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Nursing 2590 > Exam 1 Chapter 16 Cholinergics > Flashcards

Exam 1 Chapter 16 Cholinergics Flashcards

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1
Q

Parasympathetic Nervous System (PNS)
also known for its action of _____

A

Rest and Digest

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2
Q

Cholinergic Nervous System
same as the ________ Nervous System

A

Cholinergic Nervous System =
Parasympathetic Nervous System

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3
Q

What is the main neurotransmitter of the PNS?

A

Acetylcholine AcH

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4
Q

Drugs that affect the ChNS are ___
Drugs that block the ChNS are ____

A

agonist and antagonists

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5
Q

Adrenergic =
Cholinergic =

A

Adrenergic = SNS.
attached to adrenaline

Cholinergic = PNS.
Choline AcH

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6
Q

If PNS is dominant,
What are the main responses.

A

Increase in peristalsis/digestion
Increase in bladder contraction/urination
Vasodilation/dec. HR

Restorative and Elimination

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7
Q

What are the two cholinergic receptors?

A

Muscarinic receptors (smooth muscle)
Remember the M bladder, kidney

Nicotinic receptors (skeletal muscle)

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8
Q

PSN Global Effects

A

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.

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9
Q

Function of PNS -

A

To help body restore itself and eliminate waste

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10
Q

What does acetylcholinesterase (AChE) do?

A

Breaks down AcH after it performs its function

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11
Q

What are the two type of cholinergic AGONISTS?
AGONISTS perform a desired function

A

Direct and Indirect Acting

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12
Q

What are DIRECT ACTING CHOLINERGIC AGONISTS

A

Drugs act directly on the muscarinic or nicotinic receptors

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13
Q

What is a parasympathomimetic?

A

Drugs that are direct acting Cholinergic agonist

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14
Q

What are INDIRECT ACTING CHOLINERGIC AGONISTS?

A

Drugs that inhibit AChE - allow more AcH to reach the receptors. ACETYLCHOLINESTERASE INHIBITORS

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15
Q

Name 3 DIRECT ACTING CHOLINERGIC AGONISTS

A

Metoclopramide (Reglan) increases stomach emptying relieves N/V
Pilocarpine (eye drops) - releases fluid
Bethanechol chloride (urinary retention) Urecholine, Muscaran, Durvoid

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16
Q

What is the action of Metoclopramide?

A

Metoclopramide is a DIRECT acting Cholinergic agonist
inc. peristalsis
inc. gastric emptying
Used post-surgery for constipation
“Think Meto/Metro - moves things”

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17
Q

What is the action of Pilocarpine?

A

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

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18
Q

Bethanechol chloride

A

BethaneCHOL chloride:
DIRECT ACTING CHOLinergic AGONIST
USED to DECREASE urinary retention
inc. bladder contraction and relaxes the sphincter
“Think “CHOL - cholinergic”

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19
Q

3 Indications for
INDIRECT Cholinergic AGONISTS

A

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

  1. Myasthenia Gravis -less receptors or AcH. Neostigmine (inc. Secretions)
  2. Alzheimer - donepezil (aricept)
  3. Glaucoma -
    In these diseases not enough receptors for AcH
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20
Q

3 Indications for
DIRECT cholinergic Agonists

A

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

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21
Q

Myasthenia Gravis
antibodies decrease receptors for AcH
What drug do you give?

A

Indirect acting cholinergic agonist -
so gets more AcH to them
NEOSTIGMINE

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22
Q

Side Effects of
INDIRECT Cholinergic agonists

A

Too much SEE/PEE/Poop
Inc. Salvation
Blurred vision
bradycardia
diarrhea - too much peristalsis
abdominal cramping
bronchoconstriction
inc urination

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23
Q

Contraindications of
INDIRECT cholinergic agonists

A

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

24
Q

Nursing interventions for
Myasthenia Gravis meds

A

Make sure medications must be given ON TIME,
if not, symptoms can occur

25
Q

Nursing interventions for indirect cholinergic agonists

A

bowel sounds (too much)
BP
HR (too low
I and O (too much)

26
Q

Too much AcH is a cholinergic crisis
what is the acronym?

