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Pharm 1 > parasympathetic nervous system (cholinergic) > Flashcards

parasympathetic nervous system (cholinergic) Flashcards

1
Q

describe the PNS

A

regulates our “rest and digest” maintenance and promotes balance in the nervous system (opposite of SNS)

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2
Q

what physiological effects occur when PNS is activated

A
  • dilation of blood vessels
  • decreased HR
  • increased secretion of digestive enzymes/gastric motility/digestion
  • pupil constriction
  • contraction of smooth muscle in urinary bladder
  • contraction of skeletal muscle
  • constriction of bronchioles in lungs and increased lung secretions
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3
Q

what is the primary neurotransmitter in the parasympathetic nervous system

A

Acetylcholine (Ach)

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4
Q

describe Ach

A
  • former in cholinergic nerve endings/located in the brain, ANS, and neuromuscular junctions
  • exerts excitatory effects at nerve synapse and NMJ
  • inhibits effects at peripheral sites, including cardiac (resulting in a decrease HR)
  • Ach synapse is broken down by acetylcholinesterase (AchE)/cholinesterase (choline is taken up by presynaptic neuron to make more Ach)
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5
Q

name two cholinergic receptors

A
  • nicotinic
  • muscarinic
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6
Q

where are nicotinic receptors located

A

located in CNS motor nerves and skeletal muscle and adrenal medulla

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7
Q

what happens when nicotinic receptors are activated by Ach

A
  • causes cell membrane depolarization which produces muscle contraction
  • release of epinephrine from adrenal medulla
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8
Q

where are muscarinic receptors located

A

located in most internal organs (cardiac, respiratory, GI and GU)

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9
Q

what happens when muscarinic receptors are activated by Ach

A
  • excites or inhibits
  • lungs - bronchioles are constricted
  • heart - decrease HR
  • GI - increased peristalsis and secretions
  • GU - bladder contracts
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10
Q

blockage of cholinergic receptors produces…

A

anticholinergic effects

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11
Q

describe nicotinic receptors

A
  • bind nicotine
  • blocked by curare
  • linked to ionic channels
  • response is brief and fast
  • located at neuromuscular junctions, autonomic ganglia, and to a small extent in the CNS
  • mediate excitation in target cells
  • postsynaptic
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12
Q

describe muscarinic receptors

A
  • bind muscarine
  • blocked by atropine
  • linked to 2nd messenger systems through G proteins
  • response is slow and prolonged
  • found in myocardial muscles, certain smooth muscle, and discrete CNS regions
  • mediate inhibition and excitation in target cells
  • both pre and post synaptic
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13
Q

describe direct acting cholinergic drugs

A
  • bind to and activate cholinergic receptors
  • highly resistant to metabolism - longer duration of action
  • widespread systemic effects: decrease HR, vasodilation = decrease in BP
  • increase bladder tone, bronchiole smooth muscle, tone and contractility, salivary secretions, upper sphincter and GI relaxation
  • miosis (excessive pupil contriction)
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14
Q

why do cholinergic drugs have few drug applications

A

high potential for adverse effects

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15
Q

describe indirect acting cholinergic drugs

A

–cause release of the neurotransmitter

  • inhibit reuptake or destruction of Ach
  • inhibits the action of AchE
  • cholinergic effect
  • improves skeletal muscle tone and strength
  • improves acetylcholine neurotransmission
  • either reversible or irreversible acetylcholinesterase inhibitors
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16
Q

what are cholinergic drugs used in the treatment of

A
  • myasthenia gravis
  • alzheimers
  • GI and urinary smooth muscle atony
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17
Q

name some cholinergic/anticholinergic drug classifications

A
  • cholinergic
  • parasympathomimetic
  • cholinergic agonist
  • parasympatholytic
  • cholinergic antagonist
  • cholinergic blocker
  • nicotinic agonist/nicotinic antagonist
  • muscarinic agonist/muscarinic antagonist
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18
Q

what type of drugs mimic the effect of acetylcholine

A
  • parasympathomimetics
  • cholinergic agonists
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19
Q

what types of drugs block the effects of acetylcholine

A
  • parasympatholytics
  • cholinergic blockers AKA cholinergic antagonists (anticholinergic)
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20
Q

