Pt 713 Ans Drugs--Cholinergic And Adrenergic

Front 1

3 uses of cholinergic drugs

Back 1

1. used in PNS
2. ACh primary neurotransmitter at NMJ
3. important for brain fcxn

Front 2

2 major classes of cholinergic drugs

Back 2

1. cholinergic agonists (stimulants, cholinomimetics)
2. cholinergic antagonists (anti-cholinergics or blockers)

Front 3

2 kinds of cholinergic agonists (stimulants)?

Back 3

1. direct acting agonists
2. indirect acting cholinergic agonists

Front 4

What are direct acting cholinergic agonists?

Back 4

Drugs that bind to cholinergic receptor to activate it (drugs like ACh)

Front 5

What are indirect acting cholinergic agonists?

Back 5

Drugs that inhibit cholinesterase (AChE) that breaks down ACh while in its synapse (indirectly allows more ACh around in synapse)

Front 6

What is an example indirect cholinergic agonist drug?

Back 6

Neostignine--indirect cholinergic or cholinesterase inhibitor drug that is helpful in protecting the diaphragm from paralysis initially

Front 7

What are 3 true cholinergic agonist drugs that are ACh like?

Back 7

1. bethanchol (Duvoid)
2. carbachol (Carbastat) and pilocarpine (Pilocar)

Front 8

Why would it be helpful to have some specificity for a muscarinic receptor using cholinergic agonists?

Back 8

Want to have a peripheral effect where there are more muscarinic receptors

Front 9

What does bethanechol (Duvoid) do?

When is it good to use?

Back 9

Encourages urine activity and increased GI activity

Use after abdominal surgery

Cholinergic agonist drug

Front 10

What does carbachol (Carbastat) and pilocarpine (Pilocar) treat?

How are they used?

Back 10

Glaucoma

Topically (lots of SE if used systemically)

Front 11

Which are more specific, indirect or direct cholinergic agonists?

What are 2 drugs that are the exception to this rule?

Back 11

Direct cholinergic agonists

1. neostigmine (affects muscarinic)
2. tacrine/donepezil (affects brain)

Front 12

What are 6 applications for cholinergic agonists or stimulants?

Back 12

1. GI/urinary atonia (increases gut motility and bladder activity if distention)
2. Alzheimer's
3) Myasthenia Gravis
4) Glaucoma
5) Reversal of NM blockers
6) Reversal of anticholinergic effects (CNS toxicity)

Front 13

How does cholinergic agonists affect the gut and bladder? (2)

Back 13

1. increases gut motility (decreases intestinal paralysis)
2. increase bladder activity if bladder distention

Front 14

What are direct cholinergic agonists used to do with the autonomic system?

Back 14

Increase PNS activity

Front 15

What are 2 direct cholinergic agonist applications?

Back 15

1. GI/urinary bladder atonia
2. Glaucoma

Front 16

What are 5 indirect cholinergic agonist applications?

Back 16

1. Alzheimer's
2. Myasthenia Gravis
3. Glaucoma (can be either direct or indirect)
4. Reversal of NM blockers
5. Reversal of anticholinergic induced CNS toxicity

Front 17

When and how are cholinergic agonists helpful for AD pts?

Back 17

Helpful in early stages of AD when ACh is still present in synapse (indirectly prolongs ACh release)

Front 18

When are cholinergic agonists not helpful for AD pts?

Back 18

In later stages of AD when pt no longer produces ACh

Front 19

What is glaucoma? What happens if goes untreated?

Back 19

Increased intraocular pressure

Can cause blindness and impaired vision

Front 20

How do cholinergic agonists treat glaucoma?

Back 20

Increases aqueous humor outflow to decrease pressure

Front 21

What direct cholinergic stimulants or agonists are 1 type of drug used to treat glaucoma?

How are they given?

Back 21

Carbachol (Carbastat) and Pilocarpine (Pilocar)

given topically

Front 22

What happens to the cholinergic receptors within a MG pt?

Back 22

Decrease in # of functional cholinergic receptors at end-organ (NMJ)

Front 23

What are MG pts given initially to treat and what does it alleviate?
Name an example drug name

Back 23

Indirect cholinergic agonists or cholinesterase inhibitors to alleviate fatigue and allow ACh to remain in cleft longer (also protects diaphragm from paralysis)

Neostigmine as an example

Front 24

What are MG pts given when their condition is long term?

