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NURS 320 > Exam 1: Chapter 20: Cholinergic Drugs > Flashcards

Exam 1: Chapter 20: Cholinergic Drugs Flashcards

1
Q

Parasympathetic Nervous System

A

receives innervation from cell bodies located in the cranial nerve nuclei and sacral region of the spinal cord (craniosacral division)

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2
Q

Cholinergic Drugs

A
  • aka parasympathomimetics
  • mimics effects of PSNS neurotransmitter acetylcholine (ACh)
  • stimulates PSNS
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3
Q

Two Types of Cholinergic Receptors

A

Based on location and action once stimulated

  1. Nicotinic Receptors
  2. Muscarinic receptors
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4
Q

Nicotinic Receptors

A

located in the ganglia of both the PSNS and SNS

named nicotinic because they can be stimulated by the alkaloid nicotine

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5
Q

Muscarinic Receptors

A
  • located postsynaptically in the effector organs of the PSNS (smooth and cardiac muscle, glands)
  • named muscarinic because they can be stimulated by the alkaloid muscarine
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6
Q

Cholinergic Drugs (Direct-acting cholinergic agonists): MOA

A

bind to cholinergic receptors, activating them

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7
Q

Cholinergic Drugs (Indirect-acting cholinergic agonists): MOA

A

Inhibits the enzyme acetylcholinesterase, which breaks down ACh
Results in more ACh available at the receptors

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8
Q

Indirect-Acting (Cholinesterase Inhibitors)

A

Reversible: binds to cholinesterase for a period of minutes to hours
Irreversible: binds to cholinesterase and form a permanent covalent bonds. (body must make new cholinesterase to break these bonds)

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9
Q

Drugs Effects

A 
Stimulates intestine and bladder
Stimulates pupils
Increased salivation and sweating
Cardiovascular effects
Respiratory effects
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10
Q

How do cholinergic drugs affect the intestine and bladder?

A

increases gastric secretions
increases gastrointestinal motility
increases urinary frequency

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11
Q

How do cholinergic drugs affect the pupils?

A

constriction (miosis)

reduces intraocular pressure

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12
Q

What cardiovascular effects do cholinergic drugs have?

A

decreased heart rate

vasodilation

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13
Q

What respiratory effects do cholinergic drugs have?

A

bronchial constriction

narrowed airways

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14
Q

At recommended doses, cholinergics primarily affect

A

muscarinic receptors

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15
Q

At high doses, cholinergics stimulate

A

nicotinic receptors

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16
Q

Desired effects are from

A

muscarinic receptor stimulation

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17
Q

Many undesirable effects are caused by stimulation of

A

nicotinic receptors

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18
Q

Contraindications for Cholinergic Drugs

A 
Drug Allergy
GI or GU tract obstruction
Bradycardia
Hyperthyroidism
Epilepsy
Hypotension
COPD
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19
Q

Indications for Direct-acting drugs

A
  • reduce intraocular pressure
  • useful for glaucoma and intraocular surgery (echothiophate, carbachol, pilocarpine)
  • topical application because of poor oral absorption
20
Q

Bethanechol

A

direct-acting drug

oral dose or SQ

21
Q

How does bethanechol work?

A

increases tone and motility of bladder and GI tract

relaxes sphincters in bladder and GI tract, allowing them to empty

22
Q

Bethanechol is helpful for

A

postsurgical atony of the bladder and GI tract

23
Q

Cevimeline

A

direct acting drug

used to treat excessively dry mouth resulting from a disordeer known as Sjogrens syndrome

24
Q

Succinylcholine

A

direct acting drug

used as a neuromuscular blocker in general anesthesia

25
Q

Indications for indirect-acting drugs

A

causes skeletal muscle contraction
used for diagnosis and treatment of myasthenia gravis
used for reverse neuromuscular blocking drugs
used to reverse anticholinergic poisoning (antidote)

26
Q

Indirect-acting anticholinesterase drugs

A

used for treatment of mild to moderate alzheimer’s disease (donepezil, galantamine, rivastigmine)

27
Q

Adverse Effects: Cardiovascular

A

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

28
Q

Adverse Effects: CNS

A

headache, dizziness, convulsions, ataxia

29
Q

Adverse Effects: GI

A

abdominal cramps, increased secretions, nausea and vomiting

30
Q

Adverse Effects: Respiratory

A

increased bronchial secretions, bronchospasms

31
Q

Other Adverse Effects

A

lacrimation, sweating, salivation, miosis

32
Q

Interactions

A

anticholinergics, antihistamines, sympathomimetics

other cholinergic drugs (additive effects)

33
Q

Herbal Products: Ginko Uses

A

prevents memory loss
vertigo
tinnitus

34
Q

Gingko may cause

A

GI upset, headache and bleeding

35
Q

Gingko: Potential Interactions

A

aspirin
NSAIDs
Anticoagulants
Anticonvulsants

36
Q

Cholinergic Crisis

A

circulatory collapse, hypotension, bloody diarrhea, shock and cardiac arrest
SLUDGE (salivation, lacrimation, urinary incontinence, diarrhea, GI gramps and emesis)

37
Q

Early signs of Cholinergic Crisis

A

abdominal cramps, salivation, flushing of the skin, N/V, transient syncope, transient complete heart block, dyspnea, and orthostatic hypotension

38
Q

Cholinergic Crisis: Treatment in early phase

A

atropine (a cholinergic antagonist)

39
Q

Cholinergic Crisis: Treatment of severe cardiovascular reactions of bronchoconstriction

A

epinephrine (adrenergic agonist)

40
Q

Nursing Implications

A
  • Assess for allergies, presence of GI or GU obstructions, asthma, peptic ulcer disease and CAD
  • Meds should not abruptly be stopped
  • Doses spread evenly apart
41
Q

Encourage patients with myasthenia gravis to

A

take medication 30 minutes before eating to help improve swalloing and chewing

42
Q

Therapeutic effects of anti-Alzheimer’s drugs may not occur for up to

A

6 weeks

43
Q

Atropine is the antidote for

A

cholinergics

44
Q

Monitor for therapeutic effects: myasthenia gravis

A

alleviated signs and symptoms of myasthenia gravis

45
Q

In postoperative patients with decreased GI peristalsis, monitor for

A

increased bowel sounds
passage of flatus
occurrence of bowel movements

46
Q

Monitor for therapeutic effects: in patients with urinary retention/hypotonic bladder

A

urination should occur within 60 minutes of bethanechol administration

47
Q

Monitor for therapeutic effects in patients with alzheimer’s disease

A

improvement in symptoms

improvement in mood and decrease in confusion

NURS 320 (28 decks)

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