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PHARM > Cholinergic Blocking > Flashcards

Cholinergic Blocking Flashcards

1
Q

Cholinergic-Blocking Drugs

A

Drugs that block or inhibit the actions of acetylcholine (ACh) in the parasympathetic nervous system (PSNS)
Also known as anticholinergics, parasympatholytics, and antimuscarinic drugs

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2
Q

Mechanism of action of cholinergic-blocking drugs

A

Competitive antagonists
Compete with ACh for binding at muscarinic receptors in the PSNS
- As a result, ACh is unable to bind to thereceptor site and cause a cholinergic effect.
When these drugs bind to receptors, they inhibit nerve transmission at these receptors.

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3
Q

Cholinergic-Blocking Drugs: Natural Plant Alkaloids

A
  • Atropine sulphate
  • scopolamine hydropbromide
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4
Q

Cholinergic-Blocking Drugs: Synthetic and semisynthetic

A

glycopyrrolate
oxybutynin (Ditropan®)
tolterodine (Detrol®)

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5
Q

Drug Effects; Cardiovascular

A
  • Small doses: decreased heart rate
  • doses: increased heart rate
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6
Q

Drug Effects; Central nervous system (CNS)

A

Small doses: decreased muscle rigidity and tremors
Large dose: drowsiness, disorientation, hallucinations

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7
Q

Drug effects; EYE

A

Dilated pupils (mydriasis)
Decreased accommodation caused by paralysis of ciliary muscles (cycloplegia)

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8
Q

Drug effects; Gastrointestinal (GI)

A

Relaxed smooth muscle tone of GI tract
Decreased intestinal and gastric secretions
Decreased motility and peristalsis

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9
Q

Drug Effects; Genitourinary (GU)

A

Relaxed detrusor muscle
Increased constriction of internal sphincter
Result: urinary retention

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10
Q

Drug Effects; Glandular

A

Decreased sweating

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11
Q

drug effects; Respiratory

A

Decreased bronchial secretions

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12
Q

Indications: Central Nervous System

A

Decreasing muscle rigidity and muscle tremors
Parkinson’s disease (becoming less trendy)
Drug-induced extrapyramidal reactions such as those associated with antipsychotic drugs

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13
Q

Indications: Cardiovascular

A

Affects the heart’s conduction system.
- Low doses: slow the heart rate
- High doses:, block inhibitory vagal effects on sinoatrial and atrioventricular node pacemaker cells
- Results in increased heart rate

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13
Q

Indications: Cardiovascular - atropine

A

Used primarily for cardiovascular disorders
Diagnosis of sinus node dysfunction
Symptomatic second-degree heart block
Severe sinus bradycardia with hemodynamic compromise (advanced life support)

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14
Q

Indications: Respiratory

A

Blocking the cholinergic stimulation of the PSNS allows unopposed action of the sympathetic nervous system.

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15
Q

Indications: Respiratory, Results

A

Decreased secretions from the nose, mouth, pharynx, and bronchi
Relaxed smooth muscles in the bronchi and bronchioles
Decreased airway resistance
Bronchodilation

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16
Q

Indications: Respiratory, Cholinergic blockers are used to treat:

A

Exercise-induced bronchospasms
Asthma
Chronic obstructive pulmonary disease

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17
Q

Indications: Gastrointestinal

A

The PSNS controls gastric secretions and smooth muscles that produce gastric motility.

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18
Q

Indications: Gastrointestinal, Blockade of PSNS results in:

A

Decreased secretions
Relaxation of smooth muscle
Decreased GI motility and peristalsis

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19
Q

Indications: Gastrointestinal, GI drugs are used to treat what?

A

Irritable bowel disease
GI hypersecretory states

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20
Q

Indications: Genitourinary

A
  • Reflex neurogenic bladder
  • Incontinence
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21
Q

Contraindications

A

Known drug allergy
Angle-closure glaucoma
Acute asthma or other respiratory distress
Myasthenia gravis
Acute cardiovascular instability
GI or GU tract obstruction (e.g., benign prostatic hyperplasia [BPH]) or illness

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22
Q

Adverse Effects, Body system/adverse effects, Cardiovascular:

A

Increased heart rate, dysrhythmias

23
Q

Body system/adverse effects, CNS:

A

CNS excitation, restlessness, irritability, disorientation, hallucinations, delirium

24
Q

Body system/ adverse effects; eyes

A

Dilated pupils (causing blurred vision), increased intraocular pressure

25
Q

body system/adverse effects, GI

A

Decreased salivation, decreased gastric secretions, decreased motility (causing constipation)

26
Q

body system/adverse effects: GU

A

urinary retention

27
Q

body systems/adverse effect, glandular

A

decreased sweating

28
Q

body systems/ adverse effects, respiratory

A

Decreased bronchial secretions

29
Q

Toxicity and Overdose

A

Symptomatic and supportive therapy
Continuous electrocardiographic monitoring
Activated charcoal
Treatment of shock
Physostigmine (this is a cholinergic drug)

30
Q

what are the interactions?

