Chp 20 Cholinergic Drugs

Question 1

Cholinergic drugs

Answer 1

(cholinergic agonists, parasympathomimetics) the class of drugs that stimulate the parasympathetic nervous system

Question 2

Acetylcholine

Answer 2

the neurotransmitter responsible for transmission of nerve impulses to effector cells in the parasympathetic nervous system

Question 3

What are the two types of cholinergic receptors and what are they determined by?

Answer 3

Nicotinic receptors & Muscarinic receptors

Determined by location and action once stimulated

Question 4

Where are nicotinic receptors located?

Answer 4

in the ganglia of both the PSNS and SNS

Question 5

Why are nocotinic receptors named that?

Answer 5

because they can be stimulated by the alkaloid nicotine

Question 6

Where are muscarinic receptors located?

Answer 6

postsynaptically in the effector organs of the PSNS (smooth muscle, cardiac muscle, glands)

Question 7

Why are muscarinic receptors named that?

Answer 7

because they can be stimulated by the alkaloid muscarine

Question 8

How do direct acting cholinergic drugs work?

Answer 8

they bind to cholinergic receptors and activate them

Question 9

How do indirect acting cholinergic drugs work?

Answer 9

they inhibit the enzyme acetylcholinesterase, which breaks down ACh. This results in more ACh available at the receptors.

Question 10

Parasympathetic Nervous System is called what?

Answer 10

the “rest and digest” system

Question 11

What are the effects of cholinergic drugs on the intestine and bladder?

Answer 11

increased gastric secretions
increased gastrointestinal motility
Increased urinary frequency

Question 12

What are the effects of cholinergic drugs on the eyes?

Answer 12

Constriction of pupils (miosis)

Reduced intraocular pressure

Question 13

What are the effects of cholinergic drugs on the cardiovascular system?

Answer 13

Decreased heart rate

Vasodilation

Question 14

What are the effects of cholinergic drugs on the respiratory system?

Answer 14

bronchial constriction

narrowed airways

Question 15

Which receptors do recommended doses of cholinergics primarily effect?

Answer 15

mascarinic receptors which produced desired effects

Question 16

Which receptors are stimulated from high doses of cholinergics?

Answer 16

nicotinic receptors which can cause many undesired effects.

Question 17

cholinergic crisis

Answer 17

Sever muscle weakness and respiratory paralysis due to excessive acetylcholine; often seen in patients with myasthenia gravis as an adverse effect of drugs used to treat the disorder.

Question 18

myasthenia gravis

Answer 18

A weakness and rapid fatigue of muscles under voluntary control.

Question 19

What are the symptoms of cholinergic crisis?

Answer 19

circulatory collapse, hypotension, bloody diarrhea, shock, and cardiac arrest

Question 20

What are the early signs of cholinergic crisis?

Answer 20

abdominal cramps, salivation, flushing of the skin, nausea, and vomiting

Question 21

What are direct acting cholinergics used to treat?

Answer 21

intraocular pressure in patients with glaucoma

Question 22

What are some example of direct acting drugs for glaucoma and intraocular surgery and why are they limited to mostly topical?

Answer 22

echothiophate
carbachol
pilocarpine
They are poorly absorbed orally

Question 23

What is the direct acting cholinergic bethanechol used for and how is it administered?

Answer 23

• increases tone and motility of bladder and GI tract
• relaxes sphincters in bladder and GI tract, allowing them to empty
• helpful for postsurgical atony of the bladder and GI tract
• *Administered orally or by subcutaneous injection

Question 24

What are indirect-acting cholinergics used for?

Answer 24

• diagnoses and treatment of myasthenia gravis
• to reverse neuromuscular blocking drugs
• to reverse anticholinergic poisoning (antidote)

Question 25

What do indirect cholinergics cause?

Answer 25

skeletal muscle contractions

Question 26

What are indirect-acting anticholinesterase drugs used for?

Answer 26

treatment of mild to moderate Alzheimer’s disease

Question 27

What are some common indirect-acting anticholinesterase drugs?

Answer 27

donepezil (Aricept)
galantamine (Razadyne)
rivastigmine (Exelon)

Question 28

What drug is also used to treat Alzheimer’s that is not a cholinergic drug?

Answer 28

memantine (Namenda)

Question 29

What are the adverse effects of cholinergic drugs a result of?

Answer 29

overstimulation of the PSNS

Question 30

What are the adverse effects of cholinergic drugs on the cardiovascular system?

Answer 30

bradycardia, hyptoension, syncope, conduction abnormalities (AV block and cardiac arrest)

Question 31

What are the adverse effects of cholinergic drugs on the CNS?

Answer 31

headache, dizziness, convulsions, ataxia

Question 32

What are the adverse effects of cholinergic drugs on the gastrointestinal system?

Answer 32

abdominal cramps, increased secretions, nausea, vomiting

Question 33

What are the adverse effects of cholinergic drugs on the respiratory system?

Answer 33

increased bronchial secretions, bronchospasms

Question 34

What types of drugs interact with cholinergics?

Answer 34

anticholinergics, antihistamines, sympathomimetics

Question 35

What are the common uses of Gingko?

Answer 35

prevent memory loss
vertigo
tinnitus

Question 36

What are the adverse effects of Gingko?

Answer 36

GI upset, headache, bleeding

Question 37

What are the potential interactions with Gingko?

Answer 37

aspirin, NSAIDs, Anticoagulants, Anticonvulsants

Question 38

What should a nurse assess for in patients before administering cholinergics?

Answer 38

allergies, presence of GI or GU obstructions, asthma, peptic ulcer disease, or coronary artery disease

Question 39

What is given to reverse the effects of cholinergic drugs?

Answer 39

atropine

Question 40

When should a patient with myasthenia gravis take medication?

Answer 40

30 minutes before eating to help improve chewing and swallowing