gout, adrenergic,Adrenergic-Blocking Drugs, cholinergics and anticholinergics

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.

Help!

Question

Answer

The stomach secretes:

Hydrochloric acid (HCl) Bicarbonate Pepsinogen Intrinsic factor Mucus Prostaglandins

🗑

Glands of the Stomach

Cardiac Pyloric Gastric The cells of the gastric gland are the largest in number and of primary importance when discussing acid control

🗑

Cells of the Gastric Gland

Parietal Chief Mucous Endocrine Enterochromaffin

🗑

Parietal cells

Produce and secrete HCl Primary site of action for many of the drugs used to treat acid-related disorders

🗑

Chief cells

Secrete pepsinogen, a proenzyme Pepsinogen becomes pepsin when activated by exposure to acid Pepsin breaks down proteins

🗑

Mucous cells

Mucus-secreting cells (surface epithelial cells) Provide a protective mucus coat Protect against self-digestion by HCl and digestive enzymes

🗑

Hydrochloric Acid

Secreted by parietal cells when stimulated by food, caffeine, chocolate, and alcohol Maintains stomach at pH of 1 to 4 Acidity aids in the proper digestion of food and defenses against microbial infection via the GI tract

🗑

Acid-Related Diseases

Peptic ulcer disease (PUD) Gastric or duodenal ulcers that involve digestion of the GI mucosa by the enzyme pepsin

🗑

Acid-Related Diseases

Helicobacter pylori (H. pylori) Bacterium found in GI tract of 90% of patients with duodenal ulcers and 70% of those with gastric ulcers First-line therapy includes a 10- to 14-day course of a proton pump inhibitor and antibiotics

🗑

Acid-Related Diseases (cont’d)

GI lesions are a common finding in ICU patients, especially within the first 24 hours after admission Factors include decreased blood flow, mucosal ischemia, hypoperfusion, and reperfusion injury Nasogastric (NG) tubes and ventilators predispose patien

🗑

Types of Acid-Controlling Drugs

Antacids H2 antagonists Proton pump inhibitors

🗑

Antacids

Basic compounds used to neutralize stomach acid Salts of aluminum, magnesium, calcium, and/or sodium Many antacid preparations also contain the antiflatulent (antigas) drug simethicone

🗑

Antacids: Mechanism of Action

Do not prevent the overproduction of acid but instead help to neutralize acid secretions Promote gastric mucosal defensive mechanisms Stimulate secretion of: Mucus: protective barrier against HCl Bicarbonate: helps buffer acidic properties of HCl Pro

🗑

Antacids: Drug Effects

Reduction of pain associated with acid-related disorders Raising gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid Reducing acidity reduces pain as a result of:

🗑

Antacids (cont’d)

Over-the-counter formulations available as: Capsules and tablets Powders Chewable tablets Suspensions Effervescent granules and tablets

🗑

Antacids

Used alone or in combination Aluminum salts Magnesium salts Calcium salts Sodium bicarbonate

🗑

Antacids: Aluminum Salts

Have constipating effects Often used with magnesium to counteract constipation Often recommended for patients with renal disease (more easily excreted)

🗑

Antacids: Magnesium Salts

Commonly cause diarrhea; usually used with other drugs to counteract this effect Dangerous when used with renal failure—the failing kidney cannot excrete extra magnesium, resulting in accumulation

🗑

Antacids: Magnesium Salts (cont’d)

Examples Hydroxide salt: magnesium hydroxide (Milk of Magnesia) Carbonate salt: Gaviscon (also a combination product) Combination products such as Maalox, Mylanta (aluminum and magnesium)

🗑

Antacids: Calcium Salts

Many forms, but carbonate is most common May cause constipation, kidney stones Also not recommended for patients with renal disease—may accumulate to toxic levels Long duration of acid action—may cause increased gastric acid secretion (hyperacidity reb

🗑

if someone has renal failure which antacid you should not use

one with magnesium because renal can't displaced

🗑

Antacids: Sodium Bicarbonate

Highly soluble Buffers the acidic properties of HCl Quick onset, but short duration May cause metabolic alkalosis Sodium content may cause problems in patients with heart failure, hypertension, or renal insufficiency

