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unit 4.8 chapt 21
cholinergic drugs
| Question | Answer |
|---|---|
| acetylcholine (AcH) | the neurotransmitter responsible for transmission of nerve impulses to effector cells in the parasympathetic nervous system |
| acetylcholinesterase (AChE) | the enzyme responsible for the breakdown of acetylcholine |
| Alzheimer's disease | a disease of the brain characterized by progressive mental deterioration manifested by confusion, disorientation, and loss of memory ability ... |
| Atony | a lack of normal muscle tone |
| cholinergic crisis | severe muscle weakness and respiratory paralysis due to excessive acetylcholine - seen in patients with myasthenia gravis |
| cholinergic receptors | a nerve receptors that is stimulated by acetylcholine |
| miosis | contraction of the pupil |
| muscarinic receptors | cholinergic receptors located postsynaptically in the effector organs such as smooth muscle, heart muscle, and glands supply by parasympathetic fibers |
| nicotinic receptors | cholinergic receptors located in the ganglia of bothe the parasympathetic and sympathetic system can be stimulated by the alkaloid nicotine |
| parasympathomimetics | drugs that mimic parasympathetic nervous system; also referred to as cholinergic agonist drugs |
| the parasympathetic system controls | homeostasis and the body at rest - restores the body to a state of calm -slows heart rate, relaxes smooth muscle, constricts bronchiles |
| Acetylcholine is responsible for | the transmission of nerve impulses to effector cells in the parasympathetic nervous system |
| there are____types of cholinergic receptors | two |
| nicotinic receptors are located in | the ganglia of both the parasympathetic and sympathetic nervous systems. (can be stimulated by nicotine) |
| muscarine receptors are located | postsynaptically in the effector organs (is. smooth muscle, heart muscle, and glands) supplied by the parasympathetics fibers |
| cholinergic drugs | mimic the effects of Each - stimulate the cholinergic receptors directly or indirectly |
| Indirect acting cholinergic agonists | stimulate the postsynaptic release of Each at the receptor site; this allows the ACh to bind to and stimulate the receptor |
| indirect acting cholinergic drugs (also known as cholinesterase inhibitors_ work by | inhibiting the action of acetylcholinesterase (AChE) the enzyme responsible for breaking down ACh |
| there are two types of cholinesterase inhibitors | reversible inhibitors and irreversible inhibitors |
| reversible cholinesterase inhibitors | bind to cholinesterase for a short period of time |
| irreversible cholinesterase inhibitors have | a long duration of activity and the body must then generate new enzymes to override the effects of the irreversible drugs |
| parasympathetic system = | rest and digest system |
| cholinergic drugs are used primarily for their effects on | the GI tract, bladder, and eye |
| cholinergic drugs stimulate the | intestines and bladder which results in increased gastric secretions, GI motility and urinary frequency and stimulate the pupil constriction |
| cholinergic drugs also increase | salivation and sweating |
| cardiovascular effects of cholinergic drugs are | decreased heart rate and vasodilation |
| pulmonary effects of cholinergic drugs are | constriction of the bronchi of the lungs and narrowing of the airways |
| at recommended doses cholinergic drugs primarily affect the | muscarinic receptors, but at high doses the nicotinic receptors can also be stimulated |
| the desired effects of cholinergic drugs come from the | muscarinic receptor stimulation |
| many undesirable effects of cholinergic drugs come from the | stimulation of the nicotinic receptors |
| indirect-acting drugs work by | increasing ACh concentrations at the receptor sites, which leads to stimulation of the effector cells. |
| indirects acting drugs cause | skeletal muscle contraction and are used for the diagnosis and treatment of myasthenia grabis |
| myasthenia gravis is a | rare autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal muscles of the body |
| myasthenia gravis is caused by | a defect in the function of ACh at the neuromuscular junctions |
| indirect acting cholinergic drugs are also used to treat | Alzheimers disease - these drugs increase concentrations of ACh in the brain by inhibiting cholinesterase. They do not reverse the disease. |
| Three cholinesterase inhibitors used to treat Alzheimer's | donepezil (Aricept), galantine (Reminyl), and rivastigmine hydrogen tartrate (Exelon) |
| contraindications use use of cholinergic rugs include | known drug allergy, GI or genitourinary (GU) tract obstruction, hyperthyroidism, epilepsy, hypotension or COPD |
| ADE of cholinergic drugs are the consequence of | overstimulation of the parasympathetic nervous system |
| cardiovascular ADE | syncope, hypotension with reflex tachycardia, hypertension or bradycardia |
| there is little systemic absorption of | topically administered cholinergic drugs |
| the most severe consequences of overdose of a cholinergic drug is | cholinergic crisis - symptoms include circulatory collapse, hypotension, bloody diarrhea, shock and cardiac arrest |
| early signs of cholinergic shock | abdominal cramps, salivation, flushing of the skin, nausea, and vomiting |
| symptoms of cholinergic shock can be reversed by the | administration of atropine sulphate a cholinergic antagonist |
| severe cardiovascular reactions or bronchoconstriction may be aleviated by | epinephrine, an adrenergic agonist |
| cholinergic poisoning acronym | SLUDGE - salivation, lacrimation, urinary incontinence, diarrhea, gastrointestinal cramps, and emesis |
| Cholinergic interact with | anticholinergics (Atrophine sulphate), antihistamines, and sympathomimetics |
| effects of cholinergic drugs (parasympathomimetics )include | decreased heart rate, increased GI and GU tone, increased contractility and tone of bronchial smooth muscle, increased Respiratory secretions, |
| _________antidote for overdose of a cholinergic drug | atropine |
| _________cholinergic drugs that act by making more acetylcholine (ACh) available at the receptor set, which allows ACH to bind to and stimulate | indirect acting cholinergic drugs |
| _______cholinergic drugs that bind to cholinergic receptors and activate them | direct acting cholinergic drugs |
| ______receptors located postsynaptically in the effector organs (smooth muscle, cardiac muscle) supplied by the parasympathetic fibers | muscarinic |
| ____receptors located in the ganglia of the parasympathetic nervous system and the sympathetic nervous system | nicotinic |
| _____a description of the action of the parasympathetic nervous system | rest and digest |
| ______the neurotransmitter responsible for the transmission of nerve impulses to the effector cells in the PSNS | acetylcholine |
| _____the enzyme responsible for breaking down ACh | cholinesterase |
| the desired effects of cholinergic drugs come from the stimulation of which receptors | muscarinic |
| the undesired effects of the cholinergic drugs come from the stimulation of which receptors | nicotinic |
| when a patient mentions bethanechol chloride when asked about med history the nurse recognized that this drug is used to treat which condition | urinary retention |
| when caring for a patient with myasthenia grabs, nurse can expect to have the prescriber order which med | pyridostigmine bromide (Mestinon) |
| a patient has received an inadvertent overdose of a cholinergic drug what are early manifestations | salivation, flushing of the skin, abdominal cramps, dyspnea |
| Bethanechol chloride (Devoid) classification | direct acting cholinergic agonist - used in treatment of acute post-op and post party urinary retention |
| deonepezil hydrochloride (Aricept) classification | cholinesterase inhibitor arg that works to increase ACh levels in the brain by inhibiting AChE. Used for alzheaimers |
| memantin hydrochloride (Ebixa) classification | not a cholinergic drug but used for alzheimers |
| pyridostigmine bromide (Mestinon) classification | synthetic quaternary ammonium compound - indirect acting cholinergic drug work to increase ACh by inhibiting AChE. Used for myasthenia gravis |
Created by:
lalitaburg