Cholinergic/ Anticholinergic

Question 1

Cholinergic Meds (in general)

Answer 1

mimic effect of PSNS neurotransmitter acetylcholine.
DO NOT stop these meds abruptly
Nicotinic + muscarinic receptors
Direct + indirect-acting (irreversible + reversible)
Indications: decr IOP, glaucoma, intraocular surgery, improve bladder tone, treat dry mouth, improve skeletal muscle contractions, treat Alzheimers

Question 2

Cholinergic Crisis Effects

Answer 2

SLUDGE= salivation, lacrimation, urinary freq or incontinence, diaphoresis/diarrhea, GI cramping, emesis
*Also cardiac effects, respiratory paralysis, and muscle weakness

Question 3

Anti-Cholinergic Meds (in general)

Answer 3

blocks action of acetylcholine
Indications: dry up, antidiarrheal, emergency treatment of bradycardia, urinary retention, dilate pupils, bronchodilation

Question 4

Cholinergic antidote is _____

Answer 4

atropine

Question 5

Miosis is

Answer 5

pupil constriction. Occurs with cholinergics

Question 6

Direct Acting Cholinergic Meds

Answer 6

Bethanechol (Urecholine), Pilocarpine
MOA: bind to cholinergic receptors, activating them
Indication Bethanechol: urinary retention
A/E for Bethanechol: h/a, seizure, GI upset, asthma attach, diarrhea, urinary urgency
Indication Pilocarpine: glaucoma, intraocular surgery, miosis induction
A/E for Pilocarpine: blurred vision, tearing, decr night vision, h/a

Question 7

Anticholinergic Meds (list them)

Answer 7

Atropine, Dicyclomine (Bentyl), Oxybutynin (Ditropan), Scopolamine patch, Ipratropium (Atrovent)

Question 8

Atropine

Answer 8

MOA: block or inhibit the actions of ACh in the PSNS, blocking muscarinic receptors. Allow SNS to dominate.
Antidote for cholinergics
A/E: drowsy, confusion, blurred vision, tachycardia, dry mouth, flushing, decr sweating
ANTIDOTE TO THIS: PHYSOSTIGMINE

Question 9

Dicyclomine (Bentyl)

Answer 9

MOA: block or inhibit the actions of ACh in the PSNS, blocking muscarinic receptors. Allow SNS to dominate.
Indications: IBS
A/E: dizzy, nausea, blurred vision, dry mouth, drowsy, nervousness, weakness, constipation

Question 10

Indirect-Acting Cholinergic Meds

Answer 10

Donepezil (Aricept), Pyridostigmine (Mestinon)
MOA: inhibits the enzyme acetylcholinesterase, which breaks down ACh, results in more ACh available at receptors
Indications for Donepezil: Alzheimer’s disease
A/E Donepezil: GI upset, drowsy, dizzy, insomnia, muscle cramps, bradycardia, BP changes (mild, go away over time)
Indications for Pyridostigmine: Myasthenia Gravis
A/E: GI upset, excessive salivation, diarrhea, bradycardia, HTN, asthma exacerbations
GIVE PYRIDOSTIGMINE ON TIME

Question 11

Oxybutynin (Ditropan)

Answer 11

MOA: block or inhibit the actions of ACh in the PSNS, blocking muscarinic receptors. Allow SNS to dominate.
Indications: overactive neurogenic bladder
A/E: dizzy, drowsy, constipation, dry mouth, nausea, h/a, blurred vision

Question 12

Scopolamine patch

Answer 12

MOA: block or inhibit the actions of ACh in the PSNS, blocking muscarinic receptors. Allow SNS to dominate.
Indications: motion sickness, post-op nausea
A/E: drowsiness, dizziness, dry mouth, and blurred vision
Contraindication: narrow-angle glaucoma

Question 13

Ipratropium (Atrovent)

Answer 13

MOA: block or inhibit the actions of ACh in the PSNS, blocking muscarinic receptors. Allow SNS to dominate.
Indication: maintenance therapy for COPD