🗑

A patient who has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this patient? A magnesium-containing antacid A calcium-containing antacid An aluminum-containing antacid Beca

🗑

Antacids and Antiflatulents

Antiflatulents: used to relieve the painful symptoms associated with gas Several drugs are used to bind or alter intestinal gas and are often added to antacid combination products simethicone

🗑

Antacids: Adverse Effects

Minimal and depend on the compound used Aluminum and calcium Constipation Magnesium Diarrhea Calcium carbonate Produces gas and belching; often combined

🗑

if elderly has heart failure you should not give

sodium bicarb - volume, fluid retention

🗑

Antacids: Drug Interactions (cont’d)

Increased stomach pH Increased absorption of basic drugs Decreased absorption of acidic drugs Increased urinary pH Increased excretion of acidic drugs Decreased excretion of basic drugs

🗑

Histamine 2 (H2) Receptor Antagonists

Reduce acid secretion All available over the counter in lower dosage forms

🗑

Histamine 2 (H2) Receptor Antagonists

Most popular drugs for treatment of acid-related disorders cimetidine (Tagamet) nizatidine (Axid) famotidine (Pepcid) ranitidine (Zantac)

🗑

H2 Antagonists: Mechanism of Action

Competitively block the H2 receptor of acid-producing parietal cells Reduced hydrogen ion secretion from the parietal cells Increase in the pH of the stomach Relief of many of the symptoms associated with hyperacidity-related conditions

🗑

H2 Antagonists: Drug Effect and Indications

Drug effect Suppressed acid secretion in the stomach Indications Gastroesophageal reflux disease (GERD) Peptic ulcer disease (PUD) Erosive esophagitis Adjunct therapy to control upper GI bleeding Zollinger-Ellison syndrome

🗑

H2 Antagonists: Adverse Effects

Overall, very few adverse effects Central nervous system adverse effects in elderly patients include confusion and disorientation Cimetidine may induce impotence and gynecomastia Thrombocytopenia has been reported with ranitidine and famotidine

🗑

H2 Antagonists: Drug Interactions

cimetidine (Tagamet) Binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for abso

🗑

H2 Antagonists: Drug Interactions

🗑

H2 Antagonists: Drug Interactions

Smoking has been shown to decrease the effectiveness of H2 blockers For optimal results, H2 receptor antagonists are taken 1 to 2 hours before antacids

🗑

When working with an elderly patient who has been admitted for a possible gastrointestinal bleed, the nurse identifies which drug as having the potential to cause confusion and disorientation? An antacid A proton pump inhibitor An H2 antagonist A muco

An H2 antagonist

🗑

Proton Pump Inhibitors (PPIs)

The parietal cells release positive hydrogen ions (protons) during HCl production This process is called the proton pump H2 blockers and antihistamines do not stop the action of this pump

🗑

Proton Pump Inhibitors

lansoprazole (Prevacid) omeprazole (Prilosec) rabeprazole (AcipHex) pantoprazole (Protonix) esomeprazole (Nexium)

🗑

Proton Pump Inhibitors: Mechanism of Action

Irreversibly bind to H+/K+ ATPase enzyme This bond prevents the movement of hydrogen ions from the parietal cell into the stomach Results in achlorhydria—ALL gastric acid secretion is temporarily blocked To return to normal acid secretion, the parietal

🗑

Proton Pump Inhibitors: Indications

GERD Erosive esophagitis Short-term treatment of active duodenal and benign gastric ulcers Zollinger-Ellison syndrome Nonsteroidal antiinflammatory drug (NSAID)–induced ulcers Stress ulcer prophylaxis Treatment of Helicobacter pylori–induced ulcers

🗑

Proton Pump Inhibitors: Adverse Effects

PPIs are generally well tolerated Possible predisposition to GI tract infections (Clostridium difficile) Osteoporosis and risk of wrist, hip, and spine fractures in long-term users Pneumonia Depletion of magnesium

🗑

Sucralfate (Carafate)

Cytoprotective drug Used for stress ulcers, peptic ulcer disease Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas Protects these areas from pepsin, which normally breaks down proteins (making ulce

