Exam 1 Chapter 16 Cholinergics Flashcards
Parasympathetic Nervous System (PNS)
also known for its action of _____
Rest and Digest
Cholinergic Nervous System
same as the ________ Nervous System
Cholinergic Nervous System =
Parasympathetic Nervous System
What is the main neurotransmitter of the PNS?
Acetylcholine AcH
Drugs that affect the ChNS are ___
Drugs that block the ChNS are ____
agonist and antagonists
Adrenergic =
Cholinergic =
Adrenergic = SNS.
attached to adrenaline
Cholinergic = PNS.
Choline AcH
If PNS is dominant,
What are the main responses.
Increase in peristalsis/digestion
Increase in bladder contraction/urination
Vasodilation/dec. HR
Restorative and Elimination
What are the two cholinergic receptors?
Muscarinic receptors (smooth muscle)
Remember the M bladder, kidney
Nicotinic receptors (skeletal muscle)
PSN Global Effects
Eyes - dilate
Lungs - bronchioles constrict, inc. secretions
Heart - hr decreases
Blood vessels - dilate
GI - inc. peristalsis, stool passes
Bladder - contracts inc. urine output
Salivary glands - inc. salivation, perspiration, tears
Skeletal muscle - inc neuromuscular transmission, purpose to maintain muscle strength and tone.
Function of PNS -
To help body restore itself and eliminate waste
What does acetylcholinesterase (AChE) do?
Breaks down AcH after it performs its function
What are the two type of cholinergic AGONISTS?
AGONISTS perform a desired function
Direct and Indirect Acting
What are DIRECT ACTING CHOLINERGIC AGONISTS
Drugs act directly on the muscarinic or nicotinic receptors
What is a parasympathomimetic?
Drugs that are direct acting Cholinergic agonist
What are INDIRECT ACTING CHOLINERGIC AGONISTS?
Drugs that inhibit AChE - allow more AcH to reach the receptors. ACETYLCHOLINESTERASE INHIBITORS
Name 3 DIRECT ACTING CHOLINERGIC AGONISTS
Metoclopramide (Reglan) increases stomach emptying relieves N/V
Pilocarpine (eye drops) - releases fluid
Bethanechol chloride (urinary retention) Urecholine, Muscaran, Durvoid
What is the action of Metoclopramide?
Metoclopramide is a DIRECT acting Cholinergic agonist
inc. peristalsis
inc. gastric emptying
Used post-surgery for constipation
“Think Meto/Metro - moves things”
What is the action of Pilocarpine?
PILOCARPINE Is a direct acting cholinergic AGONIST
USED to DECREASE IOP by
dec. fluid accumulation of aqueous humor
“Think CARP swimming in water”
Comes from the leaves of the Jaborandi small tree/shrub,
used to induce sweating, salivation, and glaucoma
pilocarpus is the genus of the shrub that produces pilocarpine
Bethanechol chloride
BethaneCHOL chloride:
DIRECT ACTING CHOLinergic AGONIST
USED to DECREASE urinary retention
inc. bladder contraction and relaxes the sphincter
“Think “CHOL - cholinergic”
3 Indications for
INDIRECT Cholinergic AGONISTS
What are diseases where there is a lack or receptors for AcH?
What is an INDIRECT Cholinergic AGONISTS?
They are drugs bind to the enzyme Acetylcholinesterase so there is more AcH uptake
- Myasthenia Gravis -less receptors or AcH. Neostigmine (inc. Secretions)
- Alzheimer - donepezil (aricept)
- Glaucoma -
In these diseases not enough receptors for AcH
3 Indications for
DIRECT cholinergic Agonists
What is a DIRECT CHOLINERGIC AGONIST?
PNS - inc. AcH - inc. Secretions/urine/digestion
PEE SEE POOP
1.Constipation after surgery, N/V (inc of gastric secretions after surgery, so more nauseous, distended)
2. Glaucoma
3. Urinary retention
Myasthenia Gravis
antibodies decrease receptors for AcH
What drug do you give?
Indirect acting cholinergic agonist -
so gets more AcH to them
NEOSTIGMINE
Side Effects of
INDIRECT Cholinergic agonists
Too much SEE/PEE/Poop
Inc. Salvation
Blurred vision
bradycardia
diarrhea - too much peristalsis
abdominal cramping
bronchoconstriction
inc urination
Contraindications of
INDIRECT cholinergic agonists
Parkinson’s Disease patients
- do not want to stimulate skeletal muscles more (bradykinesia rigidity)
nicotinic receptors - skeletal muscles - inc. stim to muscles
Asthmatics, COPD
Bowel obstructions
Urinary obstructions
Nursing interventions for
Myasthenia Gravis meds
Make sure medications must be given ON TIME,
if not, symptoms can occur
Nursing interventions for indirect cholinergic agonists
bowel sounds (too much)
BP
HR (too low
I and O (too much)
Too much AcH is a cholinergic crisis
what is the acronym?
Sludge
What is SLUDGE?
