Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology Exam 2 > Cholinergic Agonists 1 > Flashcards

Cholinergic Agonists 1 Flashcards

1
Q

What nervous system is the PNS/Parasympathetic nervous system under?

A

Autonomic which is under the Peripheral Nervous system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some things that the Parasympathetic Nervous system do in the body?

A

Relaxing & Digesting
Lowers blood pressure & Heart rate - Vasodilate
Also in charge of urination and defecation by increasing peristalsis and releasing bile.
Increase Salivation so that we can digest food.
Constrict pupils
Bronchoconstriction
Increase respiratory secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some things that the Sympathetic nervous system do to the body?

A

Fight or Flight.
Pupil dilation - to see better
Glucose release - for more energy to run or fight
Bronchodilation - for more oxygenation to muscles.
Increase heartrate - increased perfusion to muscles
Increase BP - Increased perfusion to muscles
Dry Mouth
Vasoconstriction - to increase BP
Decrease Respiratory secretions
Decrease peristalsis - To eliminate the need to use the bathroom during fight or flight.
Urination block - To eliminate the need to use the bathroom during fight or flight.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does cholinergic drug relate to the activation of the Parasympathetic and Sympathetic nervous systems?

A

Acetylcholine is the primary neurotransmitter of the parasympathetic nervous system, so activating or inactivating acetylcholine will activate or inactivate the parasympathetic nervous system which in turn will also affect the sympathetic nervous system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does indirect cholinergic drugs act on?

A

The enzyme responsible for acting on acetylcholinesterase which is the enzyme breaking down Ach. This allow more Ach in the synaptic cleft.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does direct cholinergic drugs act on?

A

Act on the receptor itself.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the definition of Cholinergic Drugs?

A

They are chemicals that act at the same site as the neurotransmitter acetylcholine (ACh)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the action of Cholinergic drugs?

A
  • Often called parasympathomimetic drugs because they mimic the action of the parasympathetic nervous system.
  • Not limited to a specific site in the body and they are therefore associated with many undesirable systemic effects.
  • Work either directly or indirectly on the Acetylcholine/ACh receptors.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should we keep in mind when giving children Cholinergic agents?

A

Children have an increased risk of adverse effects.
Their dosage should be based on weight (it needs to be very precise)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should we keep in mind when giving adults Cholinergic agents?

A

Adults should be careful when driving while taking Cholinergic agents.
No adequate study on pregnancy/lactation.
Use alternative method to breastfeed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should we keep in mind when giving older adults Cholinergic agents?

A

Their body usually takes longer to process the medication and so we should start low and go slow.
More likely to have adverse reactions.
More likely to experience toxicity.
Institute safety precautions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are direct-acting cholinergic agonists?

A

Agent that act directly on the cell membrane at the Acetylcholine receptor sites of the postganglionic cholinergic nerves.

They cause increased stimulation of the cholinergic receptor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are indirect-acting cholinergic agonists?

A

Doesn’t work directly on the cell but on the neurotransmitter itself. It react with the enzyme acetylcholinesterase and prevent it from breaking down the Acetylcholine released from the nerve.

Produce effects indirectly by producing increase in level of Acetylcholine in the synaptic cleft, which leads to increased stimulation of cholinergic receptor site.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What suffix(es)/drug classes/outliers do we need to know for Direct-Acting Cholinergic Agonists (Muscarinic) Agents?

A

‘-chol”
Bethanechol
Carbachol
“-ine”
Cevemeline
Pilocarpine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does Pilocarpine do ?

A

The direct acting cholinergic agonists work at cholinergic receptors in the parasympathetic nervous system to mimic the effects of ACh and parasympathetic stimulation.

Pilocarpine is a Direct-acting Muscarinic cholinergic agonist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why would you give a patient Direct-acting Cholinergic Agonists?

A

If they suffer from Urinary retention - Bethanechol

To induce miosis (pupil constriction) - Carbachol & Pilocarpine

To treat dry mouth or induce salvation - Cevimeline & pilocarpine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What would be some reasons / Contraindications to not give Direct-acting Muscarinic cholinergic agonists to a patient?

A

*Hypersensitivity/allergy - Absolute

  • Any condition that would be exacerbated by parasympathetic effects such as bradycardia or hypotension as these drugs could further decrease HR and BP.

*Peptic ulcer disease, intestinal obstruction or recent GI surgery because these drugs will increase gastric secretion, contractions and motility. We do not want these areas active which is why these are contraindicated.