🗑

adrenergic drugs

drugs that stimulate the sympathetic nervous system - flight or flight, bronchodilations, elevated bp, elebated pulse, pupils are dilated

🗑

sympathetic stimulants

adrenergic, adrenominmetics, adrenergic agonists and sympathomimetics

🗑

parasympathic stimulants

cholinergics, cholinergic agonists and parasympathomimetics

🗑

characteristics of adrenergics are

mimics the effects of SNS neurotran (catecholamines) NE, EPI and dopamine

🗑

Alpha1-adrenergic receptors Located on

postsynaptic effector cells (the cell, muscle, or organ that the nerve stimulates)

🗑

Alpha2-adrenergic receptors Located on

presynaptic nerve terminals (the nerve that stimulates the effector cells) Control the release of neurotransmitters

🗑

Beta-Adrenergic Receptors Beta-Adrenergic Receptors

postsynaptic effector cells

🗑

Beta1-adrenergic receptors—located

receptors—located primarily in the heart

🗑

Beta2-adrenergic receptors—located in

in smooth muscle of the bronchioles, arterioles, and visceral organs

🗑

Beta-Adrenergic Agonist Responses

Bronchial, GI, and uterine smooth muscle relaxation Glycogenolysis Cardiac stimulation

🗑

Dopaminergic Receptors

An additional adrenergic receptor Stimulated by dopamine Causes dilation of the following blood vessels, resulting in increased blood flow

🗑

Catecholamines

Substances that can produce a sympathomimetic response Endogenous Epinephrine, norepinephrine, dopamine Synthetic Dobutamine, phenylephrine

🗑

Catecholamines Mechanism of Action

Direct-acting sympathomimetic Binds directly to the receptor and causes a physiologic response

🗑

Catecholamines Mechanism of Action

Indirect-acting sympathomimetic Causes release of catecholamine from storage sites (vesicles) in nerve endings Catecholamine then binds to receptors and causes a physiologic response

🗑

Catecholamines Mechanism of Action

Mixed-acting sympathomimetic Directly stimulates the receptor by binding to it and Indirectly stimulates the receptor by causing the release of stored neurotransmitters from vesicles in the nerve endings

🗑

Catecholamines Stimulation of

alpha-adrenergic receptors on smooth muscles results in Vasoconstriction of blood vessels Relaxation of GI smooth muscles (decreased motility) Constriction of bladder sphincter Contraction of uterus Male ejaculation Contraction of pupillary muscles

🗑

Catecholamines Stimulation of

of beta1-adrenergic receptors on the myocardium, atrioventricular (AV) node, and sinoatrial (SA) node results in cardiac stimulation

🗑

Catecholamines Drug Effects (cont’d)

Stimulation of beta2-adrenergic receptors on the airways results in Bronchodilation (relaxation of the bronchi) Other effects of beta2-adrenergic stimulation Uterine relaxation Glycogenolysis in the liver

🗑

Catecholamines

Treatment of asthma and bronchitis

🗑

examples of bronchildilators are

Examples: albuterol (works the fastest), ephedrine, epinephrine, formoterol, levalbuterol, metaproterenol, pirbuterol, salmeterol, and terbutaline*

🗑

catecholamines are used for what?

treatment of asthma and bronchitis, treatment of nasal congestion, temporary relief of conjunctival congestion (eyes), reduction of intraocular pressure & dilation of pupils

🗑

catecholamines are used for treatment of nasal congestion -- HOW so?

Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion Alpha1-adrenergic receptors Examples: ephedrine, naphazoline, oxymetazoline, phenylephrine, and tetrahydrozoline

🗑

Vasoactive Adrenergics (Pressors, Inotropes) - big hitters! seen usually in the ER

Also called cardioselective sympathomimetics Used to support the heart during cardiac failure or shock; various alpha and beta receptors affected

🗑

Vasoactive Sympathomimetics (Pressors, Inotropes): Examples

dopamine epinephrine phenylephrine norepinephrine, dobutamine ephedrine fenoldopam midodrine

🗑

Alpha-Adrenergic Adverse Effects

CNS Headache, restlessness, excitement, insomnia, euphoria Cardiovascular Palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension Other Loss of appetite, dry mouth, nausea, vomiting, taste changes (rare)

