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Pharmacology > EX 3 Cholinergic > Flashcards

EX 3 Cholinergic Flashcards

1
Q

What is the baroreceptor reflex?

A

feedback loop between the spinal cord and brain

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2
Q

what does the baroreceptor reflex do?

A

regulates BP and maintaines homeostasis
- watch for BP changes and sends a message to the brain

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3
Q

what is an agonist

A

molecules that activate reptor

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4
Q

what is an antagonist

A

prevents or blocks receptoractivation

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5
Q

these mediate responses to epinephrine and norepinephrine

A

adrenergic drugs

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6
Q

what are the Alpha1 adrenergic agonists/ which drugs act directly on the Alpha 1 receptor

A

Phenylephrine
epinephrine
norepinephrine

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7
Q

Where does the Alpha 1 receptor work on and what happens when activated

A

(BEVAPP)
Bladder - contraction (stops voiding0
Eye - contraction of iris
Veins - constriction
Areterioles - vasocnstrictions
Penis - ejacultation
Prostate capsule - contraction

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8
Q

what is phenylephrine used for and what receptor does it act on

A

nasal decongestion, Alpha 1

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9
Q

what is epinephrine used for and what receptor does it act on,

A

homeostasis
adjunct to local anaesthesia
Alpha 1,2 and Beta 1,2

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10
Q

what is mydriasis

A

contraction of iris muscle + pupil dilation

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11
Q

what is norepinephrine used for and what receptor does it act on

A

(rarely) BP elevation, Alpha 1, Alpha2, and Beta 1

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12
Q

Adv Effects of Alpha1 agonists

A

HTN (can be severe with IV admin)
Bradycardia
Tissue necrosis (if an IV extravasates)

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13
Q

Where does the alpha 2 receptor work on and what happens when activated

A

Presynaptic nerve terminals - inhibits transmitter release

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14
Q

Where does the Beta 1 receptor work on and what happens when activated

A

Heart - increased rate, contraction strength, conduction velocity over AV node
Kidney - release of renin

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15
Q

Where does the Beta 2 receptor work on and what happens when activated

A

(SKLUBA)
Skeletal muscle - enhanced contraction
Kidney - dilation of kidney blood vessels
Liver - glycogenolysis
Uterus - relaxation
Bronchi - dilation
Arterioles - Dilation

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16
Q

Where does the Dopamine receptor work on and what happens when activated

A

Kidney - dilation of kidney blood vessels

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17
Q

Alpha 1 therapeutic uses?

A

mostly based on vasoconstriction

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18
Q

Beta 1 therapeutic uses?

A

on the heart
- heart failure (dopamine, isoproterenol)
- shock (dopamine, isoproterenol)
- Av heart blocks (epinephrine)
- restarting after cardiac arrest (epinephrine)

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19
Q

Adverse effects of Beta 1 activation

A

tachycardia, dyshythmias, angina pectoris

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20
Q

Beta 2 therapeutic uses?

A

Lungs (and uterus)
asthma - albuterol
- prefer meds that are selective for B2 receptors only
- delays of preterm labor

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21
Q

Adverse effects of beta 2 activation

A
  • hyperglycemia (typically in pt w/DM
  • muscle tremors
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22
Q

Dopamine receptor activation

A

dopamine is the receptor and the drug

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23
Q

considerations for dopamine receptor activation

A

Given IV, weight based, very short T1/2

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24
Q

Dopamine receptor activation in low doses

A
  • dilation of renal blood vessels
  • improves GFR and urine output, maintains kidney function
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25
Q

Dopamine receptor activation in high doses

A
  • Beta 1 and Alpha 1 effects; vasoconstriction, increased BP & HR, improved cardiac output
  • used for hemodynamic support: shock, advanced heart failure
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26
Q

Adverse effects of dopamine receptor activation seen in high doses

A

Dysrhythmias/tachycardia (activation of B1)
Angina pectoris (activation of B1)
Tissue Necrosis if IV infusion extravasates (vasoconstriction)

