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Week 3 Flashcards

1
Q

Cholinergic drugs

A

Parasympathetic nervous sys (PNS) by mimicking or inhibiting acetylcholine (ACH) which is located at the gaglions and PNS terminal nerve endings. Innervates cholinergic receptors in organs, tissues and glands

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2
Q

Cholinergic receptors

A

Nicotine and muscarinic

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3
Q

Cholinergic Agonist

A

Stimulate PNS direct (binds direct to cholinergic rreceptors at target tissue level mimicking acetylcholine) or indirectly (inhibit acetylcholinesterase, prolonging action of natural acetylcholine)

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4
Q

Cholinergic antagonist

A

Inhibit actions of acetylcholine -> inhibits PNS

Atropine, tolterodine tartrate, scopolamine

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5
Q

CNS antagonist

A

Large doses = drowsiness, disorientation and hallucinations

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6
Q

DV agonists

A

De HR, slows conduction through AV node, de BP = vasodilation

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7
Q

CV antagonist

A

Large doses ^ hr

Small doses de hr

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8
Q

Pulmonary agonist

A

^ bronchial constriction

^ bronchial secretions

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9
Q

Pulmonary system

A

De bronchial constrictions

De bronchial secretions

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10
Q

Gastrointestinal agonist

A

^ gastric motility and peristalsis

Relaxes sphincter muscles

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11
Q

GI antagonist

A

De gastric motility and peristalsis

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12
Q

Genitourinary agonist

A

Contracts bladder, relaxes bladder’s sphincter

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13
Q

Genitourinary antagonist

A

Relaxes bladder and ^ constriction of bladder sphincter

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14
Q

Ocular agonist

A

Constricts pupils

^ ability to accommodate

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15
Q

Ocular antagonist

A 
Dilates pupils (mydriasis)
De ability to accommodate
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16
Q

Glandular

A

^ salivation, perspiration, and tears

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17
Q

Glandular antagonist

A

de salivation, perspiration and tears

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18
Q

Skeletal muscle agonist

A

^neuromuscular transmission, maintain muscle strength and tone

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19
Q

Skeletal muscles antagonists

A

De muscle rigidity and de tremors

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20
Q

Bethanechol

A

Agonist med

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21
Q

Bethanechol - mechanisms of action

A

Direct acting agonist (binds to cholinergic receptors), stimulates muscarinic receptors in bladder and GI tract

^ bladder tone, relaxes bladder sphincter
^ GI smooth muscle tone and motility and relaxes GI sphincters

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22
Q

Bethanechol - therapeutic uses

A

Treats postoperative nonobstructive urinary retention and urinary retention associated with neurogenic gladder

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23
Q

Bethanechol - pharmacokinetics

A

Poorly absorbed from GI and % bound to plasma protein is unknown. Crosses BBB. Excreted in urging. 1/2 life is unknown. Onset = 30-90 mins (oral) lasts 2 hrs

