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Pharmacology Exam #2 > Cholinergics > Flashcards

Cholinergics Flashcards

1
Q

What is acetylcholinesterase?

A

An enzyme that breaks down acetylcholine

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2
Q

What is miosis?

A

Very constricted pupils

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3
Q

What is a cholinergic agonist?

A

Drugs that mimic the effects of the neurotransmitter acetylcholine (and therefore the parasympathetic nervous system)
agonist = to stimulate/increase the effects

Not limited to a specific site –> many undesired systemic effects

Work either directly or indirectly on ACh receptors

(AKA parasympathomimetic)

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4
Q

What is Myasthenia gravis?

A
  • A chronic autoimmune disorder affecting the muscles
  • Patients make antibodies to ACh receptors, causes destruction of them
  • Progressive weakness and lack of muscle control with periodic acute episodes
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5
Q

What is Alzheimer’s Disease?

A
  • A progressive disease that causes neural degeneration in the cortex
  • Leads to marked loss of memory, decreased ability to perform ADLs
  • Believe there is a progressive loss of ACh producing neurons
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6
Q

What are the effects of the parasympathetic nervous system?

A

REST AND DIGEST
* Pupil constriction
* ⬆️ salivation
* ⬆️ respiratory secretions
* ⬆️ peristalsis
* Vasodilation (in most blood vessels)
* Bronchoconstriction
* ⬇️ heart rate
* ⬇️ blood pressure
* Bile release
* Urination

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7
Q

Lifespan Considerations of Cholinergic Drugs
In Children

A
  • Increased risk of adverse effects
  • Dosages should be based off weight
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8
Q

Lifespan Considerations of Cholinergic Drugs
In Adults

A
  • Caution against driving while on medication
  • No studies on safety during pregnancy/lactation
  • Use alternative method to breastfeeding
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9
Q

Lifespan Considerations of Cholinergic Drugs
In Older Adults

A
  • More likely to have adverse effects
  • More likely to have toxic levels
  • Start low and go slow
  • Institute safety precautions
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10
Q

Direct Acting Cholinergic Agonists
Mechanism of Action

A
  • Mimics acetylcholine at the receptor sites (muscarinic or nicotinic) on the surfaces of the target cells of the postganglionic cholinergic nerves
  • Causes an increased stimulation of the cholinergic receptor
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11
Q

Direct-Acting Cholinergic Agonists: 🍄Muscarinic
Indications

A
  • Urinary Retention (Bethanechol)
  • To induce miosis (carbachol)
  • Treat dry mouth (cevimeline & pilocarpine)
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12
Q

Direct-Acting Cholinergic Agonists: 🍄Muscarinic
Drug Names

A
  • Bethanechol (urinary retention)
  • Carbachol (to induce miosis)
  • Cevimeline (treats dry mouth)
  • Pilocarpine (treats dry mouth)
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13
Q

Direct-Acting Cholinergic Agonists: 🍄Muscarinic
Contraindications

A

Absolute:
* Allergy
* Any condition that would be exacerbated by parasympathetic effects: Bradycardia, hypotension
* Peptic Ulcer Disease, GI obstruction or recent GI surgery
* Asthma (can cause bronchoconstriction)
* Bladder obstruction
* Epilepsy and parkinsonism (can worsen)

Caution:
* Pregancy and lactation

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14
Q

Direct-Acting Cholinergic Agonists: 🍄 Muscarinic
Adverse Effects

A

💩 Diarrhea, involuntary defecation, cramps
🤮 Nausea, vomiting, increased salivation
💓 Bradycardia, heart block, hypotension
🫣 Urinary urgency
💦😳 Flushing or increased sweating

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15
Q

Direct-Acting Cholinergic Agonists: 🍄Muscarinic
Drug Interactions

A

Acetylcholinesterase Inhibitors

(Indirect-Acting Cholinergic Agonists)

Can lead to a cholinergic crisis!

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16
Q

Direct-Acting Cholinergic Agonists: 🍄Muscarinic
Assessment

A

History:
* Contraindications & Cautions

Physical:
* Vitals
* Lung sounds
* Bowel sounds
* Bladder distention
* Input & Output

17
Q

Direct-Acting Cholinergic Agonists: 🍄Muscarinic
Nursing Diagnoses

A
  • Impaired Comfort (r/t GI effects)
  • Altered cardiac output (r/t CV effects)
  • Impaired urinary elimination (r/t GU effects)
  • Injury risk (r/t blurry vision, changes in visual acuity)
  • Diarrhea (r/t GI effects)
  • Knowledge Deficit
18
Q

Direct-Acting Cholinergic Agonists: 🍄Muscarinic
Implementation/Patient Teaching

A
  • Ensure proper administration of opthalmic preparations
  • Administer oral drugs on an empty stomach
  • Monitor response closely
  • Provide safety precautions (fall risk) if pt experiences poor visual acuity
  • Monitor urinary output
19
Q

Direct-Acting Cholinergic Agonists: 🚬 Nicotinic
Indications

A

Smoking cessation

(Work mostly in CNS - quicker acting than muscarinc receptor agonists)

