cholinergic crisis?
Atropine
What is the role of benzodiazepine in a cholinergic crisis?
Suppresses convulsions
What can atropine be used for if muscarinic responses become excessive due to cholinesterase inhibitors?
Suppress them
What differentiates neostigmine and atropine in terms of their specific effects?
Atropine reduces muscarinic stimulation, while neostigmine reverses inhibition of cholinesterase.
What is the effect of pralidoxime in cholinergic crisis?
Dissociating inhibitors from the active center of cholinesterase
What is the specific antidote to poisoning by irreversible cholinesterase inhibitors?
Physostigmine
Which drug does not readily cross membranes, has minimal effects on the brain and fetus, and is a poor substrate for cholinesterase?
Pyridostigmine
What is the primary clinical application of irreversible cholinesterase inhibitors?
Glaucoma
Which drug is viewed as an indirect acting cholinergic agonist, lacks muscarinic ganglionic and neuromuscular selectivity, and has limited therapeutic applications?
Pyridostigmine
What are the symptoms of muscarinic poisoning?
Dry mouth, blurred vision, photophobia, and hot, dry flush skin
What is the role of atropine in the treatment of muscarine antagonist poisoning?
Blocks muscarinic receptors
What is the main adverse effect associated with trospium?
QT prolongation
Which structure among muscarinic antagonists can cause QT prolongation and an increase in blood pressure?
Scopolamine
What effect does atropine have on the eyes?
Causes dilation of the pupils
What is the primary effect of atropine on the ciliary muscle in the eyes?
Relaxes the ciliary muscle
Which of the following best describes the effect of atropine on the accommodation reflex in the eyes?
Inhibits the accommodation reflex
Which side effect is NOT commonly associated with oxybutynin use?
Hypertension
What can intensify the anticholinergic effects of oxybutynin when used in combination?
Antihistamines
Which population is more likely to experience hallucinations and agitation as side effects of oxybutynin?
Elderly
What is the primary difference in the metabolism of noncatecholamines compared to catecholamines?
Noncatecholamines are not substrates for COMT and metabolize slowly by MAO.
What is the therapeutic effect of activating alpha-1 receptors?
Vasoconstriction in blood vessels of the skin, viscera, and mucous membranes
What is the primary use of B2 receptor agonists?
Treatment of asthma
Which receptor activation is associated with the risk of angina in patients with compromised coronary circulation?
Beta-1 receptors
What effect does activation of B2 receptors have on the uterus?
Relaxation of uterine smooth muscle
Which receptor subtype does epinephrine act on?
A1, A2, B1, B2
What is a potential adverse effect of B1 receptor activation?
Tachycardia
Isoproterenol is less selective than albuterol because it acts at which receptors?
B1 and B2
What is the effect of activating alpha-2 receptors in the central nervous system?
Inhibition of NE release
What is a potential adverse effect of oxybutynin due to its action on muscarinic receptors?
Hyperglycemia
Activation of Dopamine receptors can improve perfusion to which organ?
Kidneys
Which group of adrenergic agonists cannot be used orally, has a brief duration of action, and cannot cross the blood-brain barrier?
Catecholamines
What is the primary mechanism by which indirect adrenergic agonists work?
Promotion of norepinephrine release
Which enzyme is responsible for the quick metabolism of catecholamines?
Monoamine oxidase [MAO]
Which adrenergic agonist is known for its inability to be used orally, short duration of action, and inability to cross the blood-brain barrier?
Norepinephrine
Which major class of adrenergic agonists includes dopamine, epinephrine, isoproterenol, and ephedrine?
Catecholamines
What distinguishes catecholamines from noncatecholamines in terms of their availability for oral use and duration of action?
Availability for oral use and duration of action
Test your knowledge of cholinergic drugs, which influence the activity of cholinergic receptors and mimic or block the actions of acetylcholine. Understand their effects, precautions, and considerations, including their impact on pregnant and lactating females.
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