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24
Q

Pre-admin - bethanechol

A 
Head to toe assessment
Med allergies
Past med history
Current meds
Alcohol and drug use
Herbal preparation use
Patient baseline vitals
Urine output (>1500 mL/d)
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25
Contraindications - bethanechol
``` Asthma Bradycardia COPD Coronary artery disease GI obstruction Hyperthyroidism Hypotension Irritable bowl syndrome Parkinsonism Peptic ulcer disease Seizures Urinary tract obstruction Integrity of GI or bladder wall is unknown ```
26
Drug interactions - bethanechol
De given sympathomimentics, anticholinergics, opioids ^ given another cholinergic agonist (direct/indirect) Use with caution with ganglionic blocking agents = severe hypotension
27
Adverse rxns of bethanechol
``` CV = in and de HR, de BP CNS = headache, dizziness and seizures GI. = cramping, diarrhea, ^ gastric acid secretion, ^ oral secretion Respiratory = ^ bronchial secretions, bronchospasms ``` Lacrimation, sweating, mitosis
28
Atropine
Antagonist med
29
Mechanisms of action - atropine
Inhibits action of acetylcholine by occupying muscarinic receptors Blocks vagus stimulation ^ HR Paralyzes iris sphincter = pupillary dilation
30
Therapeutic uses - atropine
De salivation and respiratory secretions preoperatively ^ HR = Bradycardia Dilate pupils before eye exam
31
Pharmacokinetics - atropine
Absorbed well when given parentrally and orally. % bound to plasma protein unknown. Excreted by using, crosses BBB and placenta. Onset immediate. 1/2 life is 2-3 hrs and duration is 4 hrs
32
How drugs work on the ANS
Turn off SNS | Turn off PNS
33
Drugs altering neurotransmitters
``` Affect synthesis Prevent storage Influence release Bind to receptor site Prevent normal breakdown or reuptake ```
34
Primary neurotransmitters
Norepinephrine and acetylcholine
35
Norepinephrine
SNS a catecholamine (epinephrine and dopamine are 2 other catecholamines) Adrenergic receptors - alpha and beta
36
Acetylcholine
Effects on both SNS and PNS | Cholinergic receptors - nicotinic and muscarinic
37
Sympathomimetics
Stimulation of sympathetic nervous systems Adrenergic agonist TURN ON the SNS
38
Parasympathomimetics
Stimulation of PNS Muscarinic agonist or cholinergic Turn ON the PNS
39
Sypatholytics
Adrenergic antagonists Inhibits SNS Adrenergic blocker Turn OFF SNS
40
Parasympatholytics
Inhibit PNS Anticholinergic Turn OFF PNS
41
Agonist
Turn ON | Act like natural chemical
42
Antagonist
Turn OFF | Block cellular activity
43
SNS - sympathmimetics
Adrenergic - stimulate Adrenalin Fight or flight Receptor subtypes - alpha, beta
44
Alpha 1 adrenergic
Receptor agonists Constricts blood vessels, dilate pupils Rx septic shock, low BP, nasal congestion, ophalmic exam
45
Alpha 2
Receptor agonists (don’t use a lot) Inhibit release of norepinephrine Rx hypertension
46
Beta 1
Receptor agonist ^ hr, force of contraction Rx cardiac arrest, heart failure shock Heart = pump or ^ strength HEART
47
Beta 2
LUNGS Relaxes bronchial smooth muscle Bronchodilator Rx asthma
48
Adrenergic agonist - actions
``` Cardiac stimulation ^ blood flow to skeletal muscles Peripheral vasoconstriction Bronchodilation Dilation of pupils ```
49
Adrenergic agonists - uses
``` Restore rhythm in cardiac arrest ^ bp in shock Constricting capillaries Dilating bronchioles Ophthalmic procedures Anaphylaxis ```
50
Adrenergic agonist - adverse effects
``` Tachycardia, palpitations Cardiac dysrhythmias Aginal pain Nervousness, tremor Hypertension Hyperglycemia ```
51
Adrenergic agonists - contraindications/precautions
Angina Coronary insufficiency Hypertension Cardiac dysrhythmias
52
Adrenergic agonist - prototype
Epinephrine (Adrenalin) | Acts on alpha and beta receptors
53
Norepinephrine (levophed)
``` Acute situations Vasopressin Predominant ALPHA 1 adrenergic effects Potent vasoconstrictor Rx of shock states ``` Excessive vasoconstriciton - impair cardiac performance, decrease organ and tissue perfusion ) Antidote for peripheral IV extravasation - phentolamine (regitine) alpha adrenergic blocker
54
Albuterol (ventolin)
BETA 2 Asthma, COPD Oral, inhalation, nebulizer High doses = stimulate beta 1 receptors
55
Adrenergic antagonists/blockers
Turn OFF SNS Block effects of adrenergics Occupy receptor site or inhibition release of transmitter Beta-blockers most common Hypertension, cardiac dysrhythmias, angina, migraine Hypotension, bradycardia, fatigue C/p - hypotension, asthma, diabetes
56
Beta blockers (lol)
Metoprolol (lopressor) Atenolol (tenormin) Selective beta 1 blockers
57
Selective blockers are
A jigsaw puzzle Fit into the correct sites
58
No selective blockers
Stacks of blocks Can be places on top of each other with no particular form
59
Patient education - beta blockers
CV disease Rise slowly from reclined position Possible slow heart beat Avoid alcohol, antihistamines, muscle relaxants, sedatives Report sexual dysfunction or depression Do not stop abruptly Consult before using OTC cold preparations
60
Alpha blockers
Not as common Likely to cause: orthostatic hypotension, reflex tachycardia Terazosin (hytrin) -benign prostatic hyperplasia, relaxes muscles of bladder and prostate allowing using to flow
61
Cholinergic agonists and anticholinergics
Affect PNS Parasympathomimetics Parasympatholytics Acetylcholine Muscarinic receptors - slow hr, stimulate smooth muscle Nicotinic receptors - neuromuscular junction (excitatory response), increase neuromuscular transmission
62
Cholinergic agonists
Parasympathomimetics - turn ON Increased secretions Direct acting cholinergic agonist Indirect acting cholinergic agonist - inhibit cholinesterase (break down acetylcholine)
63
Metoclopramide (reglan)
Direct active cholinergic agonist Gerd, nausea, gastroparesis Speeds up gastric emptying Adverse rxn - tar dive dyskinesia
64
Varenicline (chantix0
Nicotinic agonist Prevents binding of nicotine to receptors Decreased desire to smoke 12 week course, graduated dosing over week 1 Pregnancy category C Adverse - mental status changes, mood changes, decreased tolerance to alcohol, Stevens-Johnson syndrome
65
Cholinesterase inhibitor
Blocks the breakdown of acetylcholine Allow acetylcholine to accumulate at neuromuscular junction Donepezil (aricept) Alzheimer’s
66
Anticholinergics - actions
Drying of secretions Decreased GI/GU motility Dilation of pupils
67
Anticholinergic - uses
``` Preop Antispasmodic Antidote Bradycardia/heart block Dilation of pupils Prevent/treat bronchospams ```
68
Anticholinergic - adverse effect
Blurred vision; h/a Dry mouth, constipation, urinary retention Palpitations/tachycardia Confusion/excitement, esp in elderly Fever/flushing
69
Anticholinergic - contraindications/precautions
``` Asthma, COPD Angle-closure glaucoma GI/GU obstruction Cardiac dysrhythmias Hypertension ```
70
Anticholinergic drugs (ine)
Atropine Tolterodine tartrate (detrol) Benztorpine (cogentin) Scopolamine (transdrem scop) Anticholinergic syndrome toxicity “Red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, and full as a flask”

Pharm (7 decks)

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