🗑

Beta-Adrenergic Adverse Effects

CNS Mild tremors, headache, nervousness, dizziness Cardiovascular Increased heart rate, palpitations (dysrhythmias), fluctuations in BP Other Sweating, nausea, vomiting, muscle cramps

🗑

Nursing Implications for individuals with chronic lung disease

Instruct patients to avoid factors that exacerbate their condition Encourage fluid intake (up to 3000 mL/day) if permitted Educate patients about proper dosing, use of equipment (metered-dose inhaler [MDI], spacer, nebulizer), and equipment care

🗑

what to do with intravenous administration

Check IV site often for infiltration Use clear IV solutions Use an infusion pump Infuse drug slowly to avoid dangerous cardiovascular effects Monitor cardiac rhythm

🗑

Salmeterol is indicated for

for prevention of bronchospasms, not management of acute symptoms

🗑

Overuse of nasal decongestants may cause

rebound nasal congestion or ulcerations

🗑

Administering two adrenergic drugs together may precipitate severe cardiovascular effects such

tachycardia or hypertension

🗑

when someone is having an asthma attack there is no what?

GAS EXCHANGE - no alveoli is open -

🗑

Monitor for therapeutic effects (cardiovascular uses)

Decreased edema Increased urinary output Return to normal vital signs Improved skin color and temperature Increased LOC

🗑

Monitor for therapeutic effects (asthma)

Return to normal respiratory rate Improved breath sounds, fewer crackles Increased air exchange Decreased cough Less dyspnea Improved blood gases Increased activity tolerance

🗑

REMEMBER!! TO listen for everything so you can know a patient change of status

lungs, belly heart

🗑

adrenerigic blocking drugs, what do u expect from it?

Decrease bronchildilators, pupil constrict - Bind to adrenergic receptors, but inhibit or block stimulation of the sympathetic nervous system (SNS) Have the opposite effect of adrenergic drugs Inhibit—or lyse—sympathetic stimulation

🗑

adrenergic blockers are also known as

Adrenergic antagonists Sympatholytics Alpha blockers, beta blockers, or alpha-beta blockers

🗑

adrenergic blockers are classified by what?

type of adrenergic receptor they block Alpha1 and alpha2 receptors Beta1 and beta2 receptors

🗑

adrenergic blocker drugs effects and indication, alpha blockers

Cause both arterial and venous dilation, reducing peripheral vascular resistance and BP Used to treat hypertension Effect on receptors on prostate gland and bladder decreases resistance to urinary outflow, thus reducing urinary obstruction and relieving

🗑

adrenergic blocker drugs effects and indication, alpha blockers

Used to control and prevent hypertension in patients with pheochromocytoma

🗑

what reverse the potent vasocontstrictive effects of extravaseted vasopressors such as norepinephrine or epinephrine

Phentolamine - Restores blood flow and prevents tissue necrosis

🗑

the tumor in the adrenal gland will release catecholimes and catecholmies will do what

vasoconstriction - high blood pressure

🗑

Common Alpha Blockers

phenoxybenzamine HCl (Dibenzyline) phentolamine (Regitine) prazosin (Minipress) terazosin (Hytrin) alfuzosin (UroXatral) tamsulosin (Flomax)

🗑

Beta Blockers - Block stimulation of

beta receptors in the SNS Compete with norepinephrine and epinephrine Can be selective or nonselective Nonselective beta blockers block both beta1 and beta2 receptors

🗑

Beta1 receptors Located primarily on

he heart Beta blockers selective for these receptors are called cardioselective beta blockers

🗑

Beta2 receptors Located primarily on

smooth muscle of bronchioles and blood vessels

🗑

Mechanism of - Cardioselective beta blockers (beta1)

Reduce SNS stimulation of the heart Decrease heart rate Prolong sinoatrial (SA) node recovery Slow conduction rate through the AV node Decrease myocardial contractility, thus reducing myocardial oxygen demand

🗑

Mechanism of Action - Nonselective beta blockers (beta1 and beta2)

Cause same effects on heart as cardioselective beta blockers Constrict bronchioles, resulting in narrowing of airways and shortness of breath Produce vasoconstriction of blood vessels Other effects

