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Phamacology Summer > PART 2: PARASYMPATHETIC DIVISION > Flashcards

PART 2: PARASYMPATHETIC DIVISION Flashcards

1
Q

Parasympathetic/Cholinergic Drugs

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Bethanechol

Pyridostigmine

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2
Q

Anti-Cholinergic Drugs

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine- – SOFT Bladder
Pyridostigmine

A

Atropine

Oxybutynin, Solifenacin, Tolterodine- – SOFT Bladder

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3
Q

Parasympathetic/Cholinergic Drugs- Direct Acting:

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Bethanechol

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4
Q

Parasympathetic/Cholinergic Drugs- Indirect Acting:

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

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5
Q

“Rest and Digest” system

Para or Sympathic

A

Para

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6
Q

keeping energy use low in the body

Para or Sympathic

A

Para

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7
Q

D activities – digestion, defecation, and
diuresis

Para or Sympathic

A

Para

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8
Q

Blood pressure, heart rate, and respiratory rates are low

Para or Sympathic

A

Para

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9
Q

Gastrointestinal tract activity is high

Para or Sympathic

A

Para

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10
Q

The skin is warm and the pupils are constricted (miosis)

Para or Sympathic

A

Para

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11
Q

Produce effects that mimic Acetylcholine (ACh)

Direct Acting Agents or Indirect Acting Agents

A

Direct Acting Agents

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12
Q

Are typically agonists at Muscarinic receptors

Direct Acting Agents or Indirect Acting Agents

A

Direct Acting Agents

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13
Q

inhibit acetylcholinesterase, an enzyme that breaks
down acetylcholine

Direct Acting Agents or Indirect Acting Agents

A

Indirect Acting Agents

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14
Q

– Nicotinic
– Muscarinic

Parasympathetic Division Receptors
Sympathetic Division Receptors

A

Parasympathetic Division Receptors

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15
Q

Drugs for anesthesia/paralyzing agents

Nicotinic
Muscarinic

A

Muscarinic

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16
Q

• Important for ED, ICU, OR, Anesthesia

Nicotinic
Muscarinic

A

Muscarinic

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17
Q

• We will treat as a separate group

Nicotinic
Muscarinic

A

Muscarinic

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18
Q

USED TO TREAT
Urinary retention

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Bethanechol

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19
Q 
Most ? drugs target:
– GI Tract
– Eyes
– Bladder
– Heart (smaller percentage)

cholinergic or adrenaline drugs

A

cholinergic

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20
Q

MECHANISM OF ACTION:
• Directly stimulate the parasympathetic division (muscarinic)
receptors) mainly located in the BLADDER

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Bethanechol

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21
Q 
Match 
LOCK: ?
AGONISTS-?
KEY: ?
DRUG: ?

BethaneCHOL
Stimulate a response
Muscarinic Receptor
Natural-AcetylCHOLINE

A

LOCK: Muscarinic Receptor
AGONISTS-stimulate a response
KEY: Natural-AcetylCHOLINE
DRUG: BethaneCHOL

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22
Q

Do BOTH DRUG AND KEY WILL BIND TO SAME RECEPTOR (MUSCARINIC) focused on the BLADDER

T or F

A

T

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23
Q

ADVERSE EFFECTS
Increased salivation, gastric acid secretion, abdominal
cramps and diarrhea
– Exacerbation of asthma

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

BethaneCHOL

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24
Q

ADVERSE EFFECTS
EXTREMELY RARE: hypotension and/or bradycardia

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

BethaneCHOL

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25
Q

Increased BP/HR

Sympathetic or PARAsympathetic

A

Sympathetic

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26
Q

Decreased BP or HR

Sympathetic or PARAsympathetic

A

PARAsympathetic

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27
Q 
SLUDGE and the Killer B's
• Salivation/Secretions
• Lacrimation (tear production)
• Urination
• Defecation/Diarrhea
• GI cramping (abdominal)
• Emesis (vomiting)
• Bradycardia, Bronchospasm, Bronchorrhea

cholinergic or adrenaline drugs

A

cholinergic Drugs

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28
Q 
DUMBELS
• Diarrhea
• Urination
• Miosis (pupil constriction)
• Bradycardia/Bronchospasm/Bronchorrhea
• Emesis
• Lacrimation
• Salivation

