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64 Cards in this Set

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________________ drugs block the action of acetylocholine on the parasympathetic nervous system.
Antichoinergic
_________ amines are uncharged lipid soluble molecules
Tertiary
Some belladonna derivatives and synthetic anticholinergics are _______________ amines.
Quatenary
When given at high doses a few anticholinergic drugs are also able to block _________ receptors in autonomic ganglia and skeletal muscles.
Nicotinic
Because cholinergic ___________ receptors are widely distributed in the body anticholinergic drugs produce effects in a varity of locations including the CNS, heart, smooth muscle, glands and the eye.
Muscarinic
Prototype of anticholinergic drugs a naturally occurring belladonna alkaloid that can be extracted from the belladonna plant or prepared synthetically
Atropine
A belladonna alkaloid used in gastrointestinal and genitourinary disorders characterized by spasm increased secretion and increased motility.
Hyoscyamine
May be given by inhalation for bronchodilating effects.
Ipratropium or tiotropium
When given parenterally depresses the CNS and causes amnesia, drowsiness, euphoria, relaxation and sleep.
Scopolamine
A semisynthetic derivative of atropine used as eye drops to produce mydriasis and cycloplegia
Homatropine hydrobromide
Describe the characteristics of tertiary amines and give examples of two medications in this category.
Most anticholinergic medications are either tertiary amines or quaternary amines. Tertiary amines are uncharged lipid soluble molecules. Atropine and scopolamine are tertiary amines and therefor are able to cross cell membranes readily. They are well absorbed from the gastrointestinal tract and conjunctiva, and they cross the blood brain barrier. Tertiary animes are excreted in the urine.
Describe the characteristics of quaternary amines.
Some belladonna derivatives and synthetic anticholinergics are quaternary amines. These drugs carry a positive charge and are lipid insoluble. Consequently, they do not readily cross cell membranes. They are poorly absorbed from the GI tract and do not cross the blood brain barrier. Quaternary amines are excreted largely in the feces.
Describe the general characteristics of anticholinergic drugs.
In general, anticholinergic drugs act by occupying receptor sites on target organs innervated by parasympathetic nervous system, thereby leaving fewer receptor sites free to respond to acetylcholine. Parasympathetic response is absent or decreased depending on the number of receptors blocked by anticholinergic drugs and the underlying degree of parasympathetic activity. Because cholinergic muscarinic receptors are widely distributed in the body anticholinergic muscarinic receptors are widely distributed in the body, anticholinergic drugs produce effects in a variety of locations, including the central nervous system, heart, smooth muscle, glands, and the eye.
How do anticholinergic drugs affect the cardiovascular system?
Anticholinergic drugs cause decreased cardiovascular response to the parasympathetic, vagal, stimulation that slows heart rate. Atropine is the anticholinergic drug most often used for its cardiovascular effects. According to ACLS, advanced cardiac life support protocol, atropine is the drug of choice to treat symptomatic sinus bradycardia. Low doses less than 0.5mg may produce a slight and temporary decrease in heart rate; however, moderate to large doses 0.5 to 1mg increase heart rate by blocking parasympathetic vagal stimulation. Although the increase in heart rate may be therapeutic in bradycardia it can be an adverse effect in patient with other types of heart disease because atropine increases the myocardial oxygen demand. Atropine usually has little or no effect on blood pressure. Large doses cause facial flushing because of dilation of blood vessels in the neck.
How do anticholinergic drugs affect the respiratory system?
Anticholinergic drugs cause bronchodilation and decreased respiratory tract secretions. Anticholinergics block the action of acetylcholine in bronchial smooth muscle when given by inhalation. this action reduces intracellular GMP a bronchoconstrictive substance. When anticholinergic drugs are given systemically, respiratory secretions decrease and may become viscous, resulting in mucous plugging of small respiratory passages. Administering the medications by inhalation decreases the effect while preserving the beneficial bronchodilation effect.
___________ is the antidote for muscarinic agonist poisoning.
Atropine
Anticholinergic overdose is characterized by which of the following signs and symptoms? (select all that apply)

a. Hyperthermia

b. Most mucus membranes

c. Mydriasis

d. Urinary retention
a,c, d

Rationale: Anticholinergic overdose is characterized by hyperthermia, hot dry flushed skin, dry mouth mydriasis, delirium, tachycardia, paralytic ileus, urinary retention, myoclonic movements, seizures, coma, and respiratory arrest.
__________ is the specific antidote for anticholinergic overdose.
Physostigmine
Mrs. Briggs, age 57, has a history of two myocardial infractions in the past 3yrs. She presents to the physicians office with symptoms of an overactive bladder. She requests an anticholinergic medication that she saw advertised on television. You would expect the physician to do which of the following?