🗑

beta 2

2 lungs

🗑

beta 1

1 heart

🗑

beta blockers (beta1 and beta2) - indications

Angina Decreases demand for myocardial oxygen Cardioprotective Inhibits stimulation from circulating catecholamines Dysrhythmias Class II antidysrhythmic Migraine headache Lipophilicity allows entry into CNS Antihypertensive Heart failure Glauc

🗑

Adverse Effects: Beta Blockers

Agranulocytosis, thrombocytopenia AV block, bradycardia, heart failure Dizziness, depression, unusual dreams, drowsiness

🗑

Nonselective beta blockers may interfere with

normal responses to hypoglycemia (tremor, tachycardia, nervousness) May mask signs and symptoms of hypoglycemia Use with caution in patients with diabetes mellitus

🗑

Beta Blockers: Examples

metoprolol (Lopressor) propranolol (Inderal) sotalol (Betapace) atenolol (Tenormin) carvedilol (Coreg) esmolol (Brevibloc) labetalol (Normodyne)

🗑

Remember that alpha blockers may

precipitate hypotension

🗑

Remember that some beta blockers may

precipitate bradycardia, hypotension, heart block, heart failure, and bronchoconstriction

🗑

Adrenergic-Blocking Drugs - Possible drug interactions may occur with:

Antacids (aluminum hydroxide type) Antimuscarinics/anticholinergics Diuretics and cardiovascular drugs Neuromuscular blocking drugs Oral hypoglycemic drugs

🗑

A patient with type 2 diabetes is taking a beta blocker as part of treatment for hypertension. Which complication is most likely to develop?

Hypoglycemia

🗑

coreg effects whats?

Alpha and beta blocker!!!

🗑

alpha blockers might do what

hypotension

🗑

BPH, vasodilation in more then one area

🗑

The sympathetic nervous system is also called

the adrenergic system

🗑

the parasympathetic nervous system is called the

cholinergic system

🗑

Why is the parasympathetic nervous system called the cholinergic system?

because the neurotransmitter at theend of the neuron that innervates the muscle is acetylcholine

🗑

the cholinergic receptors at organs cells ar either

nicotinic or muscarinic meaning that they are stimulated by the alkaloid nicotine and muscarine

🗑

acetylcholine stimulates

the receptor cells to produce a response but the enzyme actylcholinesterase may inactivate acetycholine b4 it reaches the receptor cel

🗑

alpha 1

increases force of heart contraction, vasocontriction increases blood pressure, mydriasis (dilation of pupils), salivary glands decrease, increases urinary bladder relaxation and urinary sprinter conraction

🗑

alpha 2

inhibits release of of norepinephrine; dilates blood vessels; produces hypotension; decreases gastrointestinal motility and tone

🗑

beta 1

increases heart rate and force of contraction; increases renin secretin, which increases blood pressure

🗑

beta 2

dilates bronchioles; promotes gastrointestinal and uterine relaxation; promotes increase in blood sugar thorugh glycogenolysis in liver; increases blood flow in skeletal muscles

🗑

catecholamines

are the chemical structures of a substance that can produce a sympathomimetic response: example: epinephrine, norepinephrine and dopamine

🗑

Epineprhine

= Catecholamine = Adrenalin = Acts on Alpha 1, Beta 1, Beta 2. Used in Anaphylaxis - Strengthens Myocardial contraction

🗑

albuterol

selective for Beta 2 - purely bronchodilation

🗑

Clonidine and Aldomet are

selective Alpha 2 drugs to treat htn

🗑

alpha blockers are helpful in decreasing symptoms of

benign prostatic hypertrophy

🗑

alpha blockers promote vasodilation causing a

decrease in bp

🗑

beta adrenergic blockers are called

beta blockers

🗑

beta blockers * Some beta blockers are nonseletctive

decrease heart rate, decrease bp

🗑

propranolol hydrochloride (inderal)

was the first beta blocker prescribed to treat angina, cardiac dysrhythmias, hypertension and heart failure. BUT has a lot of SE bc of nonselective response for beta 1 & beta 2. Contraindicated for people for asthma

🗑

What is inderal contraindicated for?

asthma or second, 3rd degree heart block ALSO many drug interactions! Dilantin, NSAIDS.

