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Pharmacology > Module 2 Cholinergic Agonists, Anticholinergic Agents > Flashcards

Module 2 Cholinergic Agonists, Anticholinergic Agents Flashcards

1
Q

What are the two sections of the nervous system

A
  • Central nervous system
  • peripheral nervous system
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2
Q

What two structures make up the central nervous system?

A
  • Brain
  • spinal card
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3
Q

What two components make up the peripheral nervous system?

A
  • Somatic (skeletal muscle)
  • autonomic
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4
Q

What two components make up the autonomic system?

A
  • Parasympathetic (PNS)
  • sympathetic (SNS)
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5
Q

What are the two components of sympathetic (SNS)?

A
  • Alpha
  • beta
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6
Q

What is the parasympathetic nervous system also known as and what are its characteristics when activated?

A
  • “Rest and digest”
  • mitosis (pupil constriction)
  • salivation
  • vasodilation
  • decreased heart rate and blood pressure
  • bronchoconstriction
  • increase in respiratory secretions and peristalsis
    -Bile release
    -Urination
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7
Q

What is the sympathetic nervous system also known as and what are its characteristics when activated?

A
  • “Fight or flight”
  • mydriasis (pupil dilation)
  • dry mouth
  • vasoconstriction
  • increased heart rate and blood pressure
  • Bronchodilation
  • decrease in respiratory secretions and peristalsis
  • hepatic (glucose release)
  • urination blocked
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8
Q

What are cholinergic drugs?

A
  • Chemicals that act at the same site as the neurotransmitter acetylcholine (ACh)
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9
Q

Define the action of cholinergic drugs?

A
  • Often called parasympathomimetic drugs because their action mimics the action of the parasympathetic nervous system
  • not limited to a specific site
  • work either directly or indirectly on ACh receptors
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10
Q

What are the precautions of children, adults, and older adults when taking cholinergic agonist agents?

A
  • Children: increased risk of adverse effects, dosages should be based on weight
  • Adults: caution against driving while on medication, no adequate studies on effects during pregnancy and lactation, use alternative method to breastfeeding
  • Older adults: more likely to have adverse effects and toxic levels, start on lower dosage and monitor closely, institute safety precautions
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11
Q

Define direct-acting cholinergic agonists

A
  • Occupy receptor sites for ACh on the membranes of the effector cells of the postganglionic cholinergic nerves
  • cause increased stimulation of the cholinergic receptor
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12
Q

Define indirect-acting cholinergic agonists

A
  • React with the enzyme acetylcholinesterase and prevent it from breaking down the ACh released from the nerve
  • produce effects indirectly by producing increase in level of ACh in the synaptic cleft, leading to increased stimulation of cholinergic receptor site
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13
Q

List four direct-acting cholinergic agonists (muscarinic)

A
  1. Bethanechol
  2. Carbachol
  3. Cevimeline
  4. Pilocarpine
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14
Q

What is the action and indications of direct-acting cholinergic agonists (muscarinic)?

A
  • Act at cholinergic receptors in the PNS to mimic the effects of ACh and parasympathetic stimulation
  • indications: urinary retention (bethanechol), induce miosis (carbachol), treat dry mouth (cevimeline and pilocarpine)
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15
Q

What are contraindications and cautions regarding direct-acting cholinergic agonists (muscarinic)?

A
  • Contraindications: hypersensitivity, conditions exacerbated by parasympathetic effects (bradycardia, hypotension), peptic ulcer disease, asthma, bladder obstruction, epilepsy, Parkinsonism
  • cautions: pregnancy and lactation
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16
Q

Identify adverse effects and drug-drug interactions fur direct-acting cholingenc agonists (muscarinic)

A
  • Adverse effects: nausea, vomiting, cramps, diarrhea, increased salutation, involuntary defecation, bradycardia, heart block, hypotension, urinary urgency, flushing, increased sweating
  • drug-drug interactions: acetylcholinesterase inhibitors
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17
Q

How do you assess direct-acting cholinergic agonists (muscarinic)?

A
  • Assess for continindications and cautions
  • perform a physical assessment
  • vitals, lung sounds, cardiac status, bowel sounds, bladder distention
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18
Q

What are factors that would be implemented into the nursing diagnosis/planning for DACAM?

A
  • Impaired comfort related to GI effects
  • altered cardiac output related to CV effects
  • impaired urinary elimination related to GU effects
  • injury risk related to blurred vision and changes in visual acuity
  • diarrhea related to GI effects
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19
Q

What would you implement to a patient or patient family about DACAM?