Name what it stands for
Secretion Crisis
Salivation
Lacrimation
Urination
Defecation
Gastritis
Emesis
Can result in respiratory distress
ANTICHOLINERGIC’s Action is…..
Inhibit action of AcH by occupying AcH receptors
Name 1 Anticholinergic DRUG
ATROPINE treats cholinergic crisis A Tro PINE
Tolerodine
Benzotropine
Common ending “PINE”
When is an anticholinergic drug used?
Pre-op (dec broncho secretions and secretions)
peptic ulcer (dec. Gastric secretions)
sympathometic bradycardia
cholinergic overdose - SLUDGE
IBS
Why? decrease secretions
What does an anticholinergic drug do?
Inhibit Rest and Digest
Dec. secretions
inc heart rate
inc. contractility of the heart
Too much AntiCholinergic drugs will cause ____
Think fight or flight
Where am I? confusion
Up High - tachycardia inc HR In contractivity of the heart
Can’t See - photophobia - sensitivity to light
Can’t Pee -urinary retention
No stool -constipation
No drool -dry mouth, dec. secretions
Crossword questions:
Antagonist to Ach
Can occur after giving a beta blocker
contraindications to non-selective beta blocker
drugs that affect more than one receptor
indication for cholinergic agonist medication
increases gastric emptying
SNS primary neurotransmitter
symptoms for a cholinergic crisis
stimulates receptor to perform its desired function
Antagonist to Ach
ANTICHOLINERGIC
Can occur after giving a beta blocker
BRADYCARDIA
contraindications to non-selective beta blocker
COPD
drugs that affect more than one receptor
NON-SELECTIVE
indication for cholinergic agonist medication
URINARY RETENTION
increases gastric emptying BETA 2
SNS primary neurotransmitter
NOREPINEPHRINE
symptoms for a cholinergic crisis.
SLUDGE
stimulates receptor to perform its desired function
AGONIST
Anticholinergic
Turning off the PNS to stop secretions, turn on SNS
Difference between SNS and PNS
Where is the blood going?
SNS -Fight or flight -sympathomimetics, anticholinergic (no digestive enzymes, ATROPINE -can’t see, can’t pee
Blood goes to heart, brain, and lungs (Norepinephrine
PNS-Rest and Digest -parasympathomimetics, cholinergic
Blood goes to stomach, kidneys (digestion, peeing)
Cholinergic Can -See, Spit, Poop, Pee
contraindications for anti chol
glaucoma
What does MIOSIS mean
constriction of the pupils
“think - My I can’t See”
Bethanechol Chloride is
What type of drug
where are receptors located?
DIRECT acting cholinergic
RECEPTORS are in the Bladder, promotes detrusor to contract and urination.
B for Bethanechol. C for Cholinergic
çontraindications for Bethanechol Chloride
urinary obstruction, IBS, hypotension, parkinsonians
SNS stimulants will do what to
BP
HR
increase BP and HR
SNS stimulants will do what to bronchioles?
Relax bronchioles
SNS stimulants will do what to eye pupils?
Dilate eye pupils
SNS stimulatants will do what to uterine muscles?
Relax uterine muscles
SNS stimulants will do what to blood glucose?
Increase blood glucose
PINE is the ending for what class of drugs?
ANTICHOLINERGIC
example ATROPINE
“Think PINE ENDS DINE (rest and digest)”
DIRECT ACTING CHOLINERGIC AGONIST
MUSCARINIC side effects
low bp
tachy
excessive salivation
inc. acid secretion, diarrhea
bronchospasm
ANTICHOLINERGIC MEDS REACTIONS
Block effects of AcH
Where am I? confusion.
Up high? tachy
Can’t See photophobia
Cant’ Pee urinary retention
No Stool - constipation
No Drool - dry mouth
Anticholinergics are not good for what population?
Elderly - as can cause confusion - so risk of falls
Anticholinergics - what vital sign important to monitor?
(Up high)
Heart rate as can cause tachycardia
What is main anticholinergic drug?
ATROPINE
Patient teaching with Anticholinergics re photophobia
(can’t see)
Sunscreen
Hat
Sunglass
long sleeved shirt
limit time in sun to 15 minutes
Anticholinergics - intervention for urinary retention
(can’t pee)
Void 30 minutes prior to taking their medication.
Anticholinergics - intervention for constipation
Three F’s - increase
Function - exercise and movement
Fiber
Fluids
next stool softeners
Anticholinergics - intervention for dry mouth
drink
sucking candies
ANTICHOLINERGICS - DO NOT GIVE TO PATIENTS W
Inhibit AcH receptors - against the PSN
GLAUCOMA
increased IOP
Myasthenia Gravis - blocks AcH receptors
intestinal or Urinary blockage
paralytic ileus
tachycardia
INDICATION for INdirect cholinergic agonist
Myasthenia Gravis
Alzheimer
ANTICHOLINERGIC’s ACTION is to
Blocks
neurotransmitter AcH
(against the PNS)