  • Asthma - May be exacerbated due to bronchoconstriction and increased mucous secretion.
  • Bladder obstruction - May be worsened due to backflow of urine and could cause bacteria to enter the kidneys.
  • Epilepsy and parkinsonism - increase in symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When should we be cautious to giving direct-acting Muscarinic cholinergic agonists to a patient?

A

If they are pregnant or breastfeeding as safety has not been established.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What would be some adverse reactions to taking Cevimeline?

A

Drug acts systemically and have many adverse reactions such as:
Nausea, vomiting, cramps, diarrhea, increase salivation, and involuntary defecation, bradycardia, heart block,hypotension
urinary urgency, flushing or increased sweating

Cevimeline is a Direct-acting Muscarinic cholinergic agonists.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what drug-drug interaction should we be mindful/cautious of when giving a patient Bethanechol?

A

Acetylcholinesterase inhibitors - double dose may lead to cholinergic crisis.

Bethanechol is a Direct-acting Muscarinic cholinergic agonist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What assessments should we make prior to giving a patient Carbachol?

A

Assess for contraindications and cautions.
Physical assessment:
Vital signs, lung sound (since asthma is contraindicated), cardiac status (due to reduced BP, HR effect), bowel sounds (due to bladder obstruction being contraindicated), bladder distention (due to bladder obstruction being contraindicated) and I&O.

Carbachol is a Direct-acting Muscarinic cholinergic agonist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What nursing diagnosis could we expect to make when giving a patient Pilocarpine?

A

Impaired comfort related to GI effects:
* Injury risk related to blurred vision and changes in visual acuity - due to pupil constricting effect of the drug and not being able to adjust to light.

  • Altered cardiac output related to CV effects.
  • Impaired urinary elimination related to GU effects.
  • Diarrhea related to GI effects
  • Knowledge deficit regarding drug therapy.

Pilocarpine is a Direct-acting Muscarinic cholinergic agonist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What nursing implementations would we expect to make when giving a patient Bethanechol?

A
  • Give medications on an empty stomach to avoid nausea and vomiting.
  • Fall risk precautions if they are having vision problems.
  • Monitoring I&O to ensure proper hydration.
  • Provide thorough patient teaching - Patient should know what side effects to expect and how to address these.
    *Ensure proper administration of ophthalmic preparations
  • Monitor patient response closely

Bethanechol is a Direct-acting Muscarinic cholinergic agonist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What suffix(es)/drug classes/outliers do we need to know for Direct-acting Cholinergic Agonists Nicotinic agents?

A
  • Bupropion
  • Nicotine
  • Varenicline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does nicotinic agents work in the body?

A
  • Bupropion: Act by weakly inhibiting neuronal reuptake of norepinephrine and dopamine - limits cravings
  • Nicotine: replacement therapy
  • Varenicline: acts as nicotine receptor partial agonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why would we give nicotinic agents to a patient?

A

For Smoking cessation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are some conditions/ contraindications that would prevent us from wanting to give nicotinic agents to a patient?

A

*Hypersensitivity/allergy
* Seizure disorder (bupropion) - may reduce the seizure threshold.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are some conditions where we should be cautious of giving nicotinic agents to a patient?

A

Pregnancy/lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some adverse effects of Bupropion?

A

*Tachycardia, hypertension
* Seizures, neuropsychiatric adverse effects, dizziness, strange dreams (Bupropion)
* Nausea, dry mouth
* Skin rash - allergic reaction to ACh

Bupropion is a nicotinic agent

30
Q

What are some drug-drug interactions to be mindful of when it comes to Nicotinic agents?

A

Numerous - workplace should provide.

31
Q

What assessments should be done on a patient prior to giving them Varenicline?

A

*Assess for contraindications and cautions
* Assess amount of tobacco use - To assess effectiveness of treatment.
Perform a physical assessment :
*Assess VS, heart & lung sounds, ECG

  • Assess mood, sleep, suicidal thoughts and behaviors - due to the effects of dopamine availability in the brain (bupropion)

Varenicline is a nicotinic agent

32
Q

What nursing diagnosis would you expect to make prior to administering nicotine to a patient?

