Contraindications And Cautions

Muscarinic blocking agents are contraindicated in angle-closure glaucoma. Caution also should be used in

^Study Questions

1. Which of the responses to atropine listed below is most likely to be different in an elderly versus a young patient?

(A) Inhibition of sweating

(B) Tachycardia

(C) Mydriasis

(D) Drowsiness

2. You have successfully prescribed neostigmine to a young patient with myasthenia gravis, and her muscle strength has improved markedly. However, she also exhibits cardiovascular and gastrointestinal signs of excessive vagal tone, which you would like to block with atropine. Which of the following risk factors in prescribing atropine is most important to you?

(B) Ocular disturbances

(C) Paralysis of the respiratory muscles

(D) Tachycardia

3. Antimuscarinic mydriatics, such as tropicamide, are useful in ophthalmological examinations. Prior to administering tropicamide, it would be most important to know

(A) If the patient has angle-closure glaucoma

(B) If the patient has open-angle glaucoma

(C) If the patient is taking a cholinomimetic miotic drug

4. In which of the following conditions would atropine be the least likely to increase blood pressure?

(A) A healthy young medical student

(B) A patient being treated with an AChE inhibitor

(C) A patient being treated with bethanechol

5. A patient has come to you complaining of feeling drowsy and finding it hard to concentrate. The patient tells you that he is taking a medication, but he individuals with untreated open-angle glaucoma, cardiac disease, hyperthyroidism, or prostatic hypertrophy. Muscarinic antagonists can aggravate reflux esophagitis by decreasing the tone of the lower esophageal sphincter. Infants and children are especially sensitive to the hyperthermic action of muscarinic blockers. Elderly patients are especially sensitive to antimuscarinic effects in the CNS, such as impairment of memory. Pheno-thiazines and tricyclic antidepressants have antimus-carinic activity and can produce effects that are additive to those of the muscarinic blocking drugs. Anti-muscarinics should not be given to patients with gastrointestinal infections because the drug will slow gastric motility and cause the patient to retain the infectious organisms in the gastrointestinal tract.

cannot remember the name of the medication. You proceed to ask questions that might provide a clue to the source of his problems. Which of the following questions would be least likely to be helpful?

(A) Has the patient had problems with hay fever and stuffiness?

(B) Is the patient being treated for glaucoma?

(C) Has the patient had back spasms?

(D) Is the patient being treated for mood disorders?

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