Question | Answer |
Bethanechol (Urecholine)
"muscarinic" Cholinergic | MOA-cholinomimetic that is selective to smooth muscle of the gi tract and urinary bladder |
| Indications: postoperative and postpartum urinary retention or increase peristalsis |
| To avoid nausea take 1 hour prior to meals or 2 hours after meals |
| Side Effects: abdominal discomfort, salivation, flushed skin, nausea, vomiting |
| Toxic reactions: intense cramping, diarrhea, urination, bradycardia and bronchoconstriction |
| Contraindication: COPD, asthma, hyperthyroidism, peptic ulcer. |
Neostigmine (Prostigmin)
"anticholinesterase" acetylcholinterase inhibitors. | MOA: produces reversible inhibition of AChE, ionized and does not cross blood-brain barrier |
| Indication: used in the treatment of myasthenia gravis |
| Side effects: nausea, diarrhea, excessive salivation. Caution in patients with asthma |
Tacrine (cognex) Donepezil (Aricept)
"anticholinesterase" acetylcholinterase inhibitors. | MOA: centrally acting reversible cholinesterase inhibitor leading to increased levels of acetylcholine in the brain |
| Indication: treatment of mild to moderate dementia |
| Pharmacokinetics: given orally, Tacrine has low bioavailability, given 4 times daily and requires weekly liver fuction tests. Donepezil, given once daily, half-life 70 hrs, does not require LFTs. Should be taken in the evening, disintegrating tablets. |
| Side effects: related to increased cholinergic effects including nausea, vomiting, diarrhea, urinary urgency, anorexia, bradycardia. No evidence that drug leads to sustained improved function. |
Atropine or Scopolamine
"antimuscarnic" | MOA: anticholinergic competitively antagonize the effects of ACh simply by blocking the receptor site. |
| Marked CNS depressant effects, elderly may be very sensitive. Similar to atropine. |
| Indications and use: preoperative to protect heart from vagal reflexes and prevent excessive respiratory secretions |
| In aerosol form, ipratropium (Atrovent) used as a bronchodilator |
Oxybutynin (Ditropan, Oxytrol, Gelniue)
"antimuscarnic" | Indications: overactive bladder. Forms- tablets, transdermal patches or ointments. Do not shower for 1 hour after application, partners use caution with skin to skin contact.
Side effects: constipation, urinary retention, blurred vision. |
Tolterodine (detrol)
"antimuscarnic" | Indications: overactive bladder. Bioavailability is high variable(10-70%).
Warning: blurred vision, dizziness, or drowsiness. |
Characteristics of the autonomic nervous system | visceral, vegetative, involuntary nervouse system no |
Sympathetic nervous system what is the most effective way to stop norepinepherin | reuptake and stored in the neuron or destroyed by Mona amine oxidase or if it floats away MAO and comt in the liver destroy to prevent sympathetic respanse |