A
  • Impaired comfort related to GI effects
  • Altered cardiac output related to cardiovascular effects
  • Injury risk related to seizures or neuropsychiatric side effects
  • Knowledge deficit regarding drug therapy

Nicotine is a nicotinic agent

33
Q

What nursing implementations would you anticipate to make prior to administering Bupropion to a patient?

A
  • Ensure proper administration of nicotine replacement preparations - taking off old ones and using enough nicotine patches.
  • Check for medication interactions
  • May be taken with or without food - food may increase effectiveness, but may be taken on empty stomach as well.
  • Monitor patient response closely
  • Arrange to adjust dose accordingly
  • Provide safety precautions if the patient reports neuropsychiatric events, suicidal ideation or seizure activity
  • Provide thorough patient teaching

Bupropion is a Nicotinic agent.

34
Q

What is Myasthenia Gravis?

A
  • Autoimmune disease where antibodies destroy ACh receptors over time and prohibits their ability to work. This leads to decreased muscle tone and control - may cause trouble breathing or to hold head up.
35
Q

What suffix(es), drugnames and potential outliers are used to treat Myasthenia Gravis?

A

“-stigmine”

*Neostigmine
*Pyridostigmine

Edrophonium (diagnosis)

36
Q

What are the symptoms of Myasthenia Gravis?

A

Progressive weakness and lack of
muscle control with periodic acute
episodes.

37
Q

Which Indirect-Acting Cholinergic Agonists are used to Treat Myasthenia Gravis? What are their suffixes, names and potential outliers?

A

These are indirect acting because we need receptors to work on and the disease is preventing this. Indirect medications allows more acetylcholine to active the remaining receptors more frequently.

Neostigmine: Has a strong influence at the neuromuscular junction

Pyridostigmine: Has a longer duration of action than neostigmine

Edrophonium: Diagnostic agent for myasthenia gravis - short acting and would be used to evaluate if muscle strength improved. If it improved then it would indicate Myasthenia Gravis. It is not used as a diagnostics anymore as there were too many false positives.

38
Q

What is Alzheimer’s Disease?

A

A slow progressive and incurable disorder involving neural degeneration in the cortex. There is a lack of Acetylcholine being produced.

39
Q

What does Alzheimer’s Disease do to a person?

A

Leads to a marked loss of memory and the ability to carry on activities of daily living

40
Q

What is the cause of Alzheimer’s Disease?

A

Cause of the disease is not yet known - plague plays a contributing factor.
There is a progressive loss of ACh-producing neurons and their target neurons.

41
Q

How are indirect-acting cholinergic agonists used to treat Alzheimer’s Disease?

A

They are used to slow down the progression of the disease.

42
Q

What does the Indirect-acting cholinergic agonists given for Alzheimer’s disease & Myasthenia gravis do?

A

Blocks AChE from breaking down ACh
released from the nerve endings which leads to increased and prolonged stimulation of ACh in the synapse.

43
Q

What are the 3 drug classes we need to know that are used to treat Alzheimer’s disease?

A

“-mine”
Galantamine & Rivastigmine - comes in solution to make swallowing medication easier.
and
Donepezil - Has once-a-day dosing; available in rapidly dissolving tablet

44
Q

Apart from Myasthenia Gravis and Alzheimer’s disease, what is another condition where we use Indirect-Acting Cholinergic Agonists? And why?

A

Nerve Gas (?)

An indirect cholinergic agonist and is irreversible. It permanently binds to acetylcholinesterase allowing excessive acetylcholine. People who may have been exposed are preemptively given atropine and pralidoxime to block cholinergic activity and produce more acetylcholinesterase.

45
Q

Which 2 indirect cholinergic agonists would we use preemptively to treat Nerve Gas exposure?

A

Atropine and Pralidoxime

46
Q

What client condition/s would indicate that you shouldn’t give the patient Indirect-acting cholinergic agents?

A
  • Allergy
  • Bradycardia
  • Intestinal or urinary tract obstruction
47
Q

What patient condition would indicate increased caution when giving them Indirect-acting cholinergic agonists?

A
  • Any condition that could be exacerbated by cholinergic stimulation
  • Asthma, coronary disease, peptic ulcer, arrhythmias, epilepsy, or parkinsonism
  • Hepatic or renal dysfunction because drugs are metabolized in the liver and excreted in the urine.
  • Pregnancy and lactation
48
Q

What are some adverse reactions that we should be prepared for when giving patient Indirect-acting Cholinergic agonists?