20
Q

Direct-Acting Cholinergic Agonists: 🚬 Nicotinic
Drug Names

A
  • Bupropion (weakly inhibits neuronal reuptake of NE and Dopamine)
  • Varenicline (acts as nicotine receptor partial agonist)
  • Nicotine (replacement therapy)
21
Q

Direct-Acting Cholinergic Agonists: 🚬 Nicotinic
Contraindications

A

Absolute:
* Allergy
* Seizure disorder (Bupropion) reduces seizure threshold

Caution:
* Pregnancy and lactation

22
Q

Direct-Acting Cholinergic Agonists: 🚬 Nicotinic
Adverse Effects

A

💓 Tachycardia, hypertension (due to too much increased fluid)
🧠 Seizures, neuropyschiatric adv. effects, dizziness, strange dreams
🤢Nausea and dry mouth
😡Skin rash (r/t cholinergic urticaria)

MORE potential for CNS effects than muscarinic agonists

23
Q

Direct-Acting Cholinergic Agonists: 🚬 Nicotinic
Drug Interactions

A

TOO MANY to name

24
Q

Direct-Acting Cholinergic Agonists: 🚬 Nicotinic
Assessment

A

History:
* Contraindications & Cautions
* Amount of tobacco use
* Sleep patterns
* suicidal thoughts and behaviors

Physical:
* Lung sounds
* Heart Sounds
* Vital Signs
* ECG
* mood, affect

25
Q

Direct-Acting Cholinergic Agonists: 🚬 Nicotinic
Nursing Diagnoses

A
  • Impaired comfort (r/t GI effects)
  • Altered cardiac output (r/t CV effects)
  • Injury risk (r/t seizures or neurpsychiatric side effects)
  • Knowledge deficit
26
Q

Direct-Acting Cholinergic Agonists: 🚬 Nicotinic
Implementation/Patient Teaching

A
  • ensure proper administration of nicotine replacement preparations
  • Check for med interactions
  • May be taken with or without food
  • Dose may be adjusted
  • Safety precautions for neuropsychiatric effects or seizure activity
  • Correct # of patches changed at the right times
  • Take OFF old patches before applying new one
  • Report changes in CNS effects
27
Q

Indirect-Acting Cholinergic Agonists
Indications

A
  • Myasthenia gravis
  • Alzheimer’s Disease
28
Q

Indirect-Acting Cholinergic Agonists
Drugs to treat Myasthenia gravis

A
  • Neostigmine (strong influence at neuromuscular junction)
  • Pyridostigmine (longer duration of action than neostigmine)
  • Edrophonium (diagnostic agent…. no longer used - too many false positives)
29
Q

Indirect-Acting Cholinergic Agonists
Adverse Effects

A

💓 Bradycardia, hypotension
💩 Increased GI activity and secretions
💛 Increased bladder tone = overactive bladder
🟢 Relaxation of GI and Genitourinary sphincters
🫁 Bronchoconstriction
👁️ Pupil constriction

30
Q

Indirect-Acting Cholinergic Agonists
Drug Interactions

A
  • NSAIDs (cause GI erosions)
  • Cholinergic Drugs (can cause Increased secretions)

Combining the drugs can lead to a Gastric Bleed

31
Q

Indirect-Acting Cholinergic Agonists
Drugs used to treat Alzheimer’s Disease

A
  • Galantamine (avail. in solution for easy swallowing)
  • Rivastigmine (avail. in solution for easy swallowing)
  • Donepezil (once a day dosing, rapidly dissolving tablet)
32
Q

How does nerve gas affect Cholinergic receptors?

A
  • Permanently and irreversibly binds to Acetylcholinesterase –> leads to significant increase in Acetylcholine
  • Treatment: Atropine and Pralidoxime (anticholinergics)
33
Q

Indirect-Acting Cholinergic Agonists
Assessment

A

History:
* Contraindications & cautions

Physical:
* Neuro: Orientation, affect, reflexes, ability to perform ADLs
* Vital Signs
* ECG
* Urinary output

Labs:
* Renal and Liver function tests

34
Q

Indirect-Acting Cholinergic Agonists
Nursing Diagnoses

A
  • Altered thought processes (r/t CNS effects)
  • Impaired comfort (r/t GI effects)
  • Decreased cardiac output (r/t blood pressure changes, arrhythmias, and vasodilation)
  • Injury risk (r/t CNS effects)
  • Diarrhea (r/t GI stimulatory effects)
  • Knowledge deficit
35
Q

Indirect-Acting Cholinergic Agonists
Implementation

A
  • If given via IV, go slowly
  • Maintain atropine sulfate on standby for cholinergic crisis
  • Discontinue drug if: excessive salivation, diarrhea, emesis, or frequent urination
  • Oral drug with meals
  • If going into surgery, notify surgeon that they are on cholinergic drugs
  • Monitor Alzheimer’s pts for progress
  • Arrange for supportive care and comfort measures

Pharmacology Exam #2 (14 decks)

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