pharm two parasympathetic system

Question 1

Cholinergic functions

Nicotinic -N

Answer 1

All ganglia and adrenal medulla, stimulation of prostaglandin nerves and release of norepinephrine

Question 2

Nicotinic-M

Answer 2

Neuromuscular junction stimulation of muscle contractions

Question 3

Muscarinic agonists (7)

Answer 3

Negative Chronotropic 
Negative inotropic 
Vasodilation drop in BP 
Increased GI Motility 
Increase GI secretion
Urinary stimulation
Miosis

Question 4

Bethanechol (Urecholine)

Answer 4

Uses: Urinary retention
Postoperative, postpartum, neurogenic bladder, paralytic ileus

AE: hypotension, bradycardia, salivation, increased GI acid, cramps, diarrhea, bronchi constriction (never admin with people with COPD)

Contra: intestinal obstruction, urinary obstruction, asthma. Hyperthyroidism (dysrythmias), peptic ulcers

NI: T effects, urination? Defecation? Did you pass gas? Did u pee? Take between meals (reduces nausea)

Question 5

Miotics Muscarinic agonists

Acetylcholine (miochol)

Answer 5

Uses: pupil constriction, reduces introcular pressure glaucoma.

AE: itching, pain, blurred vision.

NI: apply pressure to lacrimal glands DON’T RUB EYES,
No driving with blurry vision.
Call Dr’ if still stinging/ painful.

Question 6

Muscarinic antagonists

Antimuscarinics, Cholinergic blockers, parasympatholytics

Answer 6

Prevents Acetycholine (ACh) dose dependent

Increase heart rate, low secretion (saliva, sweat, GI, bronchial), low GI motility, low urinary tone retention, smooth muscle, mydriasis, CNS delerium

AE: T-cardia, urinary retention, constipation, dry mouth, low sweat fever, blurred vision aggravate glaucoma photophobia, CNS- restlessness, delerium. Toxicity

Uses: PO, IV, INHALED. Increase Hr, antispasmodic, spasmolytic, irritable bowel, motion sickness, over active bladder, bronchodilator, mydriasis (eye exam), treat Cholinergic crisis (poisoning, OD)

Question 7

Muscarinic blocker

Scopolamine (transderm scope)

Answer 7

Uses motion sickness
NI: t-cardia (PULSE), dry mouth, restlessness, sedation, urinary retention (CONSTIPATION) , blurred vision, dry resp secretions.

Question 8

Tolteradine (Detrol)

Answer 8

Muscarinic, receptor antagonists, relax smooth muscle in u-tract.
Over active bladder.
Contra: glaucoma, u-retention, gastric retention, pregnancy.

AE: nausea, vomiting, anorexia, Anticholinergic side effects.

Question 9

Nicotinic agents.

Answer 9

Vasoconstriction, high Cronotropic and inotropic, increas GI secretion, CNS simulation, toxicity-as above respiratory paralysis treatment supportive.

Question 10

Nicotine

Answer 10

Uses nicotine addiction, (GUM, INHALER, TRANSDERMAL PATCH)
In cases of withdrawal or they are hospitalized and can’t smoke.

NI: chew slowly, don’t exceed regular dose, withdrawal gradually.
May need other therapies: group therapy, clonidine.
Tdermal patches apply to clean skin, change site daily, could cause erythema

**Do not smoke** u will over dose

Question 11

Varenicline (chantix)

Nicotinic effects

Answer 11

Partial agonists at Nicotine receptors, blocks receptors, but some mild activation of receptors dopamine release.

Helps decrease intensity of withdrawal symptoms and cravings.

AE: most common is nausea. Sleep disturbance, HA, unusual dreams.
Neuropsychiatric effects: changes in mood, behavior, concern (low incidence of suicide)

NI: given P.O take with food with nausea, start drug one week before stopping smoking. 12 week drug.

Question 12

Enzyme Acetylcholinesterase inhibitors (cholinesterase inhibitors)

Answer 12

Prevent breakdown of Ach-nonselective (muscarinic and nicotinic)
Increases cholinergic effects.
Effects: increase glandular secretion, high GIMotility, bradycardia, urinary urgency, bronchoconstriction, Miosis (constriction of pupils)
Therapeutic dose: increases high muscle contraction.
Toxic dose: can paralyze patient. Neuromuscular blocker.
Uses: reversal agent. Neuromuscular blockers, atropine,
Tx: myasthenia gravis, increases ACh at neuromuscular junction, current receptors work as good as possible.
NI: watch muscle strength.
Toxicity: Cholinergic crisis; weakness, paralysis, bradycardia, salivation
Tx: oxygen, atropine.

Question 13

ACh Inhibitors agents;

Neostigmine (prostigmin)

Answer 13

Myasthenia gravis agents.

Question 14

Physostigmine (Antilirium)

Answer 14

Reversal agent (Anticholinergic)

Question 15

Neuromuscular Blockers.

Antinicotinic

Answer 15

Blocks ACh at junction, they paralyze you, relaxer, cut into abdominal can bust out organs.
Mechanical ventilation. Patient is awake and paralyzed.

Question 16

Neuromuscular blockers
Vecuronium (Norcuron)
non depolarizing agent

Answer 16

Competes with ACh at nicotinic receptors, causes muscle skeletal relaxation.
AE: Hypotension, bradycardia.

Question 17

Depolarizing Agents.

Neuromuscular blockers

Answer 17

Causes deoplarization, causes muscle contractions (Fasciculations), One big contraction then they are paralyzed (signal can no longer activate muscles) SHORT ACTING

Degraded by pseudocolinesterace

used for short time to administer endotracheal tube.
can couple with non-depolarizing to lower AE.

Question 18

Succinylcholine (Anectine)

Answer 18

Non-depolarizing agent
AE: hypotension, bradycardia.
Muscle pain can lead to fasciculations

Question 19

Depolarizing Agent: Neuromuscular blockers (adverse effects)

Answer 19

Could cause prolonged paralysis (people with pseudocholinesterace deficiency, genetics) Hyperthermia (genetics risk high in children) muscle rigidity = fever.
NI: identify prior problems with pseudocholinesterace deficiency. Or hyperthermia. Or with anesthetics monitor for Brady cardia
* use acetycholinesterase inhibitors
Reversal agent is shorter duration than NM blocker****

Question 20

How Do we asses recovery of neuromuscular blockers.

Answer 20

Asses muscle strength; ptosis, hand grip, raise head all for five seconds.

Red flag: if hold was strong then fades.