a. Order the anticholinergic medication

b. Order blood work to rule out a UTI and order the medication.

c. Order a urinalysis to rule out a UTI. and order the medication.

d. Explain to the client that the medication is contraindicated because of her medical history.
d

Rationale: Anticholinergic drugs are contraindicated for patients with BPH, myasthenia gravis, hyperthyroidism, narrow angle glaucoma, tachy dysrhythmias, myocardial infraction, heart failure, or conditions associated with esophageal reflux.
Mr. Brady age 75 is experiencing extrapyramidal symptoms secondary to an antipsychotic drug. Which of the following drugs would you expect the physician to order to relieve these symptoms?

a. Beta blockers

b. Anticholinergics

c. ACE inhibitors

d. Physostigmine salicylate
b

Rationale: Anticholinergic drugs are given preoperatively to prevent anesthesia associated complications such as bradycardia, excessive respiratory secretions and hypotension.
____________ is the drug of choice to treat bradycardia.
Atropine
Which of the following medications may be given to children because of its bronchodilation effects in the treatment of asthma and chronic bronchitis?

a. Ipratropium

b. Atropine

c. Hyoscyamine

d. Scopolamine
a

Rationale: Ipratropium and tiotropium are anticholinergic medications given by inhalation for bronchodilation effects in the treatment of asthma and chronic bronchitis.
Opthalmic anticholinergic preparations are indicated for _______________ and ____________ effects to aid in eye examination and surgery.
mydriatic, cycloplegic
Mr. Bates is diagnosed with IBS and the physician orders an antispasmodic. Which of the following drugs would you expect the physician to order?

a. Atropine

b. Hyoscyamine

c. Glycopyrrolate

d. Ipratropium
c

Rationale: Anticholinergic drugs (ex. dicyclomine, glycopyrrolate) are indicated for antispasmodic effects in GI disorders. Historically they have also been used to treat peptic ulcer disease; however, they are weak inhibitors of gastric acid secretion and have been largely replaced other more effective medications (ex. proton pump inhibitors)
You are asked to create a presentation for your anatomy and physiology class on cholinergic receptors. You explain that cholinergic (muscrinic) receptors are widespread throughout the body and are located in which of the following body parts? (select all that apply)

a. Mitochondria

b. Heart

c. Eyes

d. Glands
b,c,d

Rationale: Cholinergic (muscarinic) receptors are widespread through the body producing effects in a variety of locations including the central nervous system, heart, smooth muscle , glands and eyes.
Most anticholinergic drugs interact with muscarinic cholinergic receptors in the brain secretory glands, heart, and smooth muscle and are sometimes called _______________.
antimuscarinic
Anticholinergic drugs block the action of acetylcholine on which of the following systems?

a. Sympathetic nervous system

b. Parasympathetic nervous system

c. Musculoskeletal system

d. Genitourinary system
b

Rationale: Anticholinergic drugs block the action of acetylcholine on the parasympathetic nervous system.
Mr. Belcher is prescribed an anticholinergic drug by his physician. He likes to hike with his grandchildren. As his home care nurse you realize that part of Mr. Belchers education plan should include heart stroke prevention, because anticholinergic medications have which of the following effects?

a. increasing sweating and the risk for heart stroke and dehydration.

b. Causing postural hypotension and increased risk for falls and from exposure to the elements.

c. Causing bradycardia in older adults, which increases the risk for falls and from exposure to the elements.

d. Preventing sweating and heat loss and increasing the risk of heat stroke.
d

Rationale: Anticholinergic drugs are commonly used in home care with children and adults. The home care nurse may need to teach older patients or caregivers that the drugs prevent the sweating and heat loss and increase risks of heat stroke if precautions to avoid overheating are not taken.
A client presents to your emergency department with evidence of bradydysrhythmias. Which of the following is the treatment of choice for bradydysrhythmias?

a. Atropine 0.5mg administered IV every 3 to 5 mins.

b. Atropine 1mg administered IV every 3 to 5 minutes.