Back 24

Immunosuppressants to react to autoimmune response

Front 25

What are NM blockers used for?

Back 25

Used in surgery with general anesthesia

Front 26

Why are reversal of NM blockers (indirect cholinergic agonist) used?

Back 26

May be used to speed up recovery after use of NM blockers during surgery

Front 27

What 3 things can overdose of anticholinergic drugs cause?

Back 27

1. delirium
2. hallucinations
3. coma

Front 28

What drugs may be used to reverse the effects of an overdose of anticholinergic drugs (delirium, hallucinations and coma)?

Back 28

Indirect cholinergic stimulants or agonists (lots of SE in CNS due to non-specificity)

Front 29

What are 2 adverse effects of cholinergic agonists or stimulants?

Back 29

1. many SE due to non-specificity
2. mimics exaggerated PNS activity

Front 30

What are 5 exaggerated PNS adverse effects from using cholinergic agonists or stimulants?

Back 30

1. GI distress (cramping, nausea, vomiting, diarrhea)
2. increased salivation (could choke)
3. bronchoconstriction
4. bradycardia
5. difficulty with visual accommodation

(High PNS activity symptoms)

Front 31

How do anticholinergic or cholinergic antagonist drugs function?

Back 31

Function by blocking the receptor from ACh effects and diminish ACh stimulation to tissues

Front 32

Are anticholinergic or cholinergic antagonists competitive or non-competitive?

Back 32

Competitive, they bind and then release from the receptor

Front 33

What are 2 types of anticholinergic or cholinergic antagonist drugs?

Back 33

1. anti-nicotinic
2. anti-muscarinic

Front 34

What are 2 uses for anti-nicotinic drugs?

Back 34

1. HTN (emergent use)
2. neuromuscular blockers during surgery

Front 35

What is a prototypical anti-muscarinic drug?

Back 35

Atropine which makes the eyes dilate

Front 36

What is the mechanism of antimuscarinic drugs?

Are they specific? Why?

Back 36

Blocks postsynaptic cholinergic muscarinic receptors

Not specific! All of these drugs will antagonize cholinergic receptors on multiple tissues

Front 37

What are anti-muscarinic drugs used for? (5)

Back 37

1. GI disorders (IBS, ulcers)
2. Parkinson's (overactive central cholinergic synapses)
3. CV
4. Motion sickness
5. Decrease bladder tone

Front 38

What are anti-muscarinic drugs primarily used for?

What are their effects?

Back 38

Adjunct treatment for GI disorders like IBS and ulcers

Decrease GI tract stimulation and secretions

Front 39

If given systemically, what are 5 most common side effects of anti-muscarinics (anticholinergics)?

What do they all have in common?

Back 39

1. dry mouth
2. blurred vision
3. urinary retention
4. constipation
5. tachycardia

All sympathetic responses, too much of a decrease in PNS!

Front 40

What are 3 rehab considerations for taking cholinergic drugs?

Back 40

1. If pt is taking cholinergic agonists for Alzheimer's or MG, schedule pt therapy at peak time effect

2. If pt is taking muscarinic antagonist for spastic bladder or incontinence, schedule pt after voiding and at peak effect

3. If nicotine use, a pt can experience SNS or PNS responses depending on comorbidities

Front 41

What do adrenergic drugs influence?

Back 41

SNS

Front 42

What are 2 major classes of adrenergic drugs?

Back 42

1. pharmacological agonists
2. pharmacological antagonists

Front 43

What are adrenergic drugs also called (agonists and antagonists)?

Back 43

Sympathomimetics (agonists)
Sympatholytics (antagonists)

Front 44

How are adrenergic drugs categorized?

Back 44

According to their mode of action or receptors, not by clinical application

Front 45

What is the primary location for alpha 1 receptors?

Back 45

Vascular smooth muscle

Front 46

Response when alpha 1 receptors are stimulated?

Back 46

Vasoconstricts organs

Front 47

Use of alpha 1 agonist drug? (3)

Back 47

1. hypotension
2. nasal congestion
3. types of increased HRs
--paroxysmal
--superventricular
--tachycardia

Front 48

Use of alpha 1 antagonist drug?