A
  • Bradycardia, hypotension
  • Increased GI secretions and activity
  • Increased bladder tone
  • Relaxation of GI and genitourinary sphincters
  • Bronchoconstriction
  • Pupil constriction
49
Q

What drug -drug interactions should we be knowledgeable about when giving patients Indirect-acting cholinergic agonists?

A

NSAIDs because the cholinergic agonists may cause increased GI secretions & NSAIDs cause GI mucosae erosion so this combinations may increase the risk of peptic ulcers.

Cholinergic drugs

50
Q

What patient assessments should we do prior to administering indirect-acting cholinergic agonists to a patient?

A
  • Assess for contraindications and cautions
    Perform a physical exam:
    assess orientation, affect, reflexes, ability to carry on activities of daily living
  • Assess vital signs, ECG as appropriate, urinary output and renal/ liver function tests (BUN and Creatinin)
51
Q

What nursing diagnosis would we anticipate to make prior to administering indirect-acting cholinergic agonists to a patient?

A
  • Altered thought processes related to CNS effects
  • Impaired comfort related to GI effects
  • Decreased cardiac output related to blood pressure changes, arrhythmias, and vasodilation
  • Knowledge deficit regarding drug therapy
  • Injury risk related to CNS effects
  • Diarrhea related to GI stimulatory effects
52
Q

What nursing implementations would we anticipate to make when administering indirect-acting cholinergic agonists to a patient?

A
  • If given intravenously, administer it slowly
  • Maintain atropine sulfate on standby in case of a cholinergic crisis.
  • Discontinued the drug if excessive salivation, diarrhea, emesis, or frequent urination occurs.
    *Administer the oral drug with meals
    *Mark the patient’s chart and notify the surgeon if the patient is to undergo surgery.
  • Monitor the patient being treated for Alzheimer disease for any progress.
    *Arrange for supportive care and comfort measures
    *Provide thorough patient teaching
53
Q

Why are cholinergic drugs also called parasympathomimetic drugs?

A

Because they action mimics the action of the parasympathetic nervous system.

54
Q

How come cholinergic are associated with many adverse reactions?

A

Due to acting systemically and not locally event though we might be seeking a local action.

55
Q

Do Cholinergic agents work directly or indirectly on ACh receptors?

A

They do both!

56
Q

Where does cholinergic agents act on the body?

A

They act at the same site as the neurotransmitter acetylcholine (ACh)

57
Q

What is Muscarinic?

A

It is a type of cholinergic receptor. therefore Direct-acting Cholinergic agonists act directly on these specific receptors. they are found in the central and peripheral nervous system.

58
Q

Where are most of the Nicotinic receptors found?

A

In the central nervous system.

59
Q

Which receptors respond faster. The Muscarinic or Nicotinic receptors?

A

The Nicotinic.

60
Q

What is Acetylcholinesterase?

A

The enzyme that breaks down acetylcholine. Its main role is to stop neuronal transmission and signaling by breaking down acetylcholine.

61
Q

What causes protein deposits in the brain?

A

Alzheimer’s Disease. Alzheimer’s diseases slowly causes shrinking of the brain and death of brain cells.

62
Q

What is an Cholinergic Agonist?

A

A drug that mimic the effect of the neurotransmitter acetylcholine.

63
Q

What is Miosis?

A

Very constricted pupils.

64
Q

What is Myasthenia gravis?

A

An chronic autoimmune disease that causes muscle weakness and affect the neuromuscular junction.

65
Q

What is an Parasympathomimetic?

A

A drug that activates the parasympathetic nervous system.

66
Q

Where are muscarinic receptors found?

A

In the peripheral and central nervous system.

67
Q

What would we give Bupropion for?

A

Smoking cessation.

68
Q

Which drug was used in the diagnostic of Myasthenia Gravis?

A

Edrophonium.

69
Q

Why is it important that we make the medications taken for Alzheimer’s easy to swallow?

A

Because the patients have increasingly worsening muscle control including the muscles used to swallow so we want to decrease the risk of aspirating.

70
Q

Which drug should be given if there is a cholinergic crisis?

A

Atropine

71
Q

What is the reason some patient develop skin rash when they are taking direct acting cholinergic agonists (Nicotinic)?

A

Due to cholinergic urticaria (rare form of hives that is triggered by an elevation in body temperature, breaking a sweat, or exposure to heat) which is a side effect of these drugs.

Pharmacology Exam 2 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions