IPilocarpine binds to muscarinic receptors causing contraction of longitudinal fiber which leads to opening of pores (AKA____) and then increased drainage and outflow of ____ thus, lower intraocular pressure.

Select two

Local 1% pilocarpine¹ was ordered by instillation every six hours for a 64-year-old man with chronic, open-angle glaucoma².  His vision had been declining for a number of years, although he was not really aware of it.  The intraocular pressure (IOP)³ dropped from 35 mm Hg to 18 mm Hg (normal pressure limits are 10 to 22 mm Hg) following instillation.  He complained of brow ache⁴ for the first few days and some dimness of vision⁵, although visual acuity was not altered.  He also wonders why he should use the drug now as he has already lost a lot of sights.

What is the reason for his brow ache?

Local 1% pilocarpine¹ was ordered by instillation every six hours for a 64-year-old man with chronic, open-angle glaucoma².  His vision had been declining for a number of years, although he was not really aware of it.  The intraocular pressure (IOP)³ dropped from 35 mm Hg to 18 mm Hg (normal pressure limits are 10 to 22 mm Hg) following instillation.  He complained of brow ache⁴ for the first few days and some dimness of vision⁵, although visual acuity was not altered.  He also wonders why he should use the drug now as he has already lost a lot of sights.

What is the reason for his dimness of vision?

Since pilocarpine only last 6 hours which means it is degraded immediately thus, lesser chance causing systemic side effects associated with cholinergic action.

Select two adrenoceptor found in the eye:

What will happen if pilocarpine doesn't metabolized immediately? What do you think the best reason if it happens? select two

Blood vessels in the sclera are also under ____ control and influence aqueous drainage.

I. Open angle - most common; open but blocked hence, stayed in canal

II. Closed angle - blocked canal

Pilocarpine is a direct-acting cholinergic that acts on the muscarinic receptor, and has no nicotinic activity

Since the duration of action of pilocarpine is 4-8 hours, thus the previous dose is already worn off when the next dose is administered. So, most often the side effects are more systemic than topical.

If choline esters and alkaloids are classified as direct acting cholinergic drug with no nicotinic effect, therefore pilocarpine is:

All of the following are indirect acting cholinergic except:

ANTI-MUSCARINIC: select two

ANTI-NICOTINIC: select two

Nerve, Heart and smooth muscle, and glands are:

neuromuscular endplate, skeletal muscle, autonomic ganglion cells are:

Indirect-acting cholinomimetics are either reversible or irreversible.

exhibits both nicotinic and muscarinic but susceptible to cholinesterase, thus shorter duration

exhibits only muscarinic, and then less susceptible with cholinesterase.

exhibits only both nicotinic and muscarinic, and then NOT susceptible with cholinesterase.

exhibits only muscarinic, and then NOT susceptible with cholinesterase.

If you have greater toxicity with ACh chloride, you may use:

M1, except:

M2, except:

M3, except:

N1, except:

N1:

I. Carbamates - Compete with Ach for the active site of the enzyme

II. Organophosphates - Have very high affinity for the active site of the enzyme

ACh binding to M2 receptor leads to: SELECT 2

Why carbachol and pilocarpine are used in glaucoma? what muscarinic receptor mediates the action?

All of the ff are true about echothiopate, except:

A forty-eight year old man required the use of echothiophate¹ by instillation twice daily for the control of his glaucoma.  After about two weeks on the drops, he developed a definite change in bowel habits consisting of mild diarrhea.  He consulted his internist about this, who, after a presumably thorough history, ordered a complete GI series which was negative.  He then did a proctoscopy², a sigmoidoscopy³, a test for occult blood in the stools, stool cultures, and stool smears.  All were negative.

About one month later the patient went out to spray his orchard with parathion⁴.  He was found dead two hours later by his wife under a peach tree in full bloom.  The death was said to be due to the careless handling of a dangerous insecticide.

What factors may have been responsible for the patient's death?

Explain how parathion poisoning should be treated, all are correct except:

The synergism effect of cholinergic drug could be attribute to man's death.

All of the ff are muscarinic antagonist, SYNTHETIC-TERTIARY COMPOUNDS:

All of the ff are clinical uses of atropine, except:

Longest duration among antimuscarinic drug lasting about 7-10 days.

Some antipsychotics, antihistamines, antidepressants, and opioids have anticholinergic effects

Possible signs of acute intoxication due to organophosphates;

miosis, salivation and sweating, bronchial constriction, vomiting, and diarrhea

is due to?

Possible signs of acute intoxication due to organophosphates;

cognitive disturbances, convulsion and coma

is due to?

Possible signs of acute intoxication due to organophosphates;

depolarizing neuromuscular blockade --- paralysis of the diaphragm

is due to?

Additive systemic effects of both drugs could have been the cause of patient’s death possibly from absorption of the pesticide through the respiratory tract or skin and absorption of echothiophate via nasal drainage. 

Because of ___ of the drug.