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Bethanechol (Urecholine) "muscarinic" Cholinergic | MOA-cholinomimetic that is selective to smooth muscle of the gi tract and urinary bladder
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Indications: postoperative and postpartum urinary retention or increase peristalsis
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To avoid nausea take 1 hour prior to meals or 2 hours after meals
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Side Effects: abdominal discomfort, salivation, flushed skin, nausea, vomiting
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Toxic reactions: intense cramping, diarrhea, urination, bradycardia and bronchoconstriction
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Contraindication: COPD, asthma, hyperthyroidism, peptic ulcer.
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Neostigmine (Prostigmin) "anticholinesterase" acetylcholinterase inhibitors. | MOA: produces reversible inhibition of AChE, ionized and does not cross blood-brain barrier
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Indication: used in the treatment of myasthenia gravis
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Side effects: nausea, diarrhea, excessive salivation. Caution in patients with asthma
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Tacrine (cognex) Donepezil (Aricept) "anticholinesterase" acetylcholinterase inhibitors. | MOA: centrally acting reversible cholinesterase inhibitor leading to increased levels of acetylcholine in the brain
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Indication: treatment of mild to moderate dementia
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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.
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Side effects: related to increased cholinergic effects including nausea, vomiting, diarrhea, urinary urgency, anorexia, bradycardia. No evidence that drug leads to sustained improved function.
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Atropine or Scopolamine "antimuscarnic" | MOA: anticholinergic competitively antagonize the effects of ACh simply by blocking the receptor site.
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Marked CNS depressant effects, elderly may be very sensitive. Similar to atropine.
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Indications and use: preoperative to protect heart from vagal reflexes and prevent excessive respiratory secretions
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In aerosol form, ipratropium (Atrovent) used as a bronchodilator
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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.
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Tolterodine (detrol) "antimuscarnic" | Indications: overactive bladder. Bioavailability is high variable(10-70%).
Warning: blurred vision, dizziness, or drowsiness.
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Characteristics of the autonomic nervous system | visceral, vegetative, involuntary nervouse system no
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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
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