c. Atropine 0.25mg administered IV every 3 to 5 mins

d. Atropine 4mg administered IV every 3 to 5 mins.
a

Rationale: Atropine is an important drug in the emergency drug box. According to ACLS guidelines atropine is the first drug to be administered in the emergency treatment of bradysrhythmias. Atropine 0.5mg should be administered IV every 3 to 5 mins and my be repeated up to 3mg (.03 to 0.04mg/kg)total dose
Mr. Giancarlo age 80, who lives in a long term care facility is prescribed anticholinergic medications by his physician. Recently he has complained of blurred vision. You call the physician regarding these symptoms. You would expect to modify Mr. Giancarlo's care plan to include which of the following?

a. Falls prevention

b. Dietary modifications

c. Use of restraints

d. Occupational therapy
a

Rationale: Older adults are especially likely to have significant adverse reactions because of slowed drug metabolism and the frequent presence of several disease processes. A patient who complains of blurred vision may need help with ambulation, especially with stairs or in other potentially hazardous environments. Obstacles and hazards should be removed if possible.
Mrs. Beach age 45 is diagnosed with overactive bladder, asthmatic bronchitis and narrow angle glaucoma. She asks the physician to prescribe the same anticholinergic medication that her friend uses for her overactive bladder. Which of the following would you expect the physician to do?

a. Order the medication

b. Order the medication with scheduled routine blood work.

c. Decline the prescription preference because of the diagnosis of asthmatic bronchitis.

d. Decline the prescription because of the diagnosis of narrow angle glaucoma.
d

Rationale: Normally, anticholinergics do not change intraocular pressure, but with narrow angle glaucoma they may increase intraocular pressure and precipitate an episode of acute glaucoma.
Mr. Wright is diagnosed with irritable bowel syndrome. The physician orders anticholinergic medication. What is the reason for this decision?

a. To reduce the inflammation to the intestines.

b. To increase the frequency of the bowel.

c. To reduce the requency of bowel movements

d. To prevent a gastrointestinal bleed.
c

Rationale: Anticholinergics may be helpful in reducing the frequency of bowel movements and abdominal discomfort associated with irritable colon or colitis.
Mr. Devlin has been a paraplegic for 5yrs. He complains of increased incontinence, and the physician order anticholinergic medications. what is the reason for this decision?

a. To increase bladder capacity

b. to strengthen the detrusor muscles

c. To decrease bladder capacity

d. To decrease irritation to the wall of the bladder.
a

Rationale: In infections such as cystitis, urethritis, and prostatitis, anticholinergic drugs decrease the frequency and pain of urination. The drugs are also given to increase bladder capacity in enuresis, paraplegia, or neurogenic bladder.
Mr. Levitz is diagnosed with Parkinson's disease. The physician orders anticholinergic drugs. What is the reason for this decision?

a. To improve his gait

b. To decrease spasticity

c. To prevent fractures

d. To improve swallowing
b

Rationale: Anticholinergic drugs are given for their central effects in decreasing salivation, spasticity, and tremors. They are used mainly in patients who has minimal symptoms, who do not respond to levodopa, or who cannot tolerate levodopa because of adverse reactions or contraindications. An additional use of anticholinergic drugs is to relieve Parkinson's like symptoms that occur with older anti-psychotic drugs.
True or false?

Tertiary amines are excreted in the urine.
True
True or false?

Tertiary amines are uncharged lipid soluble molecules and therefor can cross the cell membranes readily.
True
True or false

