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From Flashcardlet > Anticholinergics v. Cholinergics > Flashcards

Anticholinergics v. Cholinergics Flashcards

0
Q

What kind of Anticholinergic side effects can cause physical and mental impairment?

A

Peripheral and central

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1
Q

What kind of side effects do atypical antipsychotics cause?

A

Anticholinergic side effects

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2
Q

What is the action of Anticholinergic drugs?

A

Blocks the action or receptors of the neurotransmitter Acetylcholine

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3
Q

What bodily functions does acetylcholine control?

A 
Non voluntary function:
• sweating
• balancing 
• pupil dilation
• contraction of bladder muscles
• digestion 
• salivation
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4
Q

What are the side offers of anticholinergics drugs?

A
  • ⬇️ GI motility (constipation)
  • ⬇️ sweating
  • urinary retention
  • dry eyes, mouth, throat
  • dilated pupils
  • blurred vision
  • drowsiness
  • confusion, memory loss
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5
Q

What are the Action of Anticholinergics on the heart with small or large doses?

A

Large doses: ⬆️ Pulse

Small doses: ⬇️ Pulse

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6
Q

What are four examples of Anticholinergic drugs?

A
  • Cogentin (benzotropine)
  • Atropine
  • Atrovent
  • Spiriva
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7
Q

What is Cogentin used for?

A
  • Anti-Parkinson drug

* As well as medication to reduce the extrapyramidal side effects of antipsychotic medications

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8
Q

What is Atropine used for?

A
  • Treats abnormal HR rates and arrhythmias

* Preoperative med

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9
Q

What is Atrovent used for?

A

• Bronchodilator that is a derivative of atropine and used for the prevention of an asthma attack

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10
Q

What is Spiriva used for?

A

• Bronchodilator similar to Atrovent - used for pts with emphysema and chronic bronchitis

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11
Q

What is the use of Anticholinergics with the mouth, nose and throat?

A

Treat coughs and colds by drying everything out

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12
Q

When Anticholinergics drugs are not being used to treat colds but for other purposes, what can drying out the mouth and throat be bad?

A

If persistent it can cause:
• ulceration of gums
• tooth decay
• fungal infections

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13
Q

How do Anticholinergics drugs slow digestion and cause constipation?

A

By affecting the ability of the intestine to contract and ⬇️ secretions that provide moisture to intestine.

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14
Q

What does Anticholinergic drugs cause with level of consciousness

A

Causes drowsiness - (Tylenol PM & Exedrin PM contain Anticholinergics to induce sleep but any medication with Anticholinergic can cause sleepiness)

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15
Q

How does Anticholinergics drugs affect temperature?

A

⬆️ Temp

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16
Q

Why should extra care to avoid overheating during exercise and in hot weather when taking Anticholinergic drugs?

A

to avoid stroke

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17
Q

Why should saunas or hot bath no avoided with patients taking Anticholinergic drugs?

A

Because dizziness or fainting can occur

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18
Q

What are the elderly at increased risk for when taking Anticholinergic drugs?

A

Confusion and memory loss

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19
Q

Why is the risk for confusion and memory loss worse for the elderly when taking Anticholinergic drugs?

A

Because of the common practice of prescribing multiple medications that may have Anticholinergic actions

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20
Q

How do Anticholinergic drugs affect vision?

A
  • Impairs ability of the eyes to adjust for distant vision and constrict the pupils.
  • Sensitivity to light can develop.
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21
Q

Anticholinergics are a class of medications that inhibit what?

A

Inhibits parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine do it’s receptor in the nerve cells

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22
Q

What are the nerve fibers if the parasympathetic system responsible for?

A

The involuntary movements of smooth muscle present in the
• gastrointestinal tract
• urinary tract
• lungs, etc.

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23
Q

Anticholinergics are divided into 3 categories in accordance with there specific targets what systems?

A

Central and/or peripheral nervous system

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24
Q

What are the three categories that Anticholinergics are divided into?

A
  • antimuscarinic agents
  • ganglionic agents
  • neuromuscular blockers
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25
Q

What are some of the purposes for Anticholinergic drugs?

A
  • gastrointestinal cramps
  • urinary bladder spasms
  • asthma
  • motion sickness
  • muscular cramp
  • poisoning if certain toxic compounds
  • aid to anesthesia
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26
Q

What is the action of Antimuscarinics?

A

Blocks muscarine, a poisonous substance found in Muscaria (a nonedible mushroom species)

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27
Q

What is Muscarine and what does it do?

A

It is a toxic compound that competes with Acetylcholine for the same cholinoreceptors

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28
Q

What are three examples of Antimuscarinic agents?

A
  • atropine
  • scopolamine
  • ipratropium bromide
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29
Q

What are Atropine and Scopolamine?

A
  • they are alkaloids

* naturally occurring in Atropa belladonna and Datura stramonium plants

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30
Q

Where is ipratropium bromide a derivative of?

A

Atropine used to treat asthma

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31
Q

What Atropine is in the form of Atropine Sulfate, what is it used to treat?

A
  • gastrointestinal/bladder spasms
  • cardiac arrhythmias
  • poisoning by Cholinergic toxins
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32
Q

What is Atropine used to treat?

