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NRSG Pharm CH 12
Cholinergic/Anticholinergic
Question | Answer |
---|---|
Neurotransmitter of parasympathetic, receptor @ effector organ in ANS | Acetylcholine, cholinergic receptor |
Neurotransmitter of sympathetic, receptor @ effector organ in ANS | Norepinephrine, adrenergic receptor |
Neurotransmitter and receptor type at ganglia in ANS | Acetylcholine, nicotinic receptor, both symp/para- smooth muscle and gland secretion stimulations |
Muscarinic receptors, action in heart | para, @ target organs, stim smooth muscle, stim gland secretion. In heart: dec heart rate and force of contraction |
Subclasses parasympathomimetic: | Direct - bind to cholinergic receptors -> para effect Indirect - inhibit action of AchE, high potential for serious adverse effects |
Prototype drug: bethanechol (Urecholine). Classes, mech, | T: non-obstructive urinary retention drug P: Muscarinic cholinergic receptor drug Mech: Direct acting parasympathomimetic - most noted in GI/urinary, stim smooth-muscle contraction |
bethanechol (Urecholine) admin alerts | Monitor BP, HR, RR before admin and atleast 1hr post subcutaneous admin. Preg C |
bethanechol (Urecholine) side effects / treatment OD | Para stim. Inc salvation, sweating, abd cramps, hypotension -> fainting. Caution: pt with conditions that could be aggravated with inc GI contractions: suspected obstruction, active ulder, inflam disease, urinary obstruction, COPD OD atropine sulfate |
donepezil (Aricept) | Cholinesterase inhibitor, indirect, Alzheimer's disease |
adverse effects cholinergic: | brady, hypo, dysrhythmias, tremors, dizziness, headache, dyspnea, dec urinary output, abd pain, AMS |
Effects anticholinergic: | parasympatholytic: pupil dilation (mydriasis(, inc HR, drying glandular, relaxing smooth muscle - bronchodilation |
Uses anticholinergic: | PUD, ophthalmic, dysrhythmias, anesthesia adjuncts, asthma/COPD, overactive bladder, parkinson |
Prototype: atropine (Atropair) classes, mech | T: antidote for anticholinesterase poisoning P: Muscarinic cholinergic receptor blocker M: inhibit para by occupying muscarinic receptors - blocks para of Ach and inc symp response |
Atropine (Atropair) primary uses: | IBS, dilate pupils, brady, preanesthetic, asthma |
Atropine (atropair) admin alerts: | Monitor BR, HR, RR before and 1HR post subcutaneous admin |
Atropine (atropair) side/adverse: | Dry mouth, constipation, urinary retention, inc HR |
Atropine (atropair) contraindications: | glaucoma - may inc ocular pressure |
Anticholinergic considerations: | signs of anticholinergic crisis, changes in HR, BP, dysrhythmias, dry mouth, minimize cold/heat/strain, I/Os, abd distention/bowel sounds |
anticholinergic drug tox indications: | Seizures, V tach, |
Anticholinergic adverse: | tachy, hypertension, dysrhythmias, tremors, dizziness, headache, dec urinary output |