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34 Cards in this Set

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What does a cholinergic receptor do?
Binds acetylcholine and mediates its action
What does cholinergic activate or release?
Acetylcholine (ACh)
Where do Acetylcholine go?
Cholinergic receptor sites
What neurotransmitter is responsible for transmission of nerve impulses to effector cells in PSN?
Acetylcholine
What are the two types of cholinergic receptors? How are they determined?
Nicorinic receptors
Muscarinic receptors

Determined by LOCATION & ACTION ONCE STIMULATED
End in "ic"
What is the location and stimulus for Nicotinic Receptors?
Location: Gangilia of both PNS & SNS
Stimulus: Nicotine
At what dose does the cholinergic drug affect nicotinic receptors?
At high dosages
What is the location and stimulus for Muscarinic receptors?
Location: Postsynaptically in effector organs of PNS (smooth muscle, cardiac muscle, glands)
Stimulus: Alkaloid muscarine (found in mushrooms)
What system does Cholinergic drugs stimulate?
Parasympathetic nervous system
What else happens to the body with PNS, besides rest and digest?
Repairing of the body
What are other names for Cholinergic drugs?
Cholinergic "agonists" (works with drugs)
Parasympathomimetics
What is an Agonist?
Agonist causes an action, triggers response by the cell, mimic often natural occuring substance
Two types of cholinergic agonist?
Indirect and direct acting cholinergic agonist
MOA for Direct acting cholinergic agonist?
Bind to cholinergic receptors, activates them
MOA for indirect acting cholinergic agonist?
Inhibits acetylcholinesterase (breaks down acetylcholine), which results in more ACh available at receptors
The Indirect acting cholinergic drugs also known as Cholinesterase Inhibitors have two categories of inhibition?
Reversible: Bind to Cholinesterase for mins-hrs
Irreversible: Bind to Cholinesterase and form a permanent covalent bond (will work longer & better, bc it takes long to break up)
What are some Drug effects of cholinergic receptors?
-Effects seen when PNS is stimulated
-Stimulates intestine and bladder
-Stimulates pupils (reduces intraocular pressure)
-At recommended doses, cholinergics primarily affect muscarinic receptors (desire affects muscarinic). At high doses, they stimulate nicotinic receptors (many undesirable effects).
What are some contradictions to using Cholinergic drugs?
-Bradycardia
-GI Obstruction
-Hypotension
-COPD

**BC cholinergic relaxes, slows down, and moves the body systems.
What are Direct-cholinergic acting drugs used for?
-Reduce intraocular pressure
-Helps with GI, GU motility, postsurgical atony (lack of normal muscle tone) of bladder and GI tract
What are the Indirect acting cholinergic drugs used for?
-Used for dx & tx of Myasthenia gravis (muscle weakness)
-Reverse neuromuscular blocking drugs
-Reverse anticholinergic poisoning (antidote = Physostigmine)
What is an indication for indirect acting anticholinesterase drugs?
-Used to treat Alzheimer's disease
-Helps improve memory, NOT A CURE for Alzheimer's
What are drugs to help with Alzheimer's?
-Donepezil
-Galantamine*
-Rivastigmine*
-Memantine (not cholinergic drug)
Direct acting cholinergic drugs?
-Echothiophate
-Carbachol
-Pilocarpine*
^ topical to reduce intraocular pressure surgery
-Bethanechol (muscles of urinary bladder & smooth muscle of GI) [urination should occur with 60 min]
Acetylcholinesterase is also know as?
Cholinesterase
Indirect acting cholinergic drugs or cholinesterase inhibitors inhibit what action?
Acetylcholinesterase
Indirect acting drugs to help with myashthenia gravis?
-Physostigmine
-Pyridostigmine
-Edrophonium*
How do Indirect/Direct acting cholinergic drugs/ cholinesterasr inhibitors work?
They work by increasing ACh, by inhibiting acetylchlinesterase, which breaks down ACh.
What are Adverse effects of the cholinergic drugs?
They are the results of overstimulation of PNS.
*Think of going beyond the chart!
What interactions with cholinergic drugs?
-Anticholinergics, antihistamines, sympathomimetics (Decrease response)
-Other cholinergic drugs increase response
What is Ginko commonly used for?
Prevent memory loss, vertigo, tinnitus
What are adverse effects with Gingko?
Upset GI, headache, bleeding
Possible drug interactions with Gingko?
-Aspirin
-Nonsterodial antinflammatory drugs (NSAIDs)
-Anticoagulant
-Anticonvulsants
What are nursing implications for cholinergic drugs?
-Spread dosage to optimize effects
-Those with Myasthenia Gravis should take medicine 30 min. before eating to improve chewing & shallowing
-ATROPINE is antidote for cholinergic crisis
-Therapeutic effects
-Cholinergic Crises (overdose of cholinergic drugs)
Early signs or Cholinergic crisis is SLUDGE, which stands for?
Salivation
Lacrimation
Urination
Defecation
Gastric Upset
Emesis (vomiting)

*ATROPINE is antidote for cholinergic crisis!!!