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test_2_review[1] - Chapter 14 MUSCARINIC AGONISTS AND...

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Chapter 14- MUSCARINIC AGONISTS AND ANTAGONISTS Prototype Drugs: Bethanechol Pilocarpine Atropine Ipratropium 1. What are the major pharmacological effects of bethanechol? How do they relate to the therapeutic uses, adverse effects and contraindications of bethanechol? Heart: bradycardia Exocrine glands: sweating, salivation, bronchial and gastric acid secretions Smooth muscles: constriction of bronchi, increased tone and motility of GI smooth muscle, contraction of detrusor muscle and relaxation of trigone and sphincter, relaxation of vascular smooth muscle causing hypotension Eye: miosis (pupil contraction) and contraction of ciliary muscle Therapeutic uses: Urinary retention - activates muscarinic receptors which causes contraction of the detrusor leading to increased voiding pressure and relaxes the trigone and sphincter promoting urination; do not use when urinary retention is due to a physical blockage of the urinary tract GI uses – Increased GI tone and motility so can be used in postoperative abdominal distention, gastric atony, or reflux Adverse effects—Side effects rare-Hypotension and bradycardia 2. What is a therapeutic use of pilocarpine? applied to the eye for glaucoma: Causes miosis (constriction of ciliary muscles of pupil),this lowers intraocular pressure by widening the spaces within the trabecular meshwork which allows the outflow of aqueous humor; given via intraocular route (eye drops) 3. What are the pharmacological effects, therapeutic uses, and adverse effects of atropine? Pharmacologic effects – Opposite to that of muscarinic agonists increases heart rate, decreased secretions. Relaxation of bronchi, Decreased tone of detrusor muscle (decreased urination), Decreased GI tract tone &motility (decreased defecation ), no effect on blood vessels unless
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they have been given an agonist first), mydriasis and cycloplegia(paralysis of ciliary muscles) for far vision , mild excitation, high doses cause hallucinations and delirium; toxic doses can cause coma, respiratory arrest, and death Different doses are required to produce different pharmacological effects because not all of the muscarinic receptors respond to atropine in the same way Therapeutic uses Preanesthetic: cardiac effects and to decrease secretions if general anesthetic is irritating For ocular surgery and examinations: mydriasis and paralysis of ciliary muscle To accelerate heart rate ; used in ACLS (advanced cardiac life support ) –major use To relax biliary tract smooth muscle; to decrease tone and motility of intestinal smooth muscle As antidote for muscarinic poisoning For peptic ulcers but get significant side effects—theoretical use, but don’t actually use Asthma but side effect of severe drying of secretions Adverse effects—xerostomia, blurred vision and photophobia, increased intraocular pressure, urinary retention, constipation, anhidrosis (interference with sweating), tachycardia 4. What are the therapeutic uses of ipratropium?
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test_2_review[1] - Chapter 14 MUSCARINIC AGONISTS AND...

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