🗑

Inderal and Digoxin (Or calcium blocker) is BAD!!! Because?

Atrioventricular (AV) block may occur

🗑

drugs that block the release of norepinephrine from the sympathetic terminal are called

adrenergic neuron blockers

🗑

What are the two groups of drugs that affect the parasympathetic nervous system?

Cholinergics(parasympathomimetics) and anticholinergics(parasympatholytics

🗑

Drugs that stimulate the parasympathetic nervous system are called

Cholinergics/parasympathomimetics

🗑

Drugs that stimulate the parasympathetic nervous system are called Cholinergics/parasympathomimetics because

Mimic the parasympathetic neurotransmitter acetylcholine

🗑

Acetylcholine is the

neurotransmitter located at the ganglions and the parasympathetic terminal nerve endings. It innervates the receptors in organs tissues and glands

🗑

The two types of cholinergic receptors are

muscarinic receptors and which stimulate smooth muscle and slow the heart rate and nicotinic recptors (neuromuscular) which affect the skeletal muscles. *many cholinergic drugs are nonselective!!

🗑

Direct acting cholinergic drugs act on the

receptors to activate a tissue response

🗑

Indirect acting cholinergic drugs inhibit the action of the enzyme

cholinesterase (ChE) by forming a chemical complex thus permitting acetylcholine

🗑

The major responses of cholinergic drugs are to stimulate

bladder and gastrointestinal tone, constrict pupils of the eyes (miosis) and increase neuromuscular transmission.

🗑

Direct acting cholinergics are

primarily selective to the muscarinic receptors but are non specific because the muscarinic recprots are locatd in the smooth muscles of the GI and genitourinary tacts, glands and heart

🗑

Bethanechol chloride ( urecholine) a direct acting cholinergic receptor and is used

primarily to increase urination

🗑

Metoclopramide HCL (raglan) is a

direct acting cholinergic drug that is usually prescribed to treat gastroesophageal reflux disease (GERD)

🗑

Metoclopramide

increases gastric emptying time

🗑

Pilocarpine is a

direct acting cholinergic drug that constricts the pupils of the eys thus opening the canal of schlemm to promote drainage of aqueous humor. This drug is used to treat glaucoma by relieving fluid

🗑

The function of enzyme cholinersterase

is to beak down into choline and acetic acid

🗑

A cholinestersase inhibitor drug binds with cholinesterase allowing

acetylcholine to activate the muscarinic and nicotinic cholinergic receptors. This action permits skeletal muscle stimulation which increases the force of muscular contraction

🗑

Cholinesterase inhibitors are useful

to increase muscle tone for clients with myasthenia gravis ( a neuromuscular disorder) by increasing acetylcholine additional effets occur such as increase in GI motility, bradycardia, miosis, bronchial constriction and increased micturition.

🗑

The primary use of cholinesterase inhibitors is to

treat myasthenia gravis, other uses are to treat glaucoma, alzheimers disease and muscarinic antagonist poisoning.

🗑

Drugs that inhibit the actions of acetylcholine by occupying the acetylcholine receptors are called

anticholinergics/parasympatheolytics

🗑

The major body tissues and organs affected by anticholinergic group of drugs are

the heart, respiratory tract, GI tract, urinary bladder,eyes and exocrine glands.

🗑

The major responses to anticholinertics are a decrease in

GI motility, a decrease in salivation, dilation of pupils( mydriasis) and an increase in pulse rate, decrease bladder contraction which can result in urinary retention and decrease rigidity and tremors

🗑

Atropine is useful

as a preoperative medication to decrease salivary secretion, as an antispasmodic drug & 2 treat peptic ulcers bc it relaxes the smooth muscles of the GI tract & decrease peristalsis & as an agent to increase the heart rate when bradycardia is present

🗑

Drugs that stimulate the parasympathetic nervous system (PSNS)