A

eye refractive errors due to pupillary dilation properties

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33
Q

What kind of depressant is Scopolamine?

A

Central nervous system depressant but shows effect in the peripheral nervous system.

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34
Q

What is Scopolamine highly effective in treating?

A

Preventing motion sickness

Used in opthalmology identically in purpose to that of Atropine

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35
Q

What is the main use of Ipratopium?

A
  • asthma

* chronic pulmonary disease

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36
Q

What Anticholinergic drugs are used alone or in combination with other meds in Parkinson’s disease to improve motor function?

A
  • Congentin
  • Benzhexol
  • orphenadrine
  • bornaprine
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37
Q

What is associated with the symptoms in Parkinson’s disease?

A

Disturbances in Dopaminergic transmissions

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38
Q

What are the beneficial effects of Anticholinergic drugs in Parkinson’s disease due to?

A

Due to an imbalance between dopamine and acetycholine ratio in neurons (⬇️ acetylcholine levels and ⬆️ dopamine levels)

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39
Q

What can Anticholinergic agents interfere with?

A

Mood, GI movements (constipation)

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40
Q

Do Anticholinergics always return motor function to normal?

A

No, the positive effect varies

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41
Q

What Anticholinergic drugs act on the pathways of dopamine and it’s receptors to treat Parkinson’s disease?

A
  • levodopa
  • tolcapone
  • pramipexol
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42
Q

What do levodopa, tolcapone, pramipexol do?

A

Effectively ⬆️ levels of dopamine at dopaminergic receptors in neurons

43
Q

What are ganglionic blockers?

A

Anticholinergic agents that target nicotinic receptors in nerve cells of either sympathetic or parasympathetic systems

44
Q

What are the two most used ganglionic blockers?

A
  • trimethaphan

* mecamylamine

45
Q

What is Trimethaphan used for?

A

Administered thru IV for
• emergency short-term control of high BP caused by pulmonary edema
• surgeries that require controlled lower BP such as repair of aortic aneurysm

46
Q

What is Mecamylamine used to treat?

A

Moderately severe to sever hypertension - taken orally

47
Q

What do Neuromuscular Anticholinergic agents act on?

A

Motornerve cholinoreceptors

48
Q

What do Neuromuscular Anticholinergic agents prevent?

A

Prevent signals from motor nerves to neuromuscular structures of skeletal muscle

49
Q

What are Neuromuscular blockers useful for?

A

Muscle relaxants in severe surgical procedures either as an adjuvant to anesthesia or as a pre-anesthetic

50
Q

When should Atropine be avoided?

A 
When pts have:
• hepatitis
• glaucoma
• gastrointestinal obstruction
• ⬇️ liver or kidney function
• allergy to Anticholinergics
51
Q

When is Scopolamine not indicated for use?

A 
When pts have:
• glaucoma
• asthma
• severe colitis
• genitourinary obstruction
• myasthenia gravis
• sensitive to Cholinergic drugs
52
Q

When should ganglionic blockers be given with special caution and only when there is no other choice of agent to be used?

A
  • kidney insufficiency

* coronary or cerebrovascular disorders

53
Q

What does the severity of SE depend upon with Atropine?

A

The dose

54
Q

What are the SE with overdose of atropine?

A
  • delirium
  • hallucinations
  • coma
  • circulatory collapse
  • respiratory collapse
  • death
55
Q

What are the SE observed in patients on higher doses of Atropine?

A
  • Rapid HR rate
  • dilated pupils
  • blurred vision
  • restlessness
  • burning pain in throat
  • mouth dryness
  • urinary retention
56
Q

What are the SE observed in patents on lower doses of Atropine?

A
  • ⬇️ Salivary
  • ⬇️ Respirations
  • ⬇️ perspiration secretions
57
Q

What are the SE of Scopolamine?

A

Similar to those observe with Atropine

58
Q

What are the adverse effects of ganglionic blockers?

A 
paralysis of gastrointestinal movements
nausea
gastritis 
urinary retention
blurred vision.
59
Q

What are Neuromuscular blockers adverse effects?

A

apnea due to paralysis of the diaphragm, hypotension
tachycardia
post-surgery muscle pain,
increased intraocular pressure
malignant hyperthermia (uncontrolled high fever)

60
Q

What is the main reason for overactive bladder?

A

involuntary contractions of the muscle in the bladder wall (also known as the detrusor muscle)

61
Q

What do most overactive bladder treatments aim to do?

A

slow down the involuntary contractions

62
Q

What are the main medications options for overactive bladder?

A

anticholinergics

63
Q

How are anticholinergics thought to work when treating overactive bladder?

A

blocking the stimulation of the detrusor muscle that leads to involuntary contractions

64
Q

What do anticholinergics help to reduce with an overactive bladder?

A

help to reduce visits to the bathroom
the strong urges to go
the number of urine leaks

65
Q

How do you manage the side effects of dry mouth?

A

chewing sugarless gum

sucking on ice chips or sugarless hard candies using a saliva substitute

66
Q

What are the interventions for constipation as a side effect?