Some belladonna derivatives and synthetic anticholinergics are quaternary amines. These drugs carry a positive charge and are lipid insoluble. Consequently, they do not cross the cell membrane.
True
________ is the prototype of anticholinergic drugs and is a naturally occurring belladonna alkaloid that can be extracted from the belladonna plant. It is well absorbed form the GI tract and rapidly excreted in the urine. It has a short duration except when used for ocular effects and it may last for several days.
Atropine
What are the Belladonna alkaloids and derivatives?
1. Atropine
2. Opthalmic atropine
3. Homatropine
4. Hyoscyamine
5. Hyoscyamine
6. Ipratropium
7. Scopolamine
8. Tiotropium bromide
These Belladonna's are used for Mydriatic cycloplegia, inflammation of uveal tract.
1. Ophthalmic atropine
2. Homatropine
3. Scopolamine
This Belladonna is used for antispasmodic antisecretory for GI and GU disorders.
1. Hyoscyamine
These Belladonna's are used for bronchodilation.
1. Ipratropium
2. Tiotropium Bromide
This belladonna is used for systemic use, antimetic, mydriatic, cycloplegia, inflamation of uveal tract.
1. Scopolamine
What are the antisecretory antispasmodic anticholinergics for GI disorders?
1. Dicyclomine Hydrochloride
2. Glycopyrrolate
What are the anticholinergics used in Parkinson's disease?
1. Benztropine
2. Trihexyphenidyl
What are the drugs used in urinary antispasmodics (overactive bladder)?
1. Darifenacin hydrobromide
2. Flavoxate
3. Oxybutynin
4. Solifenacin succinate
5. Tolterodine
6. Trospium chloride
_________ is a mixture of alkaloids in an aqueous alcohol solution. It is most often used for GI disorders because of its antispasmodic effect.
Belladonna Tincture
_________ is a semisynthetic derivative of atropine used as eye drops to produce mydrasis and cycloplegia. May be preferred because ocular effects do not last as long.
Homatropine hydrobromide
__________ is an anticholinergic drug chemically related to atropine. Used in nasal spray, it is useful in treating rhinorrhea due to allergies or the common cold. When used to treat COPD it acts as a bronchodilator.
Ipratropium
_________ depresses the CNS and causes amnesia, drowsiness, euphoria, relaxation, and sleep. Also, it is used in motion sickness.
Scopolamine
_________ is a dry powder in capsule from intended for oral inhalation with the handihaler inhalation device. Is indicated for daily maintenance treatment of bronchospasm associated with COPD.
Tiotropium Bromide (spiriva)
__________ and ________________ are older medications used to treat peptic ulcer disease. However, one is useful as an antispasmodic agent for treatment of IBS.
Dicyclomine and glycopyrrolate.
________ is used in the treatment of parkinsonism and extrpyramidal reactions caused by some antipyschotic drugs. This drug is contraindicated in glaucoma.
Trihexyphenidyl
____________ is a synthetic drug with both anticholinergic and anithistaminic effects. A major clinical use is to treat acute dystonic reactions caused by antipyschotic drugs and to prevent their recurrence in patients receiving long term antipyschotic drug therapy. It may also be given in small doses to supplement other antiparkinson drugs.
Benztropine
_____________ is a competitive antimuscarinic anticholinergic agent with selective affinity for M3 receptors involved in contraction of the urinary bladder. It is 98% protein bound and extensively metabolized in the liver by CYP3A4 and CYP2D6 enzymes. In some Caucasians and 2% African Americans are poor metabolizers of the drug and my require reduced dosages to avoid adverse effects.
Darifenacin
__________ was developed specifically to counteract spasm in smooth muscle tissue of the urinary tract. This drug relieves dysuria, urgency, frequency, and pain with genitourinary infections such as cystitis and prostatitis.
Flavoxate
____________ has direct antispasmodic effects on smooth muscle and anticholinergic effects. it increases bladder capacity and decreases frequency of voiding in patients with neurogenic bladder.
Oxybutynin
__________ is indicated for the treatment of overactive bladder with symptoms of urgency, urge incontinence, and frequency. Dosages should be reduced in individuals with moderate renal or liver impairment. This drug may prolong QT intervals especially at higher doses potentially resulting in dysrhythmias.
Solifenacin
_______________ inhibits bladder contraction decreases detrusor muscle pressure and delays the urge to void. It is more selective for muscarinic receptors in the urinary bladder than in other areas of the body. Reduced doses (1mg) are recommended for patients with hepatic dysfunction.
Tolterodine
____________ is an antimuscarinic anticholinergic drug for treatment of urgency, urge incontinence, and urinary frequency. This drug reduces the tone of smooth muscle in the bladder, exerting an antispasmodic effect. Because of its quaternary structure less than 10% of an orally administered dose is absorbed, and food further delays absorption. Must be taken on an empty stomach or 1hr before meals. It is eliminated by a combination of glomerular filtration and active tubular secretion. Beware of interactions with digoxin, procainamide, pancuronium, morphine, vancomycin, metformin, and tenofovir. These could lead to an increased serum concentration. Reduced dosages are recommended for patients with renal insufficiency and those older than 75yrs.
Trospium
What disorders are anticholinergic drugs contraindicated?
Glaucoma, prostatic hypertrophy, reflux esophagitis, myasthenia gravis, and hyperthyroidism.
What are the characteristics of a anticholinergic overdose?
Hyperthermia, hot dry flushed skin, dry mouth, mydriasis (dilated pupils) delirium, tachycardia, paralytic ileus, urinary retention; myoclonic movements (sudden, brief, jerky, shock-like, involuntary movements) seizures, coma, and respiratory arrest.
What is the antidote for an anticholinergic overdose?
Physostigmine
What is the antidote for for a muscarinic agonist poisoning?
Atropine