Pharmacology- Cholinergic Drugs

Front 1

Cholinergic drugs are used in which system?

Back 1

parasympathetic

Front 2

What is the primary NT at the NMJ?

Back 2

ACh

Front 3

Where else is ACh important?

Back 3

brain regions

Front 4

2 major classes of cholinergic drugs:

Back 4

agonists (stimulants, cholinomimetics)

antagonists (anticholinergic drugs)

Front 5

2 types of agonists:

Back 5

direct-acting

indirect-acting

Front 6

Why is it helpful if direct-acting agonists have specificity for muscarinic receptors?

Back 6

the drugs will affect the periphery more

Front 7

Direct-acting drugs and their uses:

Back 7

Bethanechol (Duvoid)- encourages urination, inc GI activity

Carbachol (Carbastat) & Pilocarpine (Pilocar)- used topically for glaucoma

Front 8

Direct-acting agonists function similarly to what?

Back 8

ACh

Front 9

Function of indirect-acting agonists:

Back 9

inhibit AChE (allowing ACh to stay in synaptic cleft)

Front 10

Indirect-acting agonists have a relatively low _____ compared to direct-acting agonists.

Back 10

specificity

meaning they will bind anywhere ACh binds

Front 11

Exceptions to the "low specificity" of indirect-acting agonists:

Back 11

neostigmine- mostly affects muscarinic

tacrine/donepezil- mostly affects brain

Front 12

GI/urinary bladder atonia

Back 12

direct-acting agonists are used to increase GI motility and bladder activity (parasympathetic)

Front 13

Alzheimer Disease (early)

Back 13

indirect-acting agonists are used to prolong release of endogenous ACh to cholinergic neurons important for memory, cognition, etc.

(won't help once neurons can't release ACh anymore)

Front 14

Glaucoma

Back 14

direct-acting agonists are used to increase outflow of aqueous humor, thus lowering intraocular pressure

Front 15

Myasthenia Gravis

Back 15

indirect-acting agonists may alleviate fatigue

Front 16

Reversal of neuromuscular blockade

Back 16

indirect-acting agonists may be used to speed up recovery after use of neuromuscular blocker and general anesthesia

Front 17

Reversal of anticholinergic-induced CNS toxicity

Back 17

indirect-acting agonists may be used to reverse effects of overdose (delirium, hallucinations, coma)

Front 18

Adverse effects of cholinergic agonists:

Back 18

(exaggerated parasymp activity)
GI distress
inc salivation
bronchoconstriction
bradycardia
difficulty with visual accommodation

Front 19

Function of cholinergic antagonists:

Back 19

block the receptor from ACh effects

(usually competitive antagonists)

Front 20

2 types of cholinergic antagonists:

Back 20

anti-muscarinic

anti-nicotinic

Front 21

Anti-nicotinic uses:

Back 21

in hypertension

as a nm blocker during surgery

Front 22

Prototypical anti-muscarinic:

Back 22

atropine (belladonna, jimsum weed)

Front 23

Anti-muscarinic uses:

Back 23

adjust tx of GI disorders (dec tract stimulation)

tx of parkinson's (dec overactivity of central cholinergic synapses)

cardiovascular
motion sickness
prep for eye exam
dec bladder tone

Front 24

Adverse effects of cholinergic antagonists:

Back 24

(too much of a parasymp dec)
dry mouth
blurred vision
urinary retention
constipation
tachycardia

Front 25

Rehab considerations

Back 25

treat at peak effect of drug for alzheimer's or MG pts

treat at peak effect of drug, after voiding, for spastic bladder pts

nicotine users, depending on comorbidities, can experience various adverse symp/parasymp responses

Front 26

Which type of anti-nicotinic drug is used for emergent hypertension?

Back 26

ganglion blockers

Front 27

Which type of anti-nicotinic drug is used for anesthesia during surgery?

Back 27

neuromuscular blockers