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27
Q

Epinephrine receptor activation

A

activates all alpha and beta receptors= broad range of effects and clinical uses

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28
Q

Epinephrine A1 receptor activation

A
  • delay absorption of local anesthetic, control bleeding, raise blood pressure, induce mydriasis during ophthalmologic procedure
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29
Q

Epinephrine B1 receptor activation

A

reverse AV heart blokc, restore rhythm during cardia arrest

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30
Q

Epinephrine B2 receptor activation

A

Bronchodilation (not preferred drug)
- treatment of anaphylaxis/shock

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31
Q

Pharmokinetics of epinephrine

A

absorption: topically or by injection
metabolism: in liver and intestine very short T1/2

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32
Q

Adverse effects of epinephrine

A

HTN crisis,
Dysrhythmias/tachycardia
angina pectoris
necrosis if IV infusion extravasates
hyperglycemia
interacts with A1 and beta blockers

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33
Q

A1 Blocker protype

A

prazosin (selective)

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34
Q

Therapeutic uses of prazosin (A1 blocker)

A
  • essential HTN
  • renal stones
  • Raynaud’s Disease
  • Reversal of overdose/toxicity of A1 agonists
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35
Q

adverse effects of prazosin (A1 blocker)

A

Orthostatic Hypotension
Reflex tachycardia
nasal congestion
inhibition of ejaculation
Na retention and increased blood volume

36
Q

Non- selective Alpha blocker

A

phentolamine

37
Q

Therapeutic use of phentolamine

A
  • pheochromocytoma
  • treatment of tissue necrosis after extravasation of A1 agoinst
38
Q

adverse effects of phentolamine (Alpha blokcer)

A
  • same as A1 antagonists
  • significant relfex tachycardia (may need to give a B-blocker
39
Q

Beta blocker adrenergic antagonists therapeutic uses

A

HTN
stable angina
tachycardia
POst-Mi
Heart failure
hyperthyroidism
Migrains
Stage fright/anxiety
glaucoma

40
Q

adverse side effects of beta1 blockers

A
  • bradycardia
  • reduced cardiac output
  • precipitation of heart failure
  • AV heart block
  • rebound excitation
    -fatigure, often depression reported
  • can mask hypoglycemia
41
Q

Beta2 blokcer therapuetic uses

A

none

42
Q

adverse effects of beta 2 blockers

A

bronchoconstriction
inhibition of glycogenolysis

43
Q

1st generation beta blocker

A

propranolol

44
Q

propranolol (1st gen B-blocker) MOA:

A

nonselective blockade, blocks B1 and B2 receptors

45
Q

propranolol (1st gen B-blocker) uses:

A

HTN,
Angina pectoris,
Tachycardic dysrhythmias
MI
stage fright
highly lipid soluble –> crosses membranes to CNS

46
Q

propranolol (1st gen B-blocker) adv side effects:

A

Beta 1 and Beta 2 effects

47
Q

2nd generation beta blocker

A

metoprolol

48
Q

metoprolol (2nd gen B-blocker) MOA:

A

Cardio selective, blocks B1 receptors

49
Q

metoprolol (2nd gen B-blocker) uses:

A

mostly HTN
angina pectoris
tachycardic dysthrythmias
MI
HF

50
Q

metoprolol (2nd gen B-blocker) adv side effects:

A

Beta 1 effects only

51
Q

3rd gen beta blocker

A

carvedilol

52
Q

carvedilol (3rd gen B-blocker) MOA:

A

non-selective blockade + a1 blockade (casues vasodilation)

53
Q

carvedilol (3rd gen B-blocker) uses:

A

HTN
angina pectoris
Tachycardic dysrthymias
MI
HF

54
Q

carvedilol (3rd gen B-blocker) adv side effects:

A

Beta 1,2 effects
Alpha 1 effects

55
Q

What are all the locations for muscarinic receptors

A

Eye, Heart, Lung, Bladder, GI tract, Sweat glands, Sex organs, Blood vessels

56
Q

What happens when the muscarinic receptor in the eye gets activated

A

contraction of lene and iris to focus

57
Q

What happens when the muscarinic receptor in the heart gets activated

A

decrease rate

58
Q

What happens when the muscarinic receptor in the lungs gets activated

A

constriction of bronchi and promotion of secretions

59
Q

What happens when the muscarinic receptor in the bladder gets activated

A

contraction of detrusor muscle, relax sphincter and coordinate these actions

60
Q

What happens when the muscarinic receptor in the GI tract gets activated

A

salivation, increase in Gastric secretions, increase in intestinal tine and motility, and defecation