A

Sludge

27
Q

What is SLUDGE?
Name what it stands for
Secretion Crisis

A

Salivation
Lacrimation
Urination
Defecation
Gastritis
Emesis
Can result in respiratory distress

28
Q

ANTICHOLINERGIC’s Action is…..

A

Inhibit action of AcH by occupying AcH receptors

29
Q

Name 1 Anticholinergic DRUG

A

ATROPINE treats cholinergic crisis A Tro PINE
Tolerodine
Benzotropine
Common ending “PINE”

30
Q

When is an anticholinergic drug used?

A

Pre-op (dec broncho secretions and secretions)
peptic ulcer (dec. Gastric secretions)
sympathometic bradycardia
cholinergic overdose - SLUDGE
IBS
Why? decrease secretions

31
Q

What does an anticholinergic drug do?

A

Inhibit Rest and Digest
Dec. secretions
inc heart rate
inc. contractility of the heart

32
Q

Too much AntiCholinergic drugs will cause ____
Think fight or flight

A

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

33
Q

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

A

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

34
Q

Anticholinergic

A

Turning off the PNS to stop secretions, turn on SNS

35
Q

Difference between SNS and PNS

A

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

36
Q

contraindications for anti chol

A

glaucoma

37
Q

What does MIOSIS mean

A

constriction of the pupils
“think - My I can’t See”

38
Q

Bethanechol Chloride is
What type of drug
where are receptors located?

A

DIRECT acting cholinergic
RECEPTORS are in the Bladder, promotes detrusor to contract and urination.
B for Bethanechol. C for Cholinergic

39
Q

çontraindications for Bethanechol Chloride

A

urinary obstruction, IBS, hypotension, parkinsonians

40
Q

SNS stimulants will do what to
BP
HR

A

increase BP and HR

41
Q

SNS stimulants will do what to bronchioles?

A

Relax bronchioles

42
Q

SNS stimulants will do what to eye pupils?

A

Dilate eye pupils

43
Q

SNS stimulatants will do what to uterine muscles?

A

Relax uterine muscles

44
Q

SNS stimulants will do what to blood glucose?

A

Increase blood glucose

45
Q

PINE is the ending for what class of drugs?

A

ANTICHOLINERGIC
example ATROPINE
“Think PINE ENDS DINE (rest and digest)”

46
Q

DIRECT ACTING CHOLINERGIC AGONIST
MUSCARINIC side effects

A

low bp
tachy
excessive salivation
inc. acid secretion, diarrhea
bronchospasm

47
Q

ANTICHOLINERGIC MEDS REACTIONS
Block effects of AcH

A

Where am I? confusion.
Up high? tachy
Can’t See photophobia
Cant’ Pee urinary retention
No Stool - constipation
No Drool - dry mouth

48
Q

Anticholinergics are not good for what population?

A

Elderly - as can cause confusion - so risk of falls

49
Q

Anticholinergics - what vital sign important to monitor?
(Up high)

A

Heart rate as can cause tachycardia

50
Q

What is main anticholinergic drug?

A

ATROPINE

51
Q

Patient teaching with Anticholinergics re photophobia
(can’t see)

A

Sunscreen
Hat
Sunglass
long sleeved shirt
limit time in sun to 15 minutes

52
Q

Anticholinergics - intervention for urinary retention
(can’t pee)

A

Void 30 minutes prior to taking their medication.

53
Q

Anticholinergics - intervention for constipation

A

Three F’s - increase
Function - exercise and movement
Fiber
Fluids
next stool softeners

54
Q

Anticholinergics - intervention for dry mouth

A

drink
sucking candies

55
Q

ANTICHOLINERGICS - DO NOT GIVE TO PATIENTS W
Inhibit AcH receptors - against the PSN

A

GLAUCOMA
increased IOP
Myasthenia Gravis - blocks AcH receptors
intestinal or Urinary blockage
paralytic ileus
tachycardia

56
Q

INDICATION for INdirect cholinergic agonist

A

Myasthenia Gravis
Alzheimer

57
Q

ANTICHOLINERGIC’s ACTION is to

A

Blocks
neurotransmitter AcH
(against the PNS)

Nursing 2590 (6 decks)

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