A
  • Ensure proper administration
  • administer oral drug on an empty stomach
  • monitor patient response closely
  • monitor urinary output
  • provide safety precautions if the patient reports pour visual acuity
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20
Q

Define three direct-acting cholinergic agonists (nicotinic)

A
  • Bupropion
  • nicotine
  • varenicline
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21
Q

What is the therapeutic action of bupropion?

A
  • May act by weakly inhibiting neuronal rep take of norepinephrine and dopamine
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22
Q

What is the therapeutic action of nicotine?

A
  • Replacement therapy
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23
Q

What is the therapeutic action of varenicline?

A
  • Acts as nicotine receptor partial agonist
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24
Q

What are the contraindications and cautions with DACA nicotinic?

A
  • Hypersensitivity/allergy
  • seizure disorder (bupropion)
  • cautions: pregnancy and lactation
25
Q

What are the adverse effects and drug-drug interactions of DACA nicotinic?

A
  • Adverse effects: tachycardia, hypertension, seizures, neuropsychiatric adverse effects, dizziness, strange dreams, nausea, dry mouth, skin rash
  • drug-drug: numerous
26
Q

What is established in the assessment of DACA nicotinic?

A
  • Assess for contraindications and cautions
  • perform a physical assessment
  • assess amount of tobacco use
  • assess vitals, heart and lung sounds, ECG
  • assess mood, sleep, suicidal thoughts, and behaviors
27
Q

What is established in the nursing diagnosis of DACA nicotinic?

A
  • Impaired comfort related to GI effects
  • altered cardiac output related to CV effects
  • injury risk related to seizures or neuropsychiatric side effects
  • knowledge deficit regarding drug harpy
28
Q

What is established in the implementation of DACA nicotinic?

A
  • Ensure proper administration of nicotine replacement preparations
  • check for medication interactions
  • may be taken with or without food
  • monitor patient response closely
  • provide safety precautions if the patient reports neuropsychiatric events or seizure activities
29
Q

What is myasthenia gravis and what are some symptoms?

A
  • Chronic muscular disease caused by a defect in neuromuscular transmission
  • autoimmune disease; patients make antibodies to ACh receptors, causing gradual destruction of them
  • symptoms: progressive weakness and lack of muscle control with periodic acute episodes
30
Q

What are 3 indirect-acting cholinergic agonists used to treat myasthenia gravis?

A
  • Neostigmine: has a strong influence at the neuromuscular junction
  • pyridostigmine: has a longer duration of action than neostigmine
  • edrophonium: diagnostic agent for myasthenia graves
31
Q

Define Alzheimer’s disease

A

-A progressive disorder involving neural degeneration of the cortex
- leads to a marked loss of memory and the ability to carry on activities of daily living

32
Q

List 3 indirect-acting cholinergic agonists used to Trent Alzheimer’s disease

A
  • Galantamine: available in solution for swallowing ease
  • rivastigmine: available in solution for swallowing ease
  • donepezil: has once-a-day dosing; available in rapid dissolving tablet
33
Q

Identify the action of indirect-acting cholinergic agonists

A
  • Blocks AChE at the synaptic cleft, which allows the accumulation of ACh released from the nerve endings and leads to increased and prolonged stimulation of ACh
34
Q

What are the indications of indirect-acting cholinergic agonists?

A
  • Myasthenia gravis
  • Alzheimer’s
  • treatment after exposure to nerve gas
35
Q

What are the contraindications of IACA’s?

A
  • Allergy
  • bradycardia
    -Intestinal or urinary tract obstruction
36
Q

What are the cautions of IACA’s?

A
  • Hx of any condition that could be exacerbated by cholinergic stimulation such as asthma, coronary disease, peptic baker, arrhythmias, epilepsy, Parkinsonism
  • hepatic or renal dysfunction
  • pregnancy and lactation
37
Q

What ere adverse effects of IACA’s?

A
  • Bradycardia, hypotension
  • increased GI secretions
  • increased bladder Jones
  • bronchoconstriction
  • pupil constriction
38
Q

What drugs may interact with IACA’s?

A

-NSAIDs, cholinergic drugs

39
Q

How do you assess IACAs?

A
  • Assess for contraindications and cautions
  • perform physical exam
  • assess orientation, reflexes, ability to perform daily life tasks
40
Q

What is the nursing diagnosis for IACAs?

A
  • Altered thought process related to CNS effects
  • impaired comfort related to GI effects
  • decreased cardinal output
  • knowledge deficit regarding any therapy
  • diarrhea
41
Q

What are implementations for IACAs?