Cholinergic Drugs

🗑

Cholinergic Drugs Also known as

cholinergic agonists or parasympathomimetics

🗑

cholinergic receptors have 2 types

location and action once stimulated

🗑

what are the two types of cholinergic receptors

nicotinic receptors and muscarinic recptors

🗑

nicotinic receptors are located in

the ganglia of both the psns and sns

🗑

what are they names nicotinic

because they can be stimulated by alkaloid nicotine

🗑

muscarinic receptors are located

postsynaptically in the effector organs of the PSNS Smooth muscle Cardiac muscle Glands

🗑

names muscarinic because

because they can be stimulated by the alkaloid muscarine

🗑

Cholinergic Drugs: Mechanism of Action:Direct-acting cholinergic agonists

Bind to cholinergic receptors, activating them

🗑

cholinergic drug: mechanism of action: Indirect-acting cholinergic agonists

Inhibit the enzyme acetylcholinesterase, which breaks down ACh Results in more ACh available at the receptors

🗑

Indirect-Acting (Cholinesterase Inhibitors):Reversible

Bind to cholinesterase for a period of minutes to hours

🗑

Indirect-Acting (Cholinesterase Inhibitors)Irreversible

Bind to cholinesterase and form a permanent covalent bond The body must make new cholinesterase to break these bonds

🗑

Drug Effects of cholinergic

Stimulate intestine and bladder Increased gastric secretions Increased gastrointestinal motility Increased urinary frequency Stimulate pupils Constriction (miosis) Reduced intraocular pressure Increased salivation and sweating

🗑

Cholinergic Drug Effects

Cardiovascular effects Decreased heart rate Vasodilation Respiratory effects Bronchial constriction, narrowed airways

🗑

Cholinergic Drug Effects

At recommended doses, cholinergics primarily affect muscarinic receptors. At high doses, cholinergics stimulate nicotinic receptors Desired effects are from muscarinic receptor stimulation. Many undesirable effects are caused by stimulation of nicotini

🗑

cholinergic drug indications

Direct-acting drugs Reduce intraocular pressure Useful for glaucoma and intraocular surgery echothiophate carbachol pilocarpine Topical application because of poor oral absorption

🗑

cholinergic drug indications

Direct-acting drug—bethanechol Increases tone and motility of bladder and GI tract Relaxes sphincters in bladder and GI tract, allowing them to empty Helpful for postsurgical atony of the bladder and GI tract Oral dose or subcutaneous injection

🗑

cholinergic drug indications

🗑

memantine (Namenda)

🗑

adverse effects of cholinergic

Adverse effects are a result of overstimulation of the PSNS-Cardiovascular-Bradycardia, hypotension, syncope, conduction abnormalities (AV block and cardiac arrest) CNS-Headache, dizziness, convulsions, ataxia Gastrointestinal,Abdominal cramps, increase

🗑

adverse effects of cholinergic

Adverse effects are a result of overstimulation of the PSNS Cardiovascular-Bradycardia, hypotension, syncope, conduction abnormalities (AV block and cardiac arrest) CNS-Headache, dizziness, convulsions, ataxia Gastrointestinal-Abdominal cramps, increas

🗑

adverse effects of cholinergic

Respiratory Increased bronchial secretions, bronchospasms Other Lacrimation, sweating, salivation, miosis

🗑

neuromusclar blocking agents when to use

when someone having a high asthma attack!!! need to intubate them, but the body will do a gag reflex. need to settle them down. Another one is Epidural ( A BLOCKING AGENT)

🗑

what do you give to reverse a neuromuscular blocking agent - the antidote

physostigmnine & pyridstigmine

🗑

Interactions

Anticholinergics, antihistamines, sympathomimetics Antagonize cholinergic drugs, resulting in decreased responses Other cholinergic drugs Additive effects

🗑

Herbal Products: Gingko: Common uses

Prevent memory loss Vertigo Tinnitus

🗑

Herbal Products: Gingko

May cause GI upset, headache, bleeding

🗑

Herbal Products: Gingko:Potential interactions

Aspirin NSAIDs Anticoagulants Anticonvulsants

🗑

Encourage patients with myasthenia gravis to take medication 30 minutes before eating to help improve chewing and swallowing

When cholinergic drugs are prescribed for Alzheimer’s disease, be honest with caregivers and patients that the drugs are for management of symptoms (not a cure)

