cholinergic drugs

Question 1

cholinergic drugs

Answer 1

-drugs that stim the parasympathetic nervous system
-aka parasympathomimetics
- mimic acetylcholine

Question 2

2 types of cholinergic receptors

Answer 2

• nicotinic receptors
• muscarinic receptors

Question 3

nicotinic receptors

Answer 3

in the ganglia of both systems
can be stimulated by nicotine

Question 4

muscarinic receptors

Answer 4

• postsynaptically in effector organs of parasympathetic system (smooth, cardiac muscle, glands)

Question 5

cholinergic drug MOA

Answer 5

direct acting (bind to receptors activating them)
indirect-acting (cholinesterase inhibitors which is the enzyme that breaks down ACh)

Question 6

indirect acting reversible

Answer 6

binds to cholinesterase for short period of time

Question 7

indirect acting irreversible

Answer 7

• binds for long period of time
• forms a covalent bond
• body must make new cholinesterase to break these bonds

Question 8

drug effects

Answer 8

• rest and digest
• stim intestines and bladder (Increased gastric secretions, GI motility, urinary freq)
• stim pupils (constriction and reduce intraocular pressure)
• increased salivation and sweating

Question 9

cardiovascular drug effects

Answer 9

decreased HR and vasodilation

Question 10

resp drug effects

Answer 10

bronchial constriction, narrowed airways

Question 11

at recommended doses cholinergic primarily affect

Answer 11

muscarinic receptors

Question 12

at high doses cholinergics stimulate

Answer 12

nicotinic receptors
(can cause undesirable effects)

Question 12

direct acting indications

Answer 12

reduce intraocular pressure and useful for glaucoma and intraocular surgery

Question 13

eye drop direct acting ex

Answer 13

pilocarpine

Question 14

direct acting bethanechol indication

Answer 14

• increases GI activity
• PO or subcut

Question 15

direct acting succinylcholine

Answer 15

• neuromuscular blocker in general anesthesia
• IV

Question 16

indirect acting indications

Answer 16

• increases ACh concentrations to stim effector cells
• causes skeletal muscle contractions
• diagnosis and treatment of myasthenia gravis
• reverse neuromuscular blocking drugs
• reverse anticholinergic poisoning

Question 17

antidote for anticholinergic poisoning

Answer 17

physostigmine

Question 17

which indirect drug treats Alzheimer’s

Answer 17

donepezil

Question 17

contraindications of cholinergic drugs

Answer 17

GI/ GU obstruction, bradycardia, defects in cardiac impulse, hyperthyroidism, epilepsy, hypotension, COPD, parkinsons

Question 18

cardio adverse effects

Answer 18

bradycardia, hypotension, syncope, conduction abn (AV block and cardiac arrest)

Question 19

CNS adverse effects

Answer 19

headache, dizziness, convulsions, ataxia

Question 20

GI adverse effects

Answer 20

abd cramps, increased secretions, nausea, vomiting, diarrhea, weight loss

Question 21

resp adverse effects

Answer 21

increased bronchial secretions, bronchospasms

Question 22

other adverse effects

Answer 22

lacrimation, sweating, salivation, miosis

Question 23

cholinergic crisis

Answer 23

-circulatory collapse, hypotension, bloody diarrhea, shock, cardiac arrest
-SLUDGE

Question 24

early signs of cholinergic crisis

Answer 24

• abd cramps, salivation, flushing, nausea and vomiting, transient syncope, transient complete heart block, dyspnea, orthostatic hypotension

Question 25

treatment of early cholinergic crisis

Answer 25

atropine sulphate (cholinergic antagonist)

Question 26

treatment of severe cardiovascular reactions or bronchoconstriction

Answer 26

epinephrine

Question 27

cholinergic drug interactions

Answer 27

• anticholinergics, antihistamines, sympathomimetics (decreased responses)
• other cholinergic drugs (additive effects)

Question 28

bethanechol uses

Answer 28

• direct acting
• treatment of acute post op and postpartum urinary retention
• management of urinary retention associated with neurogenic atony of bladder

Question 29

bethanechol contraindications

Answer 29

hyperthyroidism, peptic ulcer, active bronchial asthma, cardiac disease, coronary artery disease, epilepsy, Parkinsonism

Question 30

bethanechol adverse effects

Answer 30

syncope, hypotension w/ reflex tachycardia, headache, seizure, GI upset, asthmatic attacks

Question 31

bethanechol interactions

Answer 31

acetylcholinesterase inhibitors

Question 32

donepezil uses

Answer 32

• indirect acting
• works centrally in brain to increase ACh by inhibiting acetylcholinesterase
• treats mod Alzheimer’s

Question 33

donepezil adverse effects

Answer 33

GI upset (ulcer risk), drowsiness, dizziness, insomnia, muscle cramps, bradycardia, syncope, hypotens w/ reflex tachy

Question 34

donepezil interacting drugs

Answer 34

• antcholinergics and NSAIDS

Question 35

pyridostigmine

Answer 35

• indirect acting that increases ACh by inhibiting acetylchoinesterase
• for myasthenia gravis

Question 36

edrophonium

Answer 36

• indirect acting
  -used to diagnose myasthenia gravis
• used to differentiate myasthenia gravis and cholinergic crisis

Question 37

pyridostigmine and physostigmine uses

Answer 37

• reverse nondepolarizing neuromuscular blocking drugs
• treats sever OD of tricyclic antidepressants
• antidote after toxic exposure to nondrug anticholinergic agents

Question 38

ginkgo uses

Answer 38

• prevent memory loss
• vertigo
• tinnitus
• may cause GI upset
• interacts w/ aspirin, NSAIDs, anticoag, anticonvulsants

Question 39

when to take drugs w/ myasthenia gravis

Answer 39

30 mins before eating

Question 40

therapeutic effect for anti-Alzheimers may take how long

Answer 40

up to 6 wks