what are some indications for use of cholinergic drugs

A
  • urinary retention
  • myasthenia gravis diagnosis and treatment
  • alzheimers disease
  • glaucoma
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21
Q

describe myasthenia gravis

A
  • chronic autoimmune neuromuscular disease characterized by varying degrees of painless weakness of the skeletal muscles of the body
  • breakdown in communication between muscles and nerves
  • symptoms may include arm and leg weakness as well as speech and chewing difficulties
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22
Q

name two specific medications that are direct acting parasympathomimetics

A
  • bethanechol
  • carbachol
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23
Q

name two specific medications that are indirect parasympathomimetics

A
  • donepezil (aricept)
  • pyridostigmine
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24
Q

describe bethanechol

A
  • direct acting parasympathomimetic
  • cholinergic agonist/synthetic muscarine stimulant
  • increases detrusor tone → contraction → micturition → bladder emptying
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25
Q

describe carbachol

A
  • direct acting parasympathomimetic
  • cholinergic agonist
  • used for glaucoma tx
  • causes miosis → constriction → fluid excretion → decrease intraocular pressure
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26
Q

describe donepezil (aricept)

A
  • indirect acting parasympathomimetic
  • selective acetylcholinesterase inhibitor (stops enzyme that breaks down acetylcholine = more acetylcholine)
  • used for treatment of confusion in alzheimer patients
  • increasing levels of available acetylcholine may compensate for loss of functioning cholinergic brain cells
27
Q

describe pyridostigmine

A
  • indirect acting parasympathomimetic
  • acetylcholinesterase inhibitor (i.e. anticholinesterase)
  • used for treatment of myasthenia gravis
28
Q

name side effects of parasympathomimetics

A
  • N/V/D
  • involuntary defacation
  • increased salivation
  • watery eyes
  • HA and dizziness
  • irregular heartrate, bradycardia
  • wheezing and/or breathing problems
  • urinary urgency
29
Q

what are some nursing concerns r/t to the side effect of N/V/D with parasympathomimetics

A
  • ginger ale
  • antiemetic
  • fluid volume status (intake and output)
  • mobility
30
Q

what are some nursing concerns r/t to the side effect of involuntary defecation with parasympathomimetics

A
  • mobility
  • skin integrity
  • dignity
31
Q

what are some nursing concerns r/t to the side effect of increased salivation with parasympathomimetics

A

drooling and dentures fitting

32
Q

what are some nursing concerns r/t to the side effect of watery eyes with parasympathomimetics

A

infection

33
Q

what are some nursing concerns r/t to the side effect of HA and dizziness with parasympathomimetics

A
  • pain scale
  • fall risks (mobility)
34
Q

what are some nursing concerns r/t to the side effect of irregular HB or bradycardia with parasympathomimetics

A
  • telemetry monitoring
  • vitals
  • fluid volume
35
Q

what are some nursing concerns r/t to the side effect of wheezing and/or breathing problems with parasympathomimetics

A
  • pulse ox
  • o2
  • bronchodilators
36
Q

what are some nursing concerns r/t to the side effect of urinary urgency with parasympathomimetics

A
  • fall risks
  • impulsiveness
  • mobility
  • skin integrity
  • dignity
  • bed/chair alarms
37
Q

because cholinergic drugs increase contractility of smooth muscle, they are contraindicated in…

A
  • urinary or GI tract obstruction
  • asthma
  • peptic ulcer disease
  • inflammatory abdominal conditions, recent bowel surgery
  • coronary artery disease
  • hypertyroidism
  • pregnancy
  • hepatic or renal impairment
38
Q

what drugs do cholinergic drugs interact with (resulting in contraindication of use)

A

interact with NSAIDs and theophylline

39
Q

which is use more commonly? parasympathomimetics or parasympatholytics?

