Pharm(T2-Ch20)

Front 1

Very similar to adrenergic blocking drug, but bind to different receptor sites

Back 1

Cholinergic Drugs

Front 2

Relating to a neuron or axon that is activated by or is capable of releasing acetylcholine when a nerve impulse passes.

Back 2

Cholinergic

Front 3

____ = neurotransmitter responsible for transmission of nerve impulses to effector cells in the PSN

Back 3

Acetylcholine

Front 4

_____ = is a receptor that binds acetylcholine and mediates its actions.

Back 4

Cholinergic Receptor

Front 5

Cholinergic Receptors

Two types__2__, determined by:
Location
Action once stimulated

Back 5

Nicotinic receptors
Muscarinic receptors

Front 6

Located in the ganglia of both the PSNS and SNS

Back 6

Nicotinic Receptors

Front 7

Named nicotinic because they can be stimulated by the nicotine

Back 7

Nicotinic Receptors

Front 8

Cholinergic drugs affect ____ at high dosages.
Considered undesirable effects - more dangerous

Back 8

nicotinic receptors

Front 9

Located postsynaptically in the effector organs of the PSNS: Smooth muscle, Cardiac muscle, Glands

Back 9

Muscarinic Receptors

Front 10

Named ____ because they can be stimulated by the alkaloid muscarine (a substance found in mushrooms).

Back 10

Muscarinic

Front 11

Provide a desired effect at recommended dosages.

Back 11

Muscarinic Receptors

Front 12

Drugs that stimulate the parasympathetic nervous system (PSNS)

Back 12

Cholinergic Drugs

Front 13

___ – The “rest and digest” system. Conserves energy as it slows the heart rate, increases intestinal and gland activity and relaxes sphincter muscles in the gastrointestinal tract.

Repairing

Back 13

PSNS

Front 14

The PSNS is the opposing system to the ____ or Fight or Flight

Back 14

sympathetic nervous system (SNS)

Front 15

Also known as cholinergic agonists or parasympathomimetics

Mimic effects of the PSNS neurotransmitter acetylcholine (ACh)

Back 15

Cholinergic Drugs

Front 16

Chemicals that bind to receptor cells and triggers a response by that cell. They often mimic the action of a naturally occurring substance.

Back 16

Agonists - (Cause an action)

Front 17

Bind to cholinergic receptors, activating them

Back 17

Direct-acting cholinergic agonists

Front 18

Inhibit the enzyme acetylcholinesterase, which breaks down acetylcholine (Ach)
Results in more ACh available at the receptors

Back 18

Indirect-acting cholinergic agonists

Front 19

breaks down acetylcholine (Ach)

Back 19

acetylcholinesterase

Front 20

Indirect-Acting (Cholinesterase Inhibitors)

2 types

Back 20

Reversible
Bind to cholinesterase for a period of minutes to hours

Irreversible
Bind to cholinesterase and form a permanent covalent bond
The body must make new cholinesterase to break these bonds

Front 21

Effects seen when PSNS is stimulated
The PSNS is the “rest and digest” system

Back 21

Cholinergic drug effects

Front 22

Stimulate intestine and bladder __3__

Stimulate pupils ___2___

Increased salivation and sweating

Back 22

Increased gastric secretions/flatus
Increased gastrointestinal motility
Increased urinary frequency

Constriction (miosis)
Reduced intraocular pressure

Front 23

Cholinergic Drug Effects

Cardiovascular effects2

Back 23

Decreased heart rate
Vasodilation

Front 24

Cholinergic Drug Effects

Respiratory effects 2

Back 24

Bronchial constriction, narrowed airways

Front 25

Cholinergic Drug Effects

Contraindications 4

Back 25

Bradycardia
Gastrointestinal Obstruction
Hypotension
COPD

Front 26

At recommended doses, cholinergics primarily affect ____ receptors

Back 26

muscarinic

Front 27

At high doses, cholinergics stimulate ____ receptors

Back 27

nicotinic

Front 28

Desired effects are from ____ receptor stimulation

Back 28

muscarinic

Front 29

Many undesirable effects are caused by stimulation of ____ receptors

Back 29

nicotinic

Front 30

severe and lead to hypotension, circulatory collapse, bloody diarrhea, shock, and cardiac arrest.

Back 30

cholinergic crisis.

Front 31

The patient has flushed skin, orthostatic blood pressure changes, and is complaining of abdominal cramps and nausea.

Back 31

early signs of a cholinergic crisis.

Front 32

Cholinergic Direct-acting drugs

Reduce intraocular pressure
Useful for glaucoma and intraocular surgery
Topical application because of poor oral absorption

3

Back 32

echothiophate
Carbachol
Pilocarpine (Pilocar)

Front 33

Cholinergic Direct-acting drug— ____

Increases tone and motility of bladder and GI tract
Relaxes sphincters in bladder and GI tract, allowing them to empty
Helpful for postsurgical atony of the bladder and GI tract
Oral dose or subcutaneous injection

Back 33

bethanechol (Urecholine)

Front 34

Urecholine deals with ___

Back 34

– urine choline

Front 35

Cholinergic Indirect-acting drugs
Cause skeletal muscle contractions
Used for diagnosis and treatment of ___
Used to reverse neuromuscular blocking drugs
Used to reverse anticholinergic poisoning (antidote)

Back 35

myasthenia gravis

Front 36

: auto immune or neuromuscular disease that causes muscle weakness and fatigue.
Can see it in face, facial droop

