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PHARM > Cholinergic drugs > Flashcards

Cholinergic drugs Flashcards

1
Q

Cholinergic Drugs what is it?

A

Drugs that stimulate the parasympathetic nervous system (the opposing system to the sympathetic nervous system), Also known as cholinergic agonists or parasympathomimetics
Mimic effects of the parasympathetic nervous system neurotransmitter acetylcholine (ACh)

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2
Q

what are the two types of cholinergic receptors?

A

Nicotine receptors and muscarinic receptors.

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3
Q

what are the two types of cholinergic receptors determined by?

A
  • location
  • Action once stimulated.
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4
Q

Nicotinic Receptors are?

A

Located in the ganglia of both systems
Named nicotinic because they can be stimulated by the alkaloid nicotine.

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5
Q

Cholinergic Drugs: Mechanism of Action, Direct-acting cholinergic agonists

A

Bind to cholinergic receptors, activating them

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6
Q

Cholinergic Drugs: Mechanism of Action, Indirect-acting cholinergic agonists

A

Also known as cholinesterase inhibitors
Inhibit the enzyme acetylcholinesterase, which breaks down ACh
Results in more ACh available at the receptors

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7
Q

Indirect-Acting (Cholinesterase Inhibitors) - reversible

A

Bind to cholinesterase for a short period of time

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8
Q

Indirect-Acting (Cholinesterase Inhibitors) - Irreversible

A

Bind to cholinesterase for a long period of time
Bind to cholinesterase and form a permanent covalent bond
The body must make new cholinesterase to break these bonds.

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9
Q

Drug Effects

A

Effects seen when parasympathetic system is stimulated
This system is the “rest and digest” system.
Sympathetic nervous system: “flight or fight”

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10
Q

Drug Effects - stimulates intestine and bladder

A

Increased gastric secretions
Increased gastrointestinal motility
Increased urinary frequency

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11
Q

Drug effects - stimulates pupils

A

Constriction (miosis)
Reduced intraocular pressure

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12
Q

whats another drug effects

A

Increased salivation and sweating

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13
Q

Cholinergic Drug Effects - Cardiovascular effects

A

Decreased heart rate
Vasodilation

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14
Q

Cholinergic Drug Effects - Respiratory effects

A

Bronchial constriction, narrowed airways

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15
Q

Cholinergic Drug Effects

A

At recommended doses, cholinergics primarily affect muscarinic receptors.
At high doses, cholinergics stimulate nicotinic receptors.
Desired effects are from muscarinic receptor stimulation.
Many undesirable effects are caused by stimulation of nicotinic receptors.

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16
Q

Indications - Direct-acting drugs

A

Reduce intraocular pressure
Useful for glaucoma and intraocular surgery

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17
Q

Indications - Direct-acting drugs

A

pilocarpine

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18
Q

Indications

A

Topical application because of poor oral absorption

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19
Q

what does direct acting bethanechol do?

A

Increases tone and motility of bladder and gastrointestinal (GI) tract
Relaxes sphincters in bladder and GI tract, allowing them to empty
Helpful for postsurgical atony of the bladder and GI tract
Oral dose or subcutaneous injection

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20
Q

Indications - Direct-acting drug succinylcholine do?

A

Used as a neuromuscular blocker in general anaesthesia
Intravenous

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21
Q

Indications - Indirect-acting drugs

A

Increase ACh concentrations at the receptor sites, which leads to stimulation of the effector cells
Cause skeletal muscle contractions
Used for diagnosis and treatment of myasthenia gravis
Used to reverse neuromuscular blocking drugs

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22
Q

Used to reverse anticholinergic poisoning (antidote)
Example

A

physostigmine

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23
Q

Indications - Indirect-acting anticholinesterase drugs, and what drug is it.

A

Used for treatment of mild to moderate Alzheimer’s disease. donepezil (Aricept®)

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24
Q

Indications - memantine (Ebixa®)

A

Not a cholinergic drug
Also used in the treatment of Alzheimer’s disease

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25
Q

Contraindications

A

Known drug allergy
GI or genitourinary (GU) tract obstruction
Bradycardia
Defects in cardiac impulse conduction
Hyperthyroidism
Epilepsy
Hypotension
Chronic obstructive pulmonary disease
Parkinson’s disease

26
Q

Adverse Effects

A

Adverse effects are a result of overstimulation of the parasympathetic system.