A

parasympatholytics

40
Q

parasympatholytics are medications that block…

A

the parasympathetic nervous system

(ie. anticholinergics)

41
Q

name some specific medication examples of parasympatholytics

A
  • atropine
  • dicyclomine, propantheline
  • meclizine, scopolamine
  • glycopyrrolate
  • ipratropium, tiotropium
42
Q

describe atropine

A
  • parasympatholytic (anticholinergic)
  • emergency medication used for patients with low HR, also used in OR to reduce salivation
  • stimulates HR, reduces salivation and GI spasms
  • side effects are opposite of cholinergic
43
Q

describe dicyclomine

A
  • parasympatholytic (anticholinergic)
  • GI antispasmotic
  • used in treatment of IBS
44
Q

describe propantheline

A
  • parasympatholytic (anticholinergic)
  • antimuscarinic
  • tx of excessive sweating, can be used for GI spasms and cramps, involuntary urination, and IBS
45
Q

describe meclizine

A
  • parasympatholytic (anticholinergic)
  • antihistamine
  • tx of motion sickness and vertigo
  • commonly used medication
46
Q

describe scopolamine

A
  • parasympatholytic (anticholinergic)
  • med that blocks Ach, anticholinergic side effect
  • can be given as a patch (educate pt on changing patch sites)
  • treatment for motion sickness, decreases N and V
47
Q

describe glycopyrrolate

A
  • parasympatholytic (anticholinergic)
  • decreases oral secretions on vented pts (used in ICU)
  • also can be used for pts with neurological issues
48
Q

describe ipratropium

A
  • parasympatholytic (anticholinergic)
  • blocks muscarinic receptors
  • opens airways and causes bronchodilation
49
Q

describe tiotropium

A
  • parasympatholytic (anticholinergic)
  • anticholinergic for COPD
  • works as bronchodilator
50
Q

when cholinergic receptors are blocked it allows…

A

sympathetic system to dominate

51
Q

what is the goal of parasympatholytics

A

control symptoms, maintain functional ability, minimize adverse drug effects, and slow disease progressions

52
Q

name some parasympatholytic/anticholinergic drug uses

A
  • GI disorders (antispasmodic in GI system)
  • ophthalmic procedures
  • cardiac rhythm abnormalities
  • pre anesthesia (decrease oral secretions)
  • asthma: bronchodilation
  • overactive bladder: smooth muscle relaxation (prototype drug: tolterodinem)
53
Q

what are some side effects of parasympatholytics/anticholinergics

A
  • tachycardia, HTN
  • CNS stimulation, confusion
  • constipation, urinary retention
  • dry mouth and eyes
  • inhibition of sweating
  • photophobia (light sensitivity) , blurred vision, increase intraocular pressure
  • weakness and dizziness
54
Q

what are some nursing concerns r/t the side effect of tachycardia/HTN with parasympatholytics

A
  • telemetry monitoring
  • vitals
  • fluid volume
55
Q

what are some nursing concerns r/t the side effect of CNS stimulation and confusion with parasympatholytics

A
  • neuro checks
  • safety
56
Q

what are some nursing concerns r/t the side effect of constipation and urinary retention with parasympatholytics

A
  • increase fruits and fiber
  • hydration
  • I&O
  • bladder scan
57
Q

what are some nursing concerns r/t the side effect of dry mouth and eyes with parasympatholytics

A
  • oral care
  • saline drops
58
Q

what are some nursing concerns r/t the side effect of inhibition of sweating with parasympatholytics

A
  • temp control
  • monitoring
  • adjust environmental temperature
59
Q

what are some nursing concerns r/t the side effect of photophobia, blurred vision, increased IOP with parasympatholytics

A
  • dim lighting
  • safety
  • physician notification
  • increased intraocular pressure may manifest as a headache
60
Q

what are some nursing concerns r/t the side effect of weakness/dizziness with parasympatholytics

A
  • safety
  • physical and occupational therapy
  • increased rounding
61
Q

what are some contraindications of anticholinergic medications

A
  • glaucoma
  • GI conditions
  • BPH or bladder obstructions
  • cardiac arrhythmias, tachycardia, MI history
  • renal or hepatic impairment
62
Q

what drugs may interact and cause contraindications of anticholinergics

A
  • antihistamines
  • antiparkinson drugs
  • MAOIs
  • TCAs
63
Q

describe physostigmine

A
  • used to reverse the effects of certain drugs or substances that interfere with nerve muscle communication
  • tx of severe anticholinergic toxicity
  • ie. anticholinergic drugs such as atropine, scopolamine, belladonna, antihistamines, and some antidepressants, etc

Pharm 1 (29 decks)

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