A

increasing the amount of fibre in your diet
getting more exercise
talk to dr abt medication to prevent/relieve

67
Q

Who should not use Anticholinergics?

A

pts who have:
urinary retention
gastric retention
narrow-angle glaucoma

68
Q

When should you talk to your doctor about not taking anticholinergics?

A 
intestinal probs
HR probs
Neurologic disease
liver disease
kidney disease
pregnant or breast feeding
69
Q

What do muscarinic receptors do?

A

receptors stimulate smooth muscle and slow heart rate

70
Q

What do Nicotinic receptors affect?

A

skeletal muscle

71
Q

What do Cholinergic Agonist do?

A

stimulate PNS by mimicking parasympathetic neurotransmitter acetylcholine

72
Q

What are the two type of cholinergic receptors?

A

Muscarinic receptors

Nicotinic receptors

73
Q

What does stimulation of parasympathetic nervous system cause?

A 
constriction of pupils
bronchiole constriction
increased bronchial secretions
decreased heart rate; vasodilation
increased peristalsis and gastric secretions
bladder muscle contraction
increased salivation.
74
Q

What are the Cholinergic Agonist effects on Cardiovascular?

A

decrease P and BP,
vasodilation
slows conduction of AV node

75
Q

What are the Cholinergic Agonist effects on the GI?

A

increase tone and motility
increase peristalsis
relax sphincter muscles

76
Q

What are the Cholinergic Agonist effects on GU?

A

increase ureter tone
contract bladder
relax sphincter muscles
stimulate urination

77
Q

What are the Cholinergic Agonist effects on lungs?

A

bronchial constriction

increase secretions

78
Q

What are the Cholinergic Agonist effects on the eyes?

A

constrict pupils

increase accommodation

79
Q

What are the Cholinergic Agonist effects on glands?

A

increase salivation, perspiration, and tears

80
Q

What are the Cholinergic Agonist effects on striated muscle?

A

increase neuromuscular transmission

maintain muscle strength and tone

81
Q

What are direct-acting Cholinergic agonists selective to?

A

muscarinic receptors

82
Q

Where are muscarinic receptors located?

A

smooth muscles: Heart, GI, GU, glands

83
Q

What are three examples of Direct-acting cholinergic agonist muscarinic receptors?

A

Reglan
Pilocar
(Bethanechol) Urecholine

84
Q

What is the use of Reglan?

A

increase gastric emptying

85
Q

What is the use of Pilocar?

A

constrics pupils

86
Q

What is the use of Urecholine?

A

increases urination

87
Q

What are the side effects/adverse reactions to Urecholine?

A 
Blurred vision
miosis
Hypotension
bradycardia
sweating
Increased salivation and gastric acid
N/V
diarrhea
abdominal cramps 
Bronchoconstriction
88
Q

What are the contraindications to Urecholine?

A 
Bradycardia
hypotension
COPD
peptic ulcer
parkinsonism
hyperthyroidism
89
Q

What are the nursing interventions when giving Urecholine?

A 
Monitor BP and P.
Teach client to rise slowly.
Record fluid intake and output.
Monitor breath sounds.
Give 1 hour ac or 2 hours pc.
Monitor bowel sounds.
90
Q

When monitoring for overdose when giving Urecholine, what do you watch for?

A

salivation
sweating
flushing
abdominal cramps

91
Q

What is the antidote for Urecholine?

A

Atropine

92
Q

What do the indirect-acting cholinergic agonist called?

A

Cholinesterase drug

93
Q

What are the direct-acting cholinergic agonists called?

A

Cholinergic drug

94
Q

What do Indirect-agonist cholinerstase inhibitors do?

A

inactivate the enzyme acetylcholinesterase (cholinesterase), thus permitting acetylcholine to react to the receptor.

95
Q

What is the function of Indirect-Acting Cholinergic Agonists?

A

Break down cholinesterase enzyme

Allow Ach to activate muscarinic and nicotinic cholinergic receptors

96
Q

What do Indirect-Acting Cholinergic Agonists affect?

A 
Stimulate skeletal muscles,
increase tone
Greater GI motility
bradycardia
miosis
Bronchial constriction
promote urination
97
Q

What are the side effects of Indirect-Acting Cholinergic Agonists affect?

A

bradycardia
asthma
peptic ulcers

98
Q

What are the contraindications of Indirect-Acting Cholinergic Agonists affect?

A

intestinal and urinary obstruction

99
Q

What are the uses of Reversible cholinesterase inhibitor?

A

Pupil constriction in glaucoma

increase muscle strength in myasthenia gravis

100
Q

What are three examples of Reversible cholinesterase inhibitors?

A

Prostigmin
Mestinon
Tensilon

101
Q

Which Reversible cholinesterase inhibitors is short acting?

A

Prostigmin

102
Q

Which Reversible cholinesterase inhibitors is moderate-acting?

A

Mestinon

103
Q

Which Reversible cholinesterase inhibitors is short acting and often used for diagnostic purposes?

A

Tensilon

104
Q

What are the side effects of Reversible cholinesterase inhibitors?

A 
Muscle cramps
twitching
bradycardia
increased bronchial secretions
cramps

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