Pharm Block 1 (PNS - Cholinergic Agonist) Flashcards
DUMBBELLS
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)
SLUDE
S - Salvation L - Lacrimation U - Urination D - Diarrhea (bowel movement) E - Excessive emesis/excretion
Eye
- Miosis
- Tear (Lacrimation)
- Increase intraocular pressure (IOP)
- accommodation changes
Cardiovascular
- Decrease chronotrope (decreases conduction velocity thru AV node)
- Decreases inotrope
Respiratory
- Bronchoconstriction
- Increases secretions
GI
Increase
- saliva
- gastric
- peristalsis
- sphincter relaxation (defecate/emesis)
GU (Genitourinary)
- Detrusor muscle contracts
- Urinate
Secretary glands
- Salivate
- Sweat
- lacriminate
- rhinorrhea
Major Therapeutic Uses of Cholinomimetics
-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)
Contraindications and Warnings
Eye
Caution during night time driving
Contraindications and Warnings
Cardiovascular
Do NOT use in px w/ bradycardia or hypotension (decrease rate and BP)
Contraindications and Warnings
Respiratory
Do NOT use in px w/ asthma
Contraindications and Warnings
GI
Do NOT use in px w/ peptic ulcer disease or GI obstructions (increase secretions and peristalsis)
Contraindications and Warnings
GU
Do NOT use in px w/ GU obstructions (increase contractions)
Contraindications and Warnings
Misc
Do NOT use in px w/ Parkinson’s
Disease (worsens disease)
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?
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
Ach: low clinical utility for what reasons?
- Poor bioavailability
- Rapidly hydrolyzed in the GI tract
- Quickly inactivated by AChE(enzyme)
- Non-specific for nicotinic or muscarinic receptors
What is another name of Indirect-Acting Cholinergic Agents?
Acetylcholinesterase Inhibitors
- Major neurotransmitter in the PNS
- 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
ACh
Alzheimer’s Disease
-the progression of the disease can be slowed (not reversed) by drugs that increase the concentrations of ACh in the CNS
4 drugs (AChE inhibitors) for Alzheimer’s Disease
- Tacrine (Cognex): Multiple daily dosing, Hepatotoxic
- Donepezil (Aricept): Daily dosing preferred
- Galantamine (Razadyne)
- Rivastigmine (Exelon): Patch may be better tolerated
CARE
Ganglionic Stimulants
Nicotine
Low Dose:
High Dose:
Low Dose: depolarizer (stimulates) autonomic ganglia —> euphoria and arousal
High Dose: Blocks the autonomic ganglia —> decreased BP and possibly respiratory paralysis