61
Q

What happens when the muscarinic receptor in the sweat glands gets activated

A

generalized sweating

62
Q

What happens when the muscarinic receptor in the sex organs gets activated

A

erection

63
Q

What happens when the muscarinic receptor in the blood vessel gets activated

A

vasodilation

64
Q

muscarinic agonists

A

bethanechol

65
Q

bethanechol (muscarinic agonist) MOA:

A

activate muscarinic receptors

66
Q

bethanechol (muscarinic agonist) Pharmacokinetics:

A

absorption: rapidly PO
- give on an empty stomach
Metabolism:
metabolized by cholinesterase at the cholinergic receptor sites, in the plasma and in the liver
short T1/2

67
Q

bethanechol (muscarinic agonist) adv side effects:

A

cardiovascular: bradycardia, hypotension
respiratory: SOB
GI/GU - increased salivation and motility

68
Q

muscarinic agonist contraindications

A
  • can OD on too much
  • pt with gastric ulcers, asthma, HF
69
Q

muscarinic agonisti nursing considerations

A
  • advise to take 1 hr before or 2 hrs after meals
    monitor HR and BP
    educate of toxicity: SLUDGE
70
Q

Cholinergic side effects: SLUDGE

A

Salivation
Lacrimation
Urination
Defecation
Gastric upset
Emesis (vomiting)

71
Q

Overactive Bladder d/t?

A

involuntary contractions of detrusor muslce of bladder more common with increasing age and multiple pregancies

72
Q

treatment of OAB

A
  • treat with non pharm therapy first,
    scheduled voiding
    timing fluid intake
    kegel exercise
    avoid caffeine
    muscarinic antagonists
73
Q

muscarinic antagonist MOA

A

blocks acetylcholine at muscarinic receptors

74
Q

muscarinic antagonists used to treat

A

OAB
bradycardia
eye disorders
motion sickness
athams

75
Q

poem for remembering what muscarinic antagonists used to treat

A

Cant think (confusion)
Cant blink (dry eyes)

Cant see (blurred vision)
Can’t pee (urine retention)

Cant spit (dry mouth)
Cant poop (constipation)

76
Q

muscarinic antagonist for OAB

A

oxybutynin

77
Q

muscarinic antagonist for OAB MOA

A

block muscarinic receptors on the bladder detrusor muscle –> inhibits bladder contractions –> decreases urge to void

78
Q

muscarinic antagonist for OAB uses

A

OAB treatment but only moderately effective

79
Q

muscarinic antagonist for OAB pharmacokinetics

A

PO, patch, gel
crosses BBB
metabolism by CYP enzymes
Short T1/2

80
Q

muscarinic antagonist for OAB adverse effects

A

causes typical anticholinergic effects
dont give with other anticholinergic drugs

81
Q

Atropine

A

muscarinic antagonist

82
Q

muscarinic antagonist atropine MOA

A

prevents recpetor activation by acetylcholine

83
Q

muscarinic antagonist atropine uses

A

bradycardia, ACLS drugs, eye exams, cholinergic overdose

84
Q

muscarinic antagonist atropine pharmacokinetics:

A

absorption: may be given PO, eye drops, or IM, IV
metabolism liver
excretion kidneys

85
Q

muscarinic antagonist atropine adverse effects:

A

CNS: mild excitation
Eyes: blurred vision
Cardiovascular: Tachycardia
GI- Decreased secretions/constipation
GU- urinary retention
Misc - decreased sweating

86
Q

Ipratropium bromide (Atrovent)

A

common muscarinic antagonist

87
Q

Ipratropium bromide (Atrovent) does what

A

inhaler - treats asthma, copd, prevents bronchoconstriction
nasal spray - treat allergic rhinitis

Pharmacology (8 decks)

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