A
  • Administer IVs slowly
  • maintain atropine on standby
  • administer oral drugs with meals
  • monitor alzhemiers patient for progress
  • provide patient teaching
42
Q

What is in the evaluation of IACAs?

A
  • Monitor patient response to drug
  • monitor for adverse effects
  • evaluate the effectiveness of teaching plan
  • monitor comfort measures
43
Q

What are the uses of anticholinergic agents?

A
  • Decreases parasympathetic activities to allow the sympathetic system to become more dominant
  • decrease GI activity and secretions (treat ulcers and hyperactive bowel)
  • Broncodilation (treat COPD bronchospasm)
  • relax bladder
  • decrease secretions before anesthesia
  • treatment of nausea, vomiting, and motion sickness
44
Q

What are the actions of anticholinergic agents?

A
  • Used to block the effects of acetylcholine
    -Lyse, or block the effects of the PNS
45
Q

Where are anticholinergic agents derived from?

A
  • The plant Belladonna
46
Q

What do anticholinergic agents block?

A
  • Muscarinic effectors in the PNS
  • Cholinergic receptors in the SNS
47
Q

Which receptors do anticholinergic agents not block?

A
  • Nicotonic receptors
48
Q

What are the effects of blocking the parasympathetic system?

A
  • Increase in heart rate
  • decrease in GI activity
  • decrease in urinary bladder tone and function
  • pupil dilation
  • cycloplegia (paralysis of the ciliary muscle of the eye)
49
Q

Identify 9 anticholinergic agents

A
  • Atropine
  • dicyclomine
  • glycopyrrolate
    -Ipratropium
  • meclizine
  • oxybutynin chloride
  • scopolamine
  • tiotropium
  • tolterodine
50
Q

What are indications of anticholinergic agents?

A
  • Decrease secretions
  • decrease bronchospasm
  • restore cardiac rate and blood pressure
  • pylorospasm and hyperactive bowel
  • relax uterine hypertonicity
  • atropine
51
Q

What are cautions of anticholinergic agents?

A
  • Cardiac arrhythmias, tachycardia, myocardial ischemia
  • impaired liver or kidney function
  • pregnancy and lactation
  • hypertension
  • spasticity
52
Q

What are adverse effects of anticholinergic agents?

A
  • Blurred vision
  • mydriasis
  • cycloplegia
  • photophobia
  • palpitations
  • dry mouth
  • urinary retention
  • constipation
53
Q

What other drugs have antichulinergic activities?

A
  • Antihistamines
  • antiparkinsonism drugs
    -MAOIs
  • TCAs
54
Q

What drugs do anticholinergic drugs have interactions with?

A
  • Any other drug with anticholinergic activity
  • phenothiazines
  • herbal therapies
55
Q

What should a nurse assess for anticholinergic drugs?

A
  • Contradictions and cautions
  • perform a physical assessment
  • assess neurological status, level of orientation, effect, reflexes, and papillary response
  • monitor vital signs and cardiopulmonary status; escalate lung sounds
  • assess abdomen; ausculate bowel sounds; evaluate bladder and bowel patterns; monitor urinary output; palpate bladder for detention
56
Q

What is the nursing diagnosis/planning for anticholinergic drugs?

A
  • Impaired comfort related to GI, CNS, GU, and cardiovascular effects
  • altered cardiac output related to cardiovascular effects
  • constipation related to GI effects
  • urinary retention
  • injury risk related to CNS effects
  • thermal injury risk related to decrease in ability to sweat
  • nonadhearance related to drug adverse effects
  • knowledge of drug temps
57
Q

What implementation should be given to patients about anticholinergic drugs?

A
  • Ensure proper administration of the drug
  • provide comfort measures to help patient calculate drug effects
  • monitor patient response closely, including blood pressure, urinary output, cardiac output
  • offer support and encouragement to help the patient deal with the drug regimen
58
Q

What should be included in the evaluation of anticholinergic drugs?

A
  1. Monitor patient response to the drug
  2. Monitor for adverse effects
    - evaluate effectiveness of treatment plan
    - monitor the effectiveness of comfort measures and adherence to the regimen
59
Q

What other drugs have anticholinergic activity?

A
  1. Antihistamines (relief of allergy symptoms)
    - diphenhydramine: Benadryl
    - loratadine: Claritin
    - cetirizine: Zyrtec
  2. Antiparkinsonism drugs
    - procyclidine
    - trihexyphenidyl
    - orphenadrine
    3.MAOI
    4.TCAs
  3. Phenothiazines (antipsychotics)
  4. Herbal therapies

Pharmacology (4 decks)

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