cholinergic or adrenaline drugs

A

cholinergic Drugs

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29
Q 
S
L
U
D
G
E 
B*3-
  • Diarrhea
  • Salivation/Secretions
  • Lacrimation (tear production)
  • Urination
  • Miosis (pupil constriction)
  • Defecation/Diarrhea
  • GI cramping (abdominal)
  • Emesis (vomiting)
  • Bradycardia, Bronchospasm, Bronchorrhea
A 
SLUDGE and the Killer B's
• Salivation/Secretions
• Lacrimation (tear production)
• Urination
• Defecation/Diarrhea
• GI cramping (abdominal)
• Emesis (vomiting)
• Bradycardia, Bronchospasm, Bronchorrhea
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30
Q 
D
U
M
B
E
L
S
  • Diarrhea
  • Salivation/Secretions
  • Lacrimation (tear production)
  • Urination
  • Miosis (pupil constriction)
  • Defecation/Diarrhea
  • GI cramping (abdominal)
  • Emesis (vomiting)
  • Bradycardia, Bronchospasm, Bronchorrhea
A 
DUMBELS
• Diarrhea
• Urination
• Miosis (pupil constriction)
• Bradycardia/Bronchospasm/Bronchorrhea
• Emesis
• Lacrimation
• Salivation
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31
Q

Antidote= Atropine

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

BethaneCHOL

Pyridostigmine

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32
Q

SLUDGE and the Killer B’s or DUMBELS =>CHOLINERGIC CRISIS

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

BethaneCHOL

Pyridostigmine

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33
Q

Exacerbation of asthma

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

BethaneCHOL

Pyridostigmine

34
Q

EXTREMELY RARE: hypotension and/or bradycardia

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

BethaneCHOL

Pyridostigmine

35
Q

GI concern- give 1 hour before or 2 hours after a meal

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

BethaneCHOL

Pyridostigmine

36
Q

USED TO TREAT
• Myasthenia Gravis

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

37
Q

USED TO TREAT
Reverse effects of Neuromuscular Blocking Agents

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

38
Q

USED TO TREAT
• Pre-treatment for exposure to nerve gas (military)

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

39
Q

Can be used for Alzheimer’s Disease

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

40
Q

• Reverse Anticholinergic Effects

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

41
Q

Directly stimulate the parasympathetic division (muscarinic receptors) mainly located in the BLADDER

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Bethanechol

42
Q

Inhibits acetylcholinesterase, thereby increasing
acetylcholine’s activity in the parasympathetic system

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

43
Q

ADVERSE EFFECTS
– SLUDGE
– Vital Signs (drop in BP and/or HR)
– Cholinergic Crisis!

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

44
Q

ADVERSE EFFECTS
– Cholinergic Crisis!

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Pyridostigmine

Organophosphates/Carbamates

45
Q

Reversal of NMB- Improve breathing status/respiratory function

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine

A

Pyridostigmine

46
Q

Alzheimer’s Disease- maintain cognition

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Pyridostigmine

47
Q

Myasthenia Gravis-recovery of muscle strength

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Pyridostigmine

48
Q

• Watch out for Cholinergic Crisis- concern is respiratory blockade

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Pyridostigmine

Organophosphates/Carbamates

49
Q

POISONINGS

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Organophosphates/Carbamates

50
Q

Insecticides (malathion)

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Organophosphates/Carbamates

51
Q

Nerve Gas- V agents (VX), Sarin

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Organophosphates/Carbamates

52
Q

MOA: acetylcholinesterase inhibitors,
potentially irreversible

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Organophosphates/Carbamates

53
Q

Can cause: Cholinergic Crisis

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Pyridostigmine

Organophosphates/Carbamates

54
Q

USED TO TREAT
– Symptomatic Bradycardia

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
55
Q

• USED TO TREAT
Poisoning by Cholinergic Drugs, Insecticides, Nerve Gas
• Known as “Cholinergic Crisis”

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
56
Q

• USED TO TREAT
Reduce Salivation and secretions (mucus)

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
57
Q

Used in the OR (to reduce secretions)

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
58
Q

Palliative Care, “Death Rattle”

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
59
Q

Hospitals Stockpile This Drug! Why?