27
Q

Adverse Effects - Cardiovascular

A

Bradycardia, hypotension, syncope, conduction abnormalities (atrioventricular block and cardiac arrest)

28
Q

adverse fx - CNS system

A

Headache, dizziness, convulsions, ataxia

29
Q

adverse fx - GI

A

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

30
Q

adverse fx - respiratory

A

Increased bronchial secretions, bronchospasms

31
Q

other adverse fx

A

Lacrimation, sweating, salivation, miosis

32
Q

Cholinergic Crisis

A

Circulatory collapse, hypotension, bloody diarrhea, shock, and cardiac arrest.
SLUDGE (salivation, lacrimation, urinary incontinence, diarrhea, gastrointestinal cramps, and emesis)

33
Q

Cholinergic Crisis - Early signs

A

Abdominal cramps, salivation, flushing of the skin, nausea and vomiting, transient syncope, transient complete heart block, dyspnea, and orthostatic hypotension

34
Q

Cholinergic Crisis - treatments in early phase

A

atropine sulphate, a cholinergic antagonist

35
Q

Cholinergic crisis - Treatment of severe cardiovascular reactions or bronchoconstriction:

A

epinephirine

36
Q

Interactions

A

Anticholinergics, antihistamines, sympathomimetics
Antagonize cholinergic drugs, resulting in decreased responses
Other cholinergic drugs
Additive effects

37
Q

bethanechol (Duvoid®) is a what?

A

Direct-acting cholinergic agonist

38
Q

bethanechol (Duvoid®) uses?

A

Treatment of acute postoperative and postpartum nonobstructive urinary retention
Management of urinary retention associated with neurogenic atony of the bladder

39
Q

bethanechol (Duvoid®) contraindications?

A

Known drug allergy, hyperthyroidism, peptic ulcer, active bronchial asthma, cardiac disease or coronary artery disease, epilepsy, and parkinsonism

40
Q

bethanechol (Duvoid®) adverse fx

A

syncope, hypotension with reflex tachycardia, headache, seizure, GI upset, and asthmatic attacks

41
Q

bethanechol (Duvoid®) - interactions

A

acetylcholinesterase inhibitors (i.e., indirect-acting cholinergics)

42
Q

donepezil (Aricept) does what?

A

Cholinesterase inhibitor that works centrally in the brain to increase levels of ACh by inhibiting acetylcholinesterase. Similar cholinesterase inhibitors include galantamine and rivastigmine.

43
Q

donepezil (Aricept) uses?

A

Used in the treatment of mild to moderate Alzheimer’s disease

44
Q

donepezil (Aricept) contraindications

A

known drug allergy

45
Q

donepezil (Aricept) adverse fx

A

GI upset (including ulcer risk caused by increased gastric secretions), drowsiness, dizziness, insomnia, and muscle cramps. The effects on the cardiovascular system are complex and may include bradycardia, syncope, hypotension with reflex tachycardia, or hypertension.

46
Q

donepezil (Aricept) - Interacting drugs

A

anticholinergics (counteract donepezil effects) and nonsteroidal anti-inflammatory drugs (NSAIDs)

47
Q

pyridostigmine (Mestinon®) is what?

A

Indirect-acting cholinergic drugs that work to increase ACh by inhibiting acetylcholinesterase

48
Q

pyridostigmine (Mestinon®) use

A

myasthenia gravis

49
Q

Edrophonium (Tensilon)

A

indirect-acting cholinergic drug that is used to diagnose myasthenia gravis. It can also be used to differentiate between myasthenia gravis and cholinergic crisis.

50
Q

pyridostigmine, and physostigmine uses.

A

reversing the effects of nondepolarizing neuromuscular blocking drugs; treating severe overdoses of tricyclic antidepressants; and antidote after toxic exposure to nondrug anticholinergic agents, including those used in chemical warfare

51
Q

Ginkgo uses

A

Common uses
Prevent memory loss
Vertigo
Tinnitus

52
Q

Gingko adverse fx

A

May cause GI upset, headache, bleeding

53
Q

Gingko potential interactions

A

Potential interactions
Aspirin
NSAIDs
Anticoagulants
Anticonvulsants

54
Q

Nursing Implications (Assessment)

A

Assess for allergies, presence of GI or GU obstructions, asthma, peptic ulcer disease, and coronary artery disease.
Perform baseline assessment of vital signs and systems overview.

55
Q

Medications should be>

A

Medications should be taken as ordered and not abruptly stopped.
Doses should be spread evenly apart to optimize the effects of the medication.

56
Q

Therapeutic effects of anti-Alzheimer’s drugs may not occur for up to?

A

6 weeks

57
Q

______is the antidote for cholinergics, and it should be available in the patient’s room for immediate use if needed.

A

Atropine

58
Q

Monitor for therapeutic effects

A

Alleviated signs and symptoms of myasthenia gravis

59
Q

Monitor for therapeutic effects - In postoperative patients with decreased GI

A

In postoperative patients with decreased GI peristalsis, monitor for:
Increased bowel sounds
Passage of flatus
Occurrence of bowel movements

60
Q

Monitor for therapeutic effects.
In patients with urinary retention or hypotonic bladder how?

A

In patients with urinary retention or hypotonic bladder, urination should occur within 60 minutes of bethanechol administration.

61
Q

Monitor for therapeutic effects - In patients with Alzheimer’s disease how?

A

Improvement in symptoms
Improvement in mood and decrease in confusion

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