NBME 22 Anticholinergic (NBME Answers)

Retired NBME 22 Answers

nbme22/Block 2/Question#36 (reveal difficulty score)
Which of the following drug effects is the ...
Anticholinergic 🔍 / 📺 / 🌳 / 📖
tags: psych antidepressant

+52 upvote downvote
submitted by ∗seagull(1933)

get full access to all content ⋅ pick a username

Which of the following reasons is why this question is bull?

1) Using the word "cyclic" instead of tricyclic for clarity

2) Knowing all of epidemiology of all drugs

3) having to reason out that anticholinergic effects are probably the worst over alpha1 or H1 effects to no certainty.

4) The crippling depression of studying for days-to-weeks on end to probably do average on the test.

get full access to all content ⋅ pick a username

nlkrueger yo, re-fucking-tweet +26

aesalmon I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4

fcambridge I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1

link981 Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +6

waterloo Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +

victor_abdullatif This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +

tekkenman101 "worst to experience" is incredibly subjective lmao. +1

+4 upvote downvote
submitted by ∗niboonsh(409)

get full access to all content ⋅ pick a username

tri-CyCliC antidepressent - anti C holinergic, C ant stand up (a1 block), C ardiotoxic (prolong qt by messing w na channels)

get full access to all content ⋅ pick a username

waterloo that's cool and all but there are so many side affects when it comes to TCAs. H1 antagonism, reduced libido, convulsions. +1

+4 upvote downvote
submitted by ∗kard(52)

get full access to all content ⋅ pick a username

Tricyclic and tetracyclic antidepressants, also called cyclic antidepressants. The peripheral anticholinergic complaints of dry mouth, constipation, ocular side effects and urinary hesitancy are described and specific clinical guidelines for their effective management are provided.

So, most common reason for noncompliance with cyclic antidepressant therapy is its anticholinergic effect.

https://www.ncbi.nlm.nih.gov/pubmed/3290996 https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

Note: Please if im mistaken, or my approach is mistaken, correct me... Thank you

get full access to all content ⋅ pick a username

+2 upvote downvote
submitted by ∗jessikasanz(9)

get full access to all content ⋅ pick a username

SSRI's make ya peepee not work, man no like when peepee not work. man stop taking SSRI. Point and Shoot: Erection= parasympathetic, so Ach is used for erections. Anticholingeric leads to lack of Ach which leads to no erection.

get full access to all content ⋅ pick a username

+1 upvote downvote
submitted by ∗lowyield(43)

get full access to all content ⋅ pick a username

my best guess for why anti-cholinergic is worse than adrenergic or histaminic was just b/c they stick atropine with diphenoxylate to prevent abuse (tbh tho idk if this logic stands at all but eh)

get full access to all content ⋅ pick a username

+1 upvote downvote
submitted by ∗umpalumpa(6)

get full access to all content ⋅ pick a username

Let's tackle down this question step-by-step: -C can be crossed-out (because TCA causes anti-M, not cholinomimetic side effects); -E can be crossed-out because TCA does not cause sympathomimetic ADR; -C can be crossed-out because anti-H effect is sedation (which is caused also by anticholinergic effect) + increased appetite/weight gain (which is something that, in my opinion, can still be under control by the pt-eg by correcting lifestyle); -the last 2 options are antiadrenergic and anticholinergic: both cause side effects that are difficult to keep under control; moreover, speaking in simple terms, anticholinergic cause a much higher number of ADR than antiadrenergic (alpha1 antagonism= ONLY orthostatic hypotension). Therefore, anticholinergic is the answer.

get full access to all content ⋅ pick a username

+1 upvote downvote
submitted by flexatronn(5)

get full access to all content ⋅ pick a username

idk about yall but sketchy pharm: that table with the rabbit and stuff is HY. Pay attention to those

get full access to all content ⋅ pick a username

Must-See Comments from nbme22

sacredazn on Unrearranged immunoglobulin gene
seagull on Decreased binding of RNA polymerase
seagull on Anticholinergic
mcl on Area labeled ‘D’
liverdietrying on Release of stored thyroid hormone from a ...
kernicterusthefrog on Displacement
keycompany on Negative nitrogen balance
joha961 on Displacement
imgdoc on Area labeled ‘C’ (Abducens nucleus, right)
alwaysanonymous on 25 mL/cm H2O
drdoom on 1 in 600
seagull on Glutamine
yotsubato on Phase variation
bubbles on Acute retroviral infection