A

Amantadine, antihistamines, phenothiazines, digoxin

31
Q

whats the result when given together with the interaction drugs?

A

When the above drugs are given with other cholinergic-blocking drugs, cause additive cholinergic effects, resulting in increased effects

32
Q

Atropine uses?

A

bradycardia, ventricular asystole, antidote for anticholinesterase inhibitor toxicity or poisoning, and preoperatively to reduce salivation and GI secretions

33
Q

Atropine is a what?

A

Naturally occurring antimuscarinic

34
Q

Atropine contraindications?

A

angle-closure glaucoma, advanced hepatic and renal dysfunction, hiatal hernia associated with reflux esophagitis, intestinal atony, obstructive GI or GU conditions, and severe ulcerative colitis

35
Q

Glycopyrrolate is a what?

A

Synthetic antimuscarinic drug, Blocks receptor sites in the autonomic nervous system that control the production of secretions

36
Q

Glycopyrrolate, uses?

A

preoperatively to reduce salivation and excessive secretions in the respiratory and GI tracts

37
Q

Glycopyrrolate, Contraindications?

A

hypersensitivity, angle-closure glaucoma, myasthenia gravis, GI or GU tract obstruction, tachycardia, myocardial ischemia, hepatic disease, ulcerative colitis, and toxic megacolon

38
Q

oxybutynin (Ditropan®) is a what?

A

Synthetic antimuscarinic drug

39
Q

oxybutynin (Ditropan®), Uses:

A

overactive bladder and antispasmodic for neurogenic bladder associated with spinal cord injuries and congenital conditions such as spina bifida

40
Q

oxybutynin (Ditropan®), Contraindications:

A

drug allergy, urinary or gastric retention, and uncontrolled angle-closure glaucoma

41
Q

Scopolamine is a what?

A

Naturally occurring cholinergic blocker and one of the principal belladonna alkaloids

42
Q

Scopolamine, Uses:

A

prevention of motion sickness and to help prevent postoperative, postanaesthesia nausea and vomiting

43
Q

Scopolamine, contraindications?

A

angle-closure glaucoma, advanced hepatic and renal dysfunction, hiatal hernia associated with reflux esophagitis, intestinal atony, obstructive GI or GU conditions, and severe ulcerative colitis.

44
Q

Scopolamine adverse effects?

A

drowsiness, dry mouth, and blurred vision

45
Q

Scopolamine with CNS depressants cause what?

A

increase sedation.

46
Q

tolterodine is a what?

A

Muscarinic receptor blocker

47
Q

tolterodine, uses?

A

urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) over-activity

48
Q

tolterodine - Newer drugs

A

Newer drugs are associated with a much lower incidence of dry mouth, partly because of their pharmacological specificity for the bladder as opposed to the salivary glands

49
Q

Nursing Implications what should we assess for?

A

Assess for allergies, presence of BPH, urinary retention, glaucoma, tachycardia, myocardial infarction, heart failure, hiatal hernia, and GI or GU obstruction.

50
Q

Nursing Implications - how should medications be taken?

A

Medications should be taken exactly as prescribed to have the maximum therapeutic effect.

51
Q

what may patients experience with light?

A

Patients may experience sensitivity to light and may want to wear dark glasses or sunglasses.

52
Q

whats the antidote for atropine overdose?

A

physostigmine.

53
Q

Nursing Implications - anticholinergics taken by older adults may cause what?

A

Anticholinergics taken by older adult patients may lead to higher risk for heatstroke because of the effects on heat-regulating mechanisms

54
Q

Patients should report the following symptoms to their physician:

A

urinary hesitancy or retention, constipation, tachycardia, palpitations, tremors, confusion, sedation, hallucinations, and decreased sweating (leading to hot, dry skin).

55
Q

For patients with Parkinson’s disease, monitor for therapeutic effects such as?

A

fewer tremors and decreased salivation and drooling

56
Q

For patients with urological problems, monitor for therapeutic effects such as?

A

improved urinary patterns, less hypermotility, increased time between voiding

PHARM (20 decks)

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