1) ACLS
2) Antidote

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
60
Q

• (this medication increases the HR!)
– BLOCKS PARASYMPATHETIC (BLOCKS REST AND DIGEST)
– ALLOWS SYMPATHETIC TO TAKE CONTROL OF THE HEART (^^HR)
– HEART- BATTLE SYMPATHETIC VS PARASYMPATHETIC

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
61
Q

Antagonists at various muscarinic receptors in
the parasympathetic division of the body

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
62
Q

– Particularly the Heart! This allows the
sympathetic division to take control

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
63
Q

• (Yin and Yang) Opposition

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
64
Q 
ADVERSE EFFECTS:
Can’t See
Can’t Pee
Can't Spit
Can’t ****
Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Atropine

Oxybutynin, Solifenacin, Tolterodine

65
Q 
Atropine
ADVERSE EFFECTS:
Can’t ?
Can’t ?
Can't ?
Can’t ?
A

Can’t See
Can’t Pee
Can’t Spit
Can’t **

66
Q

*Contra-indicated in
Glaucoma

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Atropine

Oxybutynin, Solifenacin, Tolterodine

67
Q

*Contra-indicated
Benign Prostatic Hyperplasia

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Atropine

Oxybutynin, Solifenacin, Tolterodine - SOFT

68
Q

*Avoid in urinary
retention/hesitancy!

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Atropine

Oxybutynin, Solifenacin, Tolterodine

69
Q

• Blurred vision, dry eyes, increased IOP (CI in glaucoma!)
– Mydriasis- allow more light in at night
» Protect the eyes with sunglasses

– Can’t See (mydriasis)
– Can’t Spit (Xerostomia)
– Can’t **** (constipation)
– Confusion! (Benadryl like state!)
– Can’t Pee (Urinary retention/hesitation)
A

– Can’t See (mydriasis)

70
Q
  • Report a distended bladder!
  • Do not give in patients with enlarged prostate (BPH
– Can’t See (mydriasis)
– Can’t Spit (Xerostomia)
– Can’t **** (constipation)
– Confusion! (Benadryl like state!)
– Can’t Pee (Urinary retention/hesitation)
A

– Can’t Pee (Urinary retention/hesitation)

71
Q

– Sugar Free Gum/Candy (avoid sugar, if possible, to
reduce risk of cavities)
– Avoid Alcohol based mouthwash (use artificial saliva)

– Can’t See (mydriasis)
– Can’t Spit (Xerostomia)
– Can’t **** (constipation)
– Confusion! (Benadryl like state!)
– Can’t Pee (Urinary retention/hesitation)
A

– Can’t Spit (Xerostomia)

72
Q

Increase Fiber, Fluid intake! Exercise!

– Can’t See (mydriasis)
– Can’t Spit (Xerostomia)
– Can’t **** (constipation)
– Confusion! (Benadryl like state!)
– Can’t Pee (Urinary retention/hesitation)
A

– Can’t ** (constipation)

73
Q

Can’t sweat
• Risk for Hyperthermia
• Be careful outdoors

– Can’t See (mydriasis)
– Can’t Spit (Xerostomia)
– Can’t **** (constipation)
– Confusion! (Benadryl like state!)
– Can’t Pee (Urinary retention/hesitation)
A

– Confusion! (Benadryl like state!)

74
Q

– Avoid Alcohol based mouthwash (use artificial saliva)

– Can’t See (mydriasis)
– Can’t Spit (Xerostomia)
– Can’t **** (constipation)
– Confusion! (Benadryl like state!)
– Can’t Pee (Urinary retention/hesitation)
A

– Can’t Spit (Xerostomia)

75
Q

*Contraindicated in Glaucoma and BPH, urinary retention

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Atropine

Oxybutynin, Solifenacin, Tolterodine

76
Q

Too much anticholinergic activity (drying someone out), Lifespan consideration (Geriatrics))

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Atropine

Oxybutynin, Solifenacin, Tolterodine

77
Q

Can’t Sweat, don’t forget to expand upon the Toxidrome!

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
78
Q

Can’t See, Can’t Pee, Can’t Spit, Can’t **

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Atropine

Oxybutynin, Solifenacin, Tolterodine

79
Q 
USED TO TREAT
 Overactive Bladder (OAB)
Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Oxybutynin, Solifenacin, Tolterodine

80
Q

USED TO TREAT
Urinary Incontinence

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Oxybutynin, Solifenacin, Tolterodine

81
Q

– SOFT Bladder=

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Oxybutynin, Solifenacin, Tolterodine

82
Q

NURSING CONSIDERATIONS:
Overactive Bladder (OAB)- patients should have
decrease in urinary urgency/frequency, nocturia

Atropine
Bethanechol
Oxybutynin, Solifenacin, Tolterodine
Pyridostigmine
Organophosphates/Carbamates
A

Oxybutynin, Solifenacin, Tolterodine

Phamacology Summer (48 decks)

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