Exam 1 Chapter 16 Cholinergics Flashcards by kathy Leistner

Parasympathetic Nervous System (PNS)
also known for its action of _____

Rest and Digest

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Cholinergic Nervous System
same as the ________ Nervous System

Cholinergic Nervous System =
Parasympathetic Nervous System

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What is the main neurotransmitter of the PNS?

Acetylcholine AcH

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Drugs that affect the ChNS are ___
Drugs that block the ChNS are ____

agonist and antagonists

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Adrenergic =
Cholinergic =

Adrenergic = SNS.
attached to adrenaline

Cholinergic = PNS.
Choline AcH

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If PNS is dominant,
What are the main responses.

Increase in peristalsis/digestion
Increase in bladder contraction/urination
Vasodilation/dec. HR

Restorative and Elimination

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What are the two cholinergic receptors?

Muscarinic receptors (smooth muscle)
Remember the M bladder, kidney

Nicotinic receptors (skeletal muscle)

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PSN Global Effects

Eyes - dilate
Lungs - bronchioles constrict, inc. secretions
Heart - hr decreases
Blood vessels - dilate
GI - inc. peristalsis, stool passes
Bladder - contracts inc. urine output
Salivary glands - inc. salivation, perspiration, tears
Skeletal muscle - inc neuromuscular transmission, purpose to maintain muscle strength and tone.

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Function of PNS -

To help body restore itself and eliminate waste

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What does acetylcholinesterase (AChE) do?

Breaks down AcH after it performs its function

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What are the two type of cholinergic AGONISTS?
AGONISTS perform a desired function

Direct and Indirect Acting

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What are DIRECT ACTING CHOLINERGIC AGONISTS

Drugs act directly on the muscarinic or nicotinic receptors

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What is a parasympathomimetic?

Drugs that are direct acting Cholinergic agonist

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What are INDIRECT ACTING CHOLINERGIC AGONISTS?

Drugs that inhibit AChE - allow more AcH to reach the receptors. ACETYLCHOLINESTERASE INHIBITORS

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Name 3 DIRECT ACTING CHOLINERGIC AGONISTS

Metoclopramide (Reglan) increases stomach emptying relieves N/V
Pilocarpine (eye drops) - releases fluid
Bethanechol chloride (urinary retention) Urecholine, Muscaran, Durvoid

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What is the action of Metoclopramide?

Metoclopramide is a DIRECT acting Cholinergic agonist
inc. peristalsis
inc. gastric emptying
Used post-surgery for constipation
“Think Meto/Metro - moves things”

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What is the action of Pilocarpine?

PILOCARPINE Is a direct acting cholinergic AGONIST
USED to DECREASE IOP by
dec. fluid accumulation of aqueous humor
“Think CARP swimming in water”

Comes from the leaves of the Jaborandi small tree/shrub,
used to induce sweating, salivation, and glaucoma
pilocarpus is the genus of the shrub that produces pilocarpine

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Bethanechol chloride

BethaneCHOL chloride:
DIRECT ACTING CHOLinergic AGONIST
USED to DECREASE urinary retention
inc. bladder contraction and relaxes the sphincter
“Think “CHOL - cholinergic”

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3 Indications for
INDIRECT Cholinergic AGONISTS

What are diseases where there is a lack or receptors for AcH?
What is an INDIRECT Cholinergic AGONISTS?
They are drugs bind to the enzyme Acetylcholinesterase so there is more AcH uptake

Myasthenia Gravis -less receptors or AcH. Neostigmine (inc. Secretions)
Alzheimer - donepezil (aricept)
Glaucoma -
In these diseases not enough receptors for AcH

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3 Indications for
DIRECT cholinergic Agonists

What is a DIRECT CHOLINERGIC AGONIST?
PNS - inc. AcH - inc. Secretions/urine/digestion
PEE SEE POOP

1.Constipation after surgery, N/V (inc of gastric secretions after surgery, so more nauseous, distended)
2. Glaucoma
3. Urinary retention

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Myasthenia Gravis
antibodies decrease receptors for AcH
What drug do you give?

Indirect acting cholinergic agonist -
so gets more AcH to them
NEOSTIGMINE

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Side Effects of
INDIRECT Cholinergic agonists

Too much SEE/PEE/Poop
Inc. Salvation
Blurred vision
bradycardia
diarrhea - too much peristalsis
abdominal cramping
bronchoconstriction
inc urination

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Contraindications of
INDIRECT cholinergic agonists

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Parkinson’s Disease patients
- do not want to stimulate skeletal muscles more (bradykinesia rigidity)
nicotinic receptors - skeletal muscles - inc. stim to muscles
Asthmatics, COPD
Bowel obstructions
Urinary obstructions

Nursing interventions for
Myasthenia Gravis meds

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Make sure medications must be given ON TIME,
if not, symptoms can occur

Nursing interventions for indirect cholinergic agonists

bowel sounds (too much) BP HR (too low I and O (too much)

Too much AcH is a cholinergic crisis what is the acronym?

