Exam 1: Chapter 20: Cholinergic Drugs

Question 1

Parasympathetic Nervous System

Answer 1

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

Question 2

Cholinergic Drugs

Answer 2

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

Question 3

Two Types of Cholinergic Receptors

Answer 3

Based on location and action once stimulated

1. Nicotinic Receptors
2. Muscarinic receptors

Question 4

Nicotinic Receptors

Answer 4

located in the ganglia of both the PSNS and SNS

named nicotinic because they can be stimulated by the alkaloid nicotine

Question 5

Muscarinic Receptors

Answer 5

• 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

Question 6

Cholinergic Drugs (Direct-acting cholinergic agonists): MOA

Answer 6

bind to cholinergic receptors, activating them

Question 7

Cholinergic Drugs (Indirect-acting cholinergic agonists): MOA

Answer 7

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

Question 8

Indirect-Acting (Cholinesterase Inhibitors)

Answer 8

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)

Question 9

Drugs Effects

Answer 9

Stimulates intestine and bladder
Stimulates pupils
Increased salivation and sweating
Cardiovascular effects
Respiratory effects

Question 10

How do cholinergic drugs affect the intestine and bladder?

Answer 10

increases gastric secretions
increases gastrointestinal motility
increases urinary frequency

Question 11

How do cholinergic drugs affect the pupils?

Answer 11

constriction (miosis)

reduces intraocular pressure

Question 12

What cardiovascular effects do cholinergic drugs have?

Answer 12

decreased heart rate

vasodilation

Question 13

What respiratory effects do cholinergic drugs have?

Answer 13

bronchial constriction

narrowed airways

Question 14

At recommended doses, cholinergics primarily affect

Answer 14

muscarinic receptors

Question 15

At high doses, cholinergics stimulate

Answer 15

nicotinic receptors

Question 16

Desired effects are from

Answer 16

muscarinic receptor stimulation

Question 17

Many undesirable effects are caused by stimulation of

Answer 17

nicotinic receptors

Question 18

Contraindications for Cholinergic Drugs

Answer 18

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

Question 19

Indications for Direct-acting drugs

Answer 19

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

Question 20

Bethanechol

Answer 20

direct-acting drug

oral dose or SQ

Question 21

How does bethanechol work?

Answer 21

increases tone and motility of bladder and GI tract

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

Question 22

Bethanechol is helpful for

Answer 22

postsurgical atony of the bladder and GI tract

Question 23

Cevimeline

Answer 23

direct acting drug

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

Question 24

Succinylcholine

Answer 24

direct acting drug

used as a neuromuscular blocker in general anesthesia

Question 25

Indications for indirect-acting drugs

Answer 25

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

Question 26

Indirect-acting anticholinesterase drugs

Answer 26

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

Question 27

Adverse Effects: Cardiovascular

Answer 27

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

Question 28

Adverse Effects: CNS

Answer 28

headache, dizziness, convulsions, ataxia

Question 29

Adverse Effects: GI

Answer 29

abdominal cramps, increased secretions, nausea and vomiting

Question 30

Adverse Effects: Respiratory

Answer 30

increased bronchial secretions, bronchospasms

Question 31

Other Adverse Effects

Answer 31

lacrimation, sweating, salivation, miosis

Question 32

Interactions

Answer 32

anticholinergics, antihistamines, sympathomimetics | other cholinergic drugs (additive effects)

Question 33

Herbal Products: Ginko Uses

Answer 33

prevents memory loss vertigo tinnitus

Question 34

Gingko may cause

Answer 34

GI upset, headache and bleeding

Question 35

Gingko: Potential Interactions

Answer 35

aspirin NSAIDs Anticoagulants Anticonvulsants

Question 36

Cholinergic Crisis

Answer 36

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

Question 37

Early signs of Cholinergic Crisis

Answer 37

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

Question 38

Cholinergic Crisis: Treatment in early phase

Answer 38

atropine (a cholinergic antagonist)

Question 39

Cholinergic Crisis: Treatment of severe cardiovascular reactions of bronchoconstriction

Answer 39

epinephrine (adrenergic agonist)

Question 40

Nursing Implications

Answer 40

- 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

Question 41

Encourage patients with myasthenia gravis to

Answer 41

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

Question 42

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

Answer 42

6 weeks

Question 43

Atropine is the antidote for

Answer 43

cholinergics

Question 44

Monitor for therapeutic effects: myasthenia gravis

Answer 44

alleviated signs and symptoms of myasthenia gravis

Question 45

In postoperative patients with decreased GI peristalsis, monitor for

Answer 45

increased bowel sounds passage of flatus occurrence of bowel movements

Question 46

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

Answer 46

urination should occur within 60 minutes of bethanechol administration

Question 47

Monitor for therapeutic effects in patients with alzheimer's disease

Answer 47

improvement in symptoms | improvement in mood and decrease in confusion