Cholinergic

Question 1

Direct acting cholinergic agonists initiate a ______ kind of response.

Answer 1

tissue
for example: used to treat urinary retention, glaucoma, gastroparesis.

Question 2

indirect acting is a _______esterase inhibitor
and acts on an ______ level.

Answer 2

cholinesterase, enzyme.

Question 3

cholinesterase inhibitors cause more ____ to be available at the receptors.

Answer 3

Ach

Question 4

cholinergic drugs will stimulate intestine and bladder in:
_____ gastric secretions
_____ gastric motility
_____ urinary frequency

Answer 4

increasing, increasing, increasing.

Question 5

cardiovascular effects of cholinergic drugs are seen in:
_______ HR
vaso______

Answer 5

increased, vasodilation (this is a PNS response)

Question 6

pupils will be stimulated to do what in cholinergic drugs?
_____ intraocular pressure

Answer 6

constrict (miosis)
decreased

Question 7

_________salivation and sweating.

Answer 7

increased

Question 8

bronchial ________ and what kind of effect on the airways?

Answer 8

constriction, narrowed airways.

Question 9

pilocarpine is indicated for which condition? For which surgery (hint: both involve the same structure)?
_____mouth or (_____) is treated with pilocarpine.
- this state of mouth is caused by S____’s syndrome

Answer 9

glaucoma, intraocular (decreases pressure) surgery, dry mouth or xerostomia. Sjogren’s syndrome.

Question 10

cholinergic drugs can be used for which three indications that are not related to our drug in question?

Answer 10

as a neuromuscular blocker in general anesthesia, increasing muscle strength in myasthenia gravis, and also in Alzheimer’s/

Question 11

Cholinergics are contraindicated in which conditions?
a. GI obstructions
b. GU obstructions
c. bradycardia
d. tachycardia
e. hyperthyroidism
f. hypothyroidism
g. strokes
h. seizures
i. hypotension
j. orthostatic hypotension
k. COPD
l. asthma
m. Tuberculosis
n. Parkinson’s

Answer 11

a, b, c, e, h, I, k, n

Question 12

Adverse effects of cholinergics stem from:

Answer 12

overstimulation of the PNS

Question 13

cardiac adverse effects (of cholinergics)

Answer 13

bradycardia
hypotension
syncope
conduction abnormalities (AV block or cardiac arrest)

Question 14

CNS adverse effects (of cholinergics)

Answer 14

convulsions, ataxia, HA, dizziness.

Question 15

GI adverse effects (of cholinergics)

Answer 15

abdominal cramping, increased secretions, n/v.
- mainly because of the increased GI secretions and peristalsis in PNS stimulation.

Question 16

respiratory adverse effects (of cholinergics)

Answer 16

bronchial spasms, increased bronchial secretions.

Question 17

other symptoms (for cholinergics)

Answer 17

meiosis, sweating, lacrimation

Question 18

early signs of a cholinergic crisis

Answer 18

abdominal cramps, salivation, flushing of the skin, n/v, transient syncope, transient complete heart block.

Question 19

Early signs of a cholinergic crisis

Answer 19

transient syncope/complete heart block, orthostatic hypotension, salivation, dyspnea, abdominal cramps.

Question 20

Late symptoms of a cholinergic crisis

Answer 20

bloody diarrhea, circulatory collapse, hypotension, shock, cardiac arrest.

Question 21

What is the unusual symptom of late cholinergic crisis?

Answer 21

bloody diarrhea

Question 22

What are the three transient symptoms for early crisis?

Answer 22

transient syncope, complete heart block, (orthostatic) hypotension.

Question 23

for an early crisis, give what?

Answer 23

atropine

Question 24

for a later crisis, give what?

Answer 24

epinephrine, an adrenergic agonist.

Question 25

Gingko is indicated to prevent what?

Answer 25

memory loss, vertigo, tinnitus.
“huh? whoah…the world is spinning! what is that sound?”

Question 26

gingko may cause what?

Answer 26

GI upset, bleeding, HA

Question 27

Gingko has interactions with which drugs?

Answer 27

NSAIDs, ASA, anticonvulsants, anticoagulants.
(No AAA batteries)

Question 28

Cholinergic blocking drugs compete with Ach at the _____ receptors.

Answer 28

muscarinic

Question 29

• where the GI secretions and motility were increased in cholinergic, they are _____ now.
• where miosis and decreased intraocular pressure happens; there is now ______
• in terms of external secretions:
• Heart rate was once decreased but it is now ______
• respiratory was once constriction and increased secretions, there is now______ and _____ mucous membranes/secretions.

Answer 29

decreased GI secretions and motility.
dilated pupils and increased intraocular pressure.
reduced sweating
increased HR
bronchodilation and dry mucous membranes.

Question 30

atropine is available in which forms?

Answer 30

IV, PO, eye drops

Question 31

atropine is the antidote for what?

Answer 31

a cholinergic crisis.

Question 32

atropine solves heart problems with that cholinergic crisis by:

Answer 32

increasing the heart rate.

Question 33

atropine is used _____operatively to reduce which kind of secretions?

Answer 33

pre-op, GI and saliva secretions.

Question 34

which condition is contraindicated in atropine?

Answer 34

closed angle glaucoma.

Question 35

caution for pts with which conditions, when taking atropine?

Answer 35

renal and hepatic dysfunction.