🗑

Therapeutic effects of anti-Alzheimer’s drugs may not occur for up to 6 weeks

Atropine is the antidote for cholinergics, and it should be available in the patient’s room for immediate use if needed

🗑

Patients should notify their physician if they experience muscle weakness, abdominal cramps, diarrhea, or difficulty breathing

🗑

cholinergic will increase peptic acid bad for peptic ulcer

🗑

Cholinergic-Blocking Drugs

Drugs that block or inhibit the actions of acetylcholine (ACh) in the parasympathetic nervous system (PSNS) Also known as anticholinergics, parasympatholytics, and antimuscarinic drugs

🗑

Mechanism of Action Cholinergic-Blocking Drugs

Competitive antagonists:Compete with ACh for binding at muscarinic receptors in the PSNS:As a result, ACh is unable to bind to thereceptor site and cause a cholinergic effect:Once these drugs bind to receptors, they inhibit nerve transmission at these re

🗑

Cholinergic-Blocking Drugs: Examples

atropine dicyclomine (Bentyl) - gi glycopyrrolate (Robinul) oxybutynin (Ditropan) scopolamine (Transderm-Scōp) - n/v tolterodine (Detrol) - urinary

🗑

Cholinergic-Blocking Drugs: Drug Effects

Cardiovascular Small doses: decrease heart rate Large doses: increase heart rate CNS Small doses: decrease muscle rigidity and tremors Large doses: drowsiness, disorientation, hallucinations

🗑

Cholinergic-Blocking Drugs: Drug Effects

Eye Dilated pupils (mydriasis) Decreased accommodation caused by paralysis of ciliary muscles (cycloplegia) Gastrointestinal Relax smooth muscle tone of GI tract Decrease intestinal and gastric secretions Decrease motility and peristalsis

🗑

Cholinergic-Blocking Drugs: Drug Effects

Genitourinary Relaxed detrusor muscle Increased constriction of internal sphincter Result: urinary retention Glandular Decreased bronchial secretions, salivation, sweating

🗑

Cholinergic-Blocking Drugs: Drug Effects

Respiratory Decreased bronchial secretions Dilated bronchial airways

🗑

Cholinergic-Blocking indication Drugs: CNS

Decreasing muscle rigidity and muscle tremors Parkinson’s disease Drug-induced extrapyramidal reactions

🗑

Cholinergic-Blocking indication Drugs:cardiovascular

Affects the heart’s conduction system Low doses: slow the heart rate High doses: block inhibitory vagal effects on sinoatrial (SA) and atrioventricular (AV) node pacemaker cells Results in increased heart rate

🗑

Cholinergic-Blocking indication Drugs:cardiovascular

Atropine Used primarily for cardiovascular disorders Diagnosis of sinus node dysfunction Symptomatic second-degree heart block Severe sinus bradycardia with hemodynamic compromise (advanced life support)

🗑

Cholinergic-Blocking indication Drugs:Respiratory

Blocking the cholinergic stimulation of the PSNS allows unopposed action of the SNS Results Decreased secretions from nose, mouth, pharynx, bronchi Relaxed smooth muscles in bronchi and bronchioles Decreased airway resistance Bronchodilation

🗑

Cholinergic-Blocking indication Drugs:Respiratory

Cholinergic blockers are used to treat: Exercise-induced bronchospasms Chronic bronchitis Asthma Chronic obstructive pulmonary disease

🗑

Cholinergic-Blocking indication Drugs:Gastrointestinal

PSNS controls gastric secretions and smooth muscles that produce gastric motility Blockade of PSNS results in: Decreased secretions Relaxation of smooth muscle Decreased GI motility and peristalsis

🗑

cholinergic block adverse effects

cardiovascular - increse hr dysrhythmias, cns restlessness, irritability, disorientation, dilated pupils, GI decreased salivation, genitourinary - urinary retention, glandular decreased sweating, respiratory decresed bronchial secretions

🗑

cholinergics block interactions

Amantadine, antihistamines, phenothiazines, tricyclic antidepressants, digoxin When given with other cholinergic blocking drugs, cause additive cholinergic effects, resulting in increased effects

🗑