Chapter 12: Cholinergic Drugs Affecting The Autonomic Nervous System - Pathophysiology Of PNS

Question 1

What is the Peripheral Nervous System (PNS)

Answer 1

Transmits signals between the CNS and the rest of the body

Question 2

What are the two types of Neurons in the PNS

Answer 2

Motor Neurons: carry signals from the CNS that control the activities of muscles and glands

Sensory Neurons: carry signals to the CNS from the sensory organs

Question 3

What part of the PNS controls voluntary movements by activating skeletal muscles?

Answer 3

Somatic Nervous System

Question 4

What part of the PNS controls involuntary responses by influencing organs, glands and smooth muscle?

Answer 4

Autonomic Nervous system

Question 5

What are the two divisions of the Autonomic Nervous System?

Answer 5

Sympathetic Division and the Parasympathetic Division

Question 6

What is the Sympathetic Division of the ANS?

Answer 6

Prepares the body for stressful or energetic activity, “fight or flight”

Question 7

What is the Parasympathetic Division of the ANS?

Answer 7

Dominates during times of “rest and digestion”, directs maintenance activities

Question 8

What Type of receptors are associated with the sympathetic division of the ANS?

Answer 8

Adrenergic Receptors

Question 9

What type of receptors are associated with the Parasympathetic Division of the ANS?

Answer 9

Cholinergic Receptors

Question 10

What is the neurotransmitter for the parasympathetic nervous system?

Answer 10

Acetylcholine (ACH)

Question 11

What parts of the body does ACH act on receptors?

Answer 11

• Mouth
• Eyes
• Bladder
• GI - Digestion
• Heart
• Lungs

Question 12

What is the acronym to help you remember the effects of ACH on receptors in the different parts of the body>

Answer 12

• S: salivation and sweating (mouth)
• L: lacrimation (eyes)
• U: Urination (bladder)
• D: Diarrhea (GI)
• G: GI Distress (GI)
• E: Emesis (GI)
• D: Decreased HR (heart)

Question 13

What is a Parasypathomimetic (Cholinergic drug)

Answer 13

• A drug that activates or mimics the Parasympathetic Nervous System
• will see an increase in effects (SLUDGED)
• Binds to Cholinergic receptors to produce the rest-and-digest response
• Inhibits the action of AChE
• High potential for serious adverse effects

Question 14

What is the difference between a targeted effect and adverse effect of a parasympathomimetic?

Answer 14

Targeted effect is the expected therapeutic response from the medication and the rest would be Adverse effects

Question 15

What can we use Parasympathomimetics for?

Answer 15

Myasthenia Gravis and Alzheimer’s disease

Question 16

What is Myasthenia Gravis

Answer 16

Condition where the ACH receptors are damaged by an autoimmune mechanism which inhibits muscle contraction - for these patients parasympathomimetics act like ACH in some ways which increase the ability for the muscles to contract

Question 17

Why can we use parasympathomimetics for Alzheimer’s disease>

Answer 17

In Alzheimer’s there is either a lack of ACH or damage to the receptors, parasympathomimetics Mimic ACH which is moderately helpful for these patients

Question 18

What Other uses for parasympathomimetics other than Myasthenia Gravis and Alzheimer’s disease?

Answer 18

These uses logically flow form the effects of the drug

• Glaucoma (think pupillary constriction)
• Urinary retention (think of increased urination)
• Waking up the GI tract after surgery (stimulates digestion)

Question 19

What are some contraindications of parasympathomimetics?

Answer 19

• Parkinson’s disease (imbalance in dopamine and ACH so increasing the activity of ACH will further that imbalance)
• BPH
• Peptic Ulcer disease (because of GI stimulation - leads to more HCI which we don’t want in peptic ulcer disease)
• Bradycardia (Because of decreased HR and contractility)
• Asthma (because of bronchoconstriction)

Question 20

What do parasympatholytics do?

Answer 20

• Inhibit the action of ACH in some way
• Decreased SLUDGED

Question 21

What are the effects of parasympatholytics?

Answer 21

• opposite of SLUDGED
• Dry Mouth
• Pupillary constriction
• Dry eyes
• Urinary retention
• Constipation
• Increased HR
• Bronchodilation.

Question 22

Pneumonic for Anticholinergics

Answer 22

Can’t See
Can’t Pee
Can’t Spit
Can’t Poop

Question 23

What are parasympatholytics used for?

Answer 23

• Parkinson’s disease - restore the balance between ACH and dopamine
• Anesthesia adjunct (decrease secretion - reduce aspiration during surgery)
• Eye Exams (ability to dilate the pupils)
• overactive bladder (will cause urinary retention)
• IBS and peptic ulcers (decreased digestion)
• Bradycardia (ability to increase the HR)
• Asthma/COPD (promotes bronchodilation)

Question 24

What are contraindications for Parasympatholytics?

Answer 24

• Myasthenia Gravis (because we need ACH for this condition and parasympatholytics will decrease ACH)
• Glaucoma (pupillary dilation, can’t drain and increases the pressure)
• Urinary obstruction or BPH (already trying to reduce urination so would compound the obstruction disorders)
• GI obstructive disorders (because they slow down digestion and secretion)
• Cardiac Insufficiency (we don’t want to further decrease the hearts ability to work)

Question 25

What stimulates the parasympathetic nervous system?

Answer 25

Cholinergic agents or parasympathomimetics

Question 26

What inhibits the parasympathetic nervous system?

Answer 26

Anticholinergics, parasympatholytics

Question 27

Cholinergic Drugs (Parasympathomimetics)

Answer 27

• Binds to Cholinergic receptors to produce the rest-and-digest response
• Inhibits the action of AChE
• High potential for serious adverse effects