Pharm Block 1 (PNS - Cholinergic Agonist)

Question 1

DUMBBELLS

Answer 1

D - Defecation (diarrhea)
U - Urination
M - Miosis (constriction of the pupil of the eye)
B - Bradycardia
B - Bronchospasm (difficulty breathing)
E - Emesis
L - Lacrimation (tearing)
L - Lethargy
S - Salivation (excessive drooling)

Question 2

SLUDE

Answer 2

S - Salvation
L - Lacrimation
U - Urination
D - Diarrhea (bowel movement)
E - Excessive emesis/excretion

Question 3

Eye

Answer 3

• Miosis
• Tear (Lacrimation)
• Increase intraocular pressure (IOP)
• accommodation changes

Question 4

Cardiovascular

Answer 4

• Decrease chronotrope (decreases conduction velocity thru AV node)
• Decreases inotrope

Question 5

Respiratory

Answer 5

• Bronchoconstriction

- Increases secretions

Question 6

GI

Answer 6

Increase

• saliva
• gastric
• peristalsis
• sphincter relaxation (defecate/emesis)

Question 7

GU (Genitourinary)

Answer 7

• Detrusor muscle contracts

- Urinate

Question 8

Secretary glands

Answer 8

• Salivate
• Sweat
• lacriminate
• rhinorrhea

Question 9

Major Therapeutic Uses of Cholinomimetics

Answer 9

-Anti-cholinergic overdose
-Glaucoma (optic nerve damage often secondary to increase IOP)
-Alzheimer’s Disease
-At the Neuromuscular Junction
A. Myasthenia Gravis (weakness of the voluntary skeletal muscles secondary antibodies that block Ach Nm receptors)

Question 10

Contraindications and Warnings

Eye

Answer 10

Caution during night time driving

Question 11

Contraindications and Warnings

Cardiovascular

Answer 11

Do NOT use in px w/ bradycardia or hypotension (decrease rate and BP)

Question 12

Contraindications and Warnings

Respiratory

Answer 12

Do NOT use in px w/ asthma

Question 13

Contraindications and Warnings

GI

Answer 13

Do NOT use in px w/ peptic ulcer disease or GI obstructions (increase secretions and peristalsis)

Question 14

Contraindications and Warnings

GU

Answer 14

Do NOT use in px w/ GU obstructions (increase contractions)

Question 15

Contraindications and Warnings

Misc

Answer 15

Do NOT use in px w/ Parkinson’s

Disease (worsens disease)

Question 16

Cholinergic Effects on the Eye

What receptors are involved in this effect?

What are the cholinergic effects on the Eyes?

What is the clinical use?

Answer 16

Muscarinic Receptors (M3)

• Miosis/pinpoint pupils
• bulge of lens; near vision
• reduction in intraocular pressure

-Refractive measurements and ophthalmoscopes examination of the retina and other structure of the eye

Ex Drug: Pilocarpine

Question 17

Ach: low clinical utility for what reasons?

Answer 17

• Poor bioavailability
• Rapidly hydrolyzed in the GI tract
• Quickly inactivated by AChE(enzyme)
• Non-specific for nicotinic or muscarinic receptors

Question 18

What is another name of Indirect-Acting Cholinergic Agents?

Answer 18

Acetylcholinesterase Inhibitors

Question 19

1. Major neurotransmitter in the PNS
2. Also major neurotransmitter outside the PNS

• in the CNS (Alzheimer’s Parkinson’s Disease)
• at the GANGLIA within the PNS and SNS
• in the SOMATIC nervous system

Answer 19

ACh

Question 20

Alzheimer’s Disease

Answer 20

-the progression of the disease can be slowed (not reversed) by drugs that increase the concentrations of ACh in the CNS

Question 21

4 drugs (AChE inhibitors) for Alzheimer’s Disease

Answer 21

• Tacrine (Cognex): Multiple daily dosing, Hepatotoxic
• Donepezil (Aricept): Daily dosing preferred
• Galantamine (Razadyne)
• Rivastigmine (Exelon): Patch may be better tolerated

CARE

Question 22

Ganglionic Stimulants

Nicotine

Low Dose:

High Dose:

Answer 22

Low Dose: depolarizer (stimulates) autonomic ganglia —> euphoria and arousal

High Dose: Blocks the autonomic ganglia —> decreased BP and possibly respiratory paralysis