Back 48

HTN

Front 49

Primary location for alpha 2 receptors?

Back 49

CNS symptoms (inhibitory)

Front 50

Response when alpha 2 receptors are stimulated? (3)

Back 50

1. inhibit sympathetic signals
2. inhibit interneurons
3. decrease motor excitability

Front 51

Use of alpha 2 agonist drugs? (2)

Back 51

1. HTN
2. spasticity

Front 52

Use of alpha 2 antagonist drugs?

Back 52

n/a

Front 53

Primary location of beta 1 receptors?

Back 53

Heart

Front 54

Response when beta 1 receptors are stimulated? (2)

Back 54

1. Increase HR
2. Increase contractility

Front 55

Use of beta 1 agonist drugs?

Back 55

Increase cardio fcxn and output

Front 56

Use of beta 1 antagonists? (5)

Back 56

1. HTN
2. arrhythmia
3. angina
4. heart failure
5. MI

Front 57

Primary location of beta 2 receptors?

Back 57

Bronchioles

Front 58

Response when beta 2 receptors are stimulated?

Back 58

Dilation of airways

Front 59

Use of beta 2 agonist (bronchodilators) drugs?

Back 59

Prevent bronchospasms

Front 60

Use of beta 2 antagonists?

Back 60

n/a

Front 61

What 3 types of adrenergic receptors can treat HTN?

Back 61

1. alpha 1 antagonist (smooth muscles)
2. alpha 2 agonist (inhibits CNS sympathetic)
3. beta 1 antagonist (heart)

Front 62

What are 2 mixed adrenergic agonists?

Back 62

1. ephedrine
2. epinephrine

Front 63

How does ephedrine (mixed adrenergic agonist) work and when is it used?

Back 63

Works on both alpha and betas indirectly

Used for emergent hypotension or as a bronchodilator

Front 64

How does epinephrine (mixed adrenergic agonist) work?

Back 64

Works directly on all 4 receptors (alphas and betas)

Front 65

What type of drug is Phenylephrine (neo-synephrine)?

What is it used for?

Back 65

Alpha 1 selective agonist

Used for hypotension to vasoconstrict and decongestant

Front 66

Name an example drug of an alpha 1 selective agonist

Back 66

Phenylephrine (neo-synephrine) to vasoconstrict and decongestant

Front 67

What are 3 adverse effects of alpha 1 selective agonist drugs?

Back 67

1. HTN
2. HA
3. Reflex bradycardia

Front 68

How does reflex bradycardia occur with using an alpha 1 selective agonist drug?

Back 68

Drug will increase BP, barorecptors will initiate decrease in HR and cardiac output in response to drug

Front 69

What are 2 alpha 2 selective agonist drugs and what are they used for?

Back 69

1. Clonidine (Duraction) for HTN and anxiety
2. Tizanidine (Zanaflex) for spasticity

Front 70

What does Clonidine (Duraction) do? What does it treat?

Back 70

Alpha 2 selective agonist that treats HTN and anxiety

Front 71

What is tizanidine (Zanaflex) and what does it treat?

Back 71

Alpha 2 selective agonist that treats spasticity

Front 72

What are 3 adverse effects of alpha 2 selective agonists?

3 more serious effects due to toxicity?

Back 72

1. dizziness
2. drowsiness
3. dry mouth

more serious effects due to toxicity:
1. difficulty breathing
2. bradycardia
3. synscope

Front 73

What is an example beta 1 selective agonist?

2 indications to use it in treatment?

Back 73

Dobutamine (Dobutrex)

1. treat shock
2. heart failure

Front 74

What is an adverse effect of beta 1 selective agonist?

Back 74

Arrhythmia

Front 75

What is Dobutamine (Dobutrex) and what is it used for?
Treats for?

Back 75

Beta 1 selective agonist to increase heart function/output

Treats heart failure and shock

Front 76

What is an example drug of a beta 2 selective agonist?

What is it used for? (3)

Back 76

Albuterol (Proventil)

1. treat asthma
2. bronchitis
3. emphysema

Front 77

What are 3 adverse effects of beta 2 selective agonists?

Back 77

1. nervousness
2. restlessness
3. trembling

Front 78

What is Albuterol (Proventil) and what is it used for?