Back 36

myasthenia gravis

Front 37

Cholinergic Indirect-acting drugs

3

Back 37

Examples:

physostigmine (eserine)
pyridostigmine (Mestinon)
edrophonium (Tensilon)(most common for myasthenia)

Front 38

(most common for myasthenia)

Back 38

edrophonium (Tensilon)

Front 39

Indirect-acting anticholinesterase drugs
Used for treatment of ___
May help improve ____

Back 39

mild to moderate Alzheimer’s disease

memory

Front 40

Indirect-acting anticholinesterase drugs

3

Back 40

donepezil (Aricept) Most common
galantamine (Razadyne)
rivastigmine (Exelon) Most common (patch)

Front 41

Inhibit cholinesterase from breaking down cholinergic drugs

Back 41

Indirect-acting anticholinesterase drugs

Front 42

Not a cholinergic drug
Also used in the treatment of Alzheimer’s disease

Back 42

memantine (Namenda)

Front 43

Cholinergic Adverse Effects

Cardiovascular

4

Back 43

Bradycardia, hypotension, syncope, conduction abnormalities (AV block and cardiac arrest)

Front 44

Cholinergic's

Adverse effects are a result of ___

Back 44

overstimulation of the PSNS

Front 45

Cholinergic Adverse Effects

CNS

4

Back 45

Headache, dizziness (due to shrunken vessels- decreased o2), convulsions, ataxia (loss of muscle control – involuntary movements)

Front 46

Cholinergic Adverse Effects

Gastrointestinal

4

Back 46

Abdominal cramps, increased secretions, nausea, vomiting

Front 47

Cholinergic Adverse Effects

Respiratory

2

Back 47

Increased bronchial secretions, bronchospasms

Front 48

Cholinergic Adverse Effects

Other

Back 48

Lacrimation (tearing), sweating, salivation, miosis
Helps with pt who have Sjogren’s syndrome (inability to cry or salivate)

Front 49

Helps with pt who have Sjogren’s syndrome (inability to cry or salivate)

Back 49

Cholinergic drugs

Front 50

Cholinergic Interactions

4

Back 50

Anticholinergics, antihistamines, sympathomimetics (Antagonize cholinergic drugs, resulting in decreased responses)

Produce antagonistic effect

Other cholinergic drugs
Additive effects

Front 51

Cholinergic Herbal Products:

Back 51

Gingko

Front 52

Gingko

Common uses

3

Back 52

Prevent memory loss
Vertigo
Tinnitus

Front 53

Gingko

May cause

3

Back 53

GI upset, headache, bleeding*

Front 54

Gingko

Potential interactions
4

Back 54

Aspirin
NSAIDs
Anticoagulants
Anticonvulsants

Front 55

Note that these drugs will stimulate the PSNS and mimic the action of ACh
Assess for allergies, presence of GI or GU obstructions, asthma, peptic ulcer disease, or coronary artery disease
Perform baseline assessment of vital signs and systems overview

Back 55

Nursing Implications

Front 56

Medications should be taken as ordered and not abruptly stopped
Doses should be spread evenly apart to optimize the effects of the medication
Overdosing can cause life-threatening problems. Patients should not adjust dosages unless directed by their health care provider

Back 56

Nursing Implications

Front 57

pyridostigmine should be taken ___ a meal for maximal therapeutic effect

Back 57

30 minutes before

Front 58

Encourage patients with myasthenia gravis (neuromuscular disorder) to take medication 30 minutes before eating to help improve chewing and swallowing because ____

Back 58

These patients have a choking hazard

Front 59

When cholinergic drugs are prescribed for Alzheimer’s disease, be honest with caregivers and patients that the drugs are _____

Back 59

for management of symptoms (not a cure)

Front 60

When cholinergic drugs are prescribed for Alzheimer’s disease, their effect __

Back 60

Does not last more than 2 years

Front 61

Therapeutic effects of anti-Alzheimer’s drugs may not occur for up to ___

Back 61

6 weeks

Front 62

____ is the antidote for cholinergics, and it should be available in the patient’s room for immediate use if needed

Back 62

Atropine

Front 63

Patients should notify their physician if they experience muscle weakness, abdominal cramps, diarrhea, or difficulty breathing

Back 63

Nursing Implications

Front 64

____can be given to reverse the effects of an overdose of a cholinergic drug.

Back 64

Atropine

Front 65

Monitor for therapeutic effects
(neuromuscular disorder)

1
In postoperative patients with decreased GI peristalsis, monitor for:
3

Back 65

Alleviated signs and symptoms of myasthenia gravis

Increased bowel sounds
Passage of flatus
Occurrence of bowel movements

Front 66

Monitor for therapeutic effects
In patients with urinary retention/hypotonic bladder, urination should occur within ____

In patients with Alzheimer’s disease:3

Back 66

60 minutes of bethanechol administration

Improvement in symptoms
Improvement in mood and decrease in confusion

Front 67

overdose of a cholinergic drug

Back 67

Cholinergic Crises –

Front 68

Cholinergic Crises S&S 4

Back 68

Ex – hypotension, bloody diarrhea, shock, cardiac arrest. Early signs-abdominal cramps, salivation, flushing of skin.

Front 69

Tip for remembering

Cholinergic Crisis

Back 69

SLUDGE

SALIVATION

LACRIMATION (tearing)

URINATION

DEFECATION

GASTRIC UPSET

EMESIS