Chapter 14: Cholinergic Drugs

Question 1

Cholinergic stimulation acronym “SLUDGE”

Answer 1

Salivation, Lacrimation, Urination, Defecation, GI motility, Enhanced perfusion (vasodilation).

Question 2

Pilocarpine (Akarpine)

*Hint: P-“eye”-locarpine

Answer 2

direct acting muscarinic agonist that causes miosis, and increases: aqueous humor outflow from eyes, and salivary gland secretions. Pilocarpine is used for glaucoma, jinduction of miosis and xerostomia. Side effects of Pilocarpine include stinging/burning (eyes), htn, tachy-c, bronchospasm, pulmonary edema, sweating, N&V. If the solution and the gel are both used, solution is first, then gel 5 minutes later.

Question 3

Nicotine

Answer 3

direct acting nicotinic agonist that is a potent ganglionic and CNS stimulant. Nicotine is used for an adjunct tx in smoking cessation. Side effects include increased BP, tachy-c, headache, paresthesias, nervousness, nausea, dyspepsia, xerostomia, insomnia (CV, GI, & CNS effects).

Question 4

Neostigmine (Prostigmin)

Answer 4

an indirect-acting cholinergic agonist/cholinesterase inhibitor used to treat myasthenia gravis. Neostigmine works by increasing the amount of ACh available at the myoneural junction, causing enhanced muscle contraction and strength. Side effects include N&V, diarrhea, miosis, salivation, diaphoresis, brady-c, and bronchospasm. Can also cause cholinergic crisis which needs to differentiated by a myasthenic crisis by giving edrophonium. If symptoms worsen then the p. had a cholinergic crisis and dose needs to be lowered.

Question 5

Cholinergic crisis (seen with Neostigmine therapy)

Answer 5

Severe muscle weakness and resp paralysis caused by excessive acetylcholine. This is commonly the result of an overdose with anticholinesterases.

Question 6

Myasthenic crisis

Answer 6

a life-threatening condition c/b severe depression of respiratory muscles. This needs to be differentiated from a cholinergic crisis when a p. is being given an anticholinesterase medication.

Question 7

Atropine

Answer 7

antimuscarinic/anticholinergic drug used to tx arrhythmias and used pre-op to decrease resp secretions. The drugs inhibits cholinergic receptors causing decreased secretions and GI motility, mydriasis, contraction of the bladder muscle, and increased HR. Side effects include blurred vision, xerostomia, constipation, and urinary retention. Overdose is noted by the phrase: “mad as a hatter, blind as a bat, dry as a bone, red as a beet, and hot as a pistol.”

Question 8

Atropine poisoning phrase

Answer 8

“mad as a hatter, blind as a bat, dry as a bone, red as a beet, and hot as a pistol.” (CNS psychosis, blurred vision from mydriasis, dry mouth, peripheral vasodilation, decreased sweating–high temp.