Back 78

Beta 2 selective agonist used to treat asthma, bronchitis and emphysema (bronchodilator)

Front 79

What are 3 adverse effects of Albuterol (Proventil)?

Back 79

1. nervousness
2. restlessness
3. trembling

Front 80

What is an adverse effect of using Dobutamine (Dobutrex)?

Back 80

Arrhythmia

Front 81

What are 3 adverse effects of using Clonidine (Duraction) and/or Tizanidine (Zanaflex)?

Back 81

1. dizziness
2. drowsiness
3. dry mouth

(3 serious effects if toxic--breathing difficulty, bradycardia, synscope)

Front 82

What are 3 adverse effects of using Phenylephrine (neo-synephrine)?

Back 82

1. HTN
2. HA
3. reflex bradycardia

Front 83

What are mixed alpha and beta adrenergic agonists?

Back 83

Drug with agonist activity at all adrenergic receoptors or act as indirect agonists

Front 84

What are 6 varied indications for mixed alpha and beta agonist?

Back 84

1. ADD
2. Narcolepsy
3. Hypotension
4. Asthma (inhalers)
5. Anaphylactic shock
6. Anesthesia

Front 85

What are 2 adverse effects of mixed alpha and beta adrenergic agonists?

Back 85

1. excess CNS excitation
2. excess stimulation of CV system (HTN, arrhythmias and cardiac arrests)

Front 86

What can mixed alpha and beta adrenergic agonists do in reference to their receptors?

Back 86

Any agonist will affect any alpha and beta receptor (SE!)

Front 87

What do adrenergic antagonists usually end in?

Back 87

-olol

Front 88

What drug is an example of an alpha blocker or antagonist that is non-selective?

How is it given?

Back 88

Phentolamine (Regitine)

Given IV or IM

Front 89

When is Phentolamine (Regitine) an alpha blocker (antagonist) used?

Back 89

For a surgery when a tumor is secreting too much epinephrine or norepinephrine

Front 90

What are 2 adverse effects of using Phentolamine (Regitine) an alpha blocker?

Back 90

1. reflex tachycardia
2. OH

Front 91

What are 2 adverse effects of using an alpha antagonist?

Back 91

1. reflex tachycardia
2. OH

Front 92

How does reflex tachycardia occur when using Phentolamine (Regitine) an alpha blocker?

Back 92

Drug decreases BP and BR respond with increasing HR and CO

Front 93

What is an example drug that is an alpha 1 selective antagonist or blocker?

Back 93

Prazosin (Minipress)

Front 94

What is Prazosin (Minipress) and what does it treat?

Back 94

Alpha 1 blocker or antagonist

Treats HTN

Front 95

What are 2 adverse effects of using Prazosin (Minipress) an alpha 1 blocker?

Back 95

1. reflex tachycardia
2. OH

Front 96

What is an example of a beta blocker (antagonist) that is non-selective?

Back 96

Propranolol (Inderal)

Front 97

What is Propranolol (Inderal) and what is it used for?

Back 97

Beta blocker (antagonists) that is non-selective

Treats HTN and angina

Front 98

What are 2 adverse effects to taking Propranolol (Inderal)?

Back 98

1. some bronchoconstriction and increased airway resistance
2. excess depression of cardiac function

Front 99

What are 2 adverse effects to taking a non-selective beta blocker?

Back 99

1. some bronchoconstriction and increased airway resistance
2. excess depression of cardiac function

Front 100

What type of pt should not take Propranolol (Inderal) when treating HTN? Why?

What should they take?

Back 100

Asthmatic or COPD pt b/c not selective to beta 2 receptors

Should take beta 1 selective antagonist or blocker

Front 101

What is an example drug of a beta 1 selective antagonist or blocker?

Back 101

Metoprolol (Lopressor)

Front 102

What is Metoprolol (Lopressor) and what is it used for?

Back 102

Beta 1 selective blocker or antagonist (caridoselective)

Used for HTN and angina

Front 103

What is an adverse effect when taking Metoprolol (Lopressor)?

Back 103

Excess depression of cardiac function

Front 104

What is an adverse effect when taking a beta 1 selective blocker?

Back 104

Excess depression of cardiac function