Sludge

What is SLUDGE? Name what it stands for Secretion Crisis

Salivation Lacrimation Urination Defecation Gastritis Emesis Can result in respiratory distress

ANTICHOLINERGIC's Action is.....

Inhibit action of AcH by occupying AcH receptors

Name 1 Anticholinergic DRUG

ATROPINE treats cholinergic crisis A Tro PINE Tolerodine Benzotropine Common ending "PINE"

When is an anticholinergic drug used?

Pre-op (dec broncho secretions and secretions) peptic ulcer (dec. Gastric secretions) sympathometic bradycardia cholinergic overdose - SLUDGE IBS Why? decrease secretions

What does an anticholinergic drug do?

Inhibit Rest and Digest Dec. secretions inc heart rate inc. contractility of the heart

Too much AntiCholinergic drugs will cause ____ Think fight or flight

Where am I? confusion Up High - tachycardia inc HR In contractivity of the heart Can't See - photophobia - sensitivity to light Can't Pee -urinary retention No stool -constipation No drool -dry mouth, dec. secretions

Crossword questions: Antagonist to Ach Can occur after giving a beta blocker contraindications to non-selective beta blocker drugs that affect more than one receptor indication for cholinergic agonist medication increases gastric emptying SNS primary neurotransmitter symptoms for a cholinergic crisis stimulates receptor to perform its desired function

Antagonist to Ach ANTICHOLINERGIC Can occur after giving a beta blocker BRADYCARDIA contraindications to non-selective beta blocker COPD drugs that affect more than one receptor NON-SELECTIVE indication for cholinergic agonist medication URINARY RETENTION increases gastric emptying BETA 2 SNS primary neurotransmitter NOREPINEPHRINE symptoms for a cholinergic crisis. SLUDGE stimulates receptor to perform its desired function AGONIST

Anticholinergic

Turning off the PNS to stop secretions, turn on SNS

Difference between SNS and PNS

Where is the blood going? SNS -Fight or flight -sympathomimetics, anticholinergic (no digestive enzymes, ATROPINE -can't see, can't pee Blood goes to heart, brain, and lungs (Norepinephrine PNS-Rest and Digest -parasympathomimetics, cholinergic Blood goes to stomach, kidneys (digestion, peeing) Cholinergic Can -See, Spit, Poop, Pee

contraindications for anti chol

glaucoma

What does MIOSIS mean

constriction of the pupils "think - My I can't See"

Bethanechol Chloride is What type of drug where are receptors located?

DIRECT acting cholinergic RECEPTORS are in the Bladder, promotes detrusor to contract and urination. B for Bethanechol. C for Cholinergic

çontraindications for Bethanechol Chloride

urinary obstruction, IBS, hypotension, parkinsonians

SNS stimulants will do what to BP HR

increase BP and HR

SNS stimulants will do what to bronchioles?

Relax bronchioles

SNS stimulants will do what to eye pupils?

Dilate eye pupils

SNS stimulatants will do what to uterine muscles?

Relax uterine muscles

SNS stimulants will do what to blood glucose?

Increase blood glucose

PINE is the ending for what class of drugs?

ANTICHOLINERGIC example ATROPINE "Think PINE ENDS DINE (rest and digest)"

DIRECT ACTING CHOLINERGIC AGONIST MUSCARINIC side effects

low bp tachy excessive salivation inc. acid secretion, diarrhea bronchospasm

ANTICHOLINERGIC MEDS REACTIONS Block effects of AcH

Where am I? confusion. Up high? tachy Can't See photophobia Cant' Pee urinary retention No Stool - constipation No Drool - dry mouth

Anticholinergics are not good for what population?

Elderly - as can cause confusion - so risk of falls

Anticholinergics - what vital sign important to monitor? (Up high)

Heart rate as can cause tachycardia

What is main anticholinergic drug?

ATROPINE

Patient teaching with Anticholinergics re photophobia (can't see)

Sunscreen Hat Sunglass long sleeved shirt limit time in sun to 15 minutes

Anticholinergics - intervention for urinary retention (can't pee)

Void 30 minutes prior to taking their medication.

Anticholinergics - intervention for constipation

Three F's - increase Function - exercise and movement Fiber Fluids next stool softeners

Anticholinergics - intervention for dry mouth

drink sucking candies

ANTICHOLINERGICS - DO NOT GIVE TO PATIENTS W Inhibit AcH receptors - against the PSN

GLAUCOMA increased IOP Myasthenia Gravis - blocks AcH receptors intestinal or Urinary blockage paralytic ileus tachycardia

INDICATION for INdirect cholinergic agonist

Myasthenia Gravis Alzheimer

ANTICHOLINERGIC's ACTION is to

Blocks neurotransmitter AcH (against the PNS)

Exam 1 Chapter 16 Cholinergics Flashcards

(57 cards)