Cholinergic Agonists Basics
This division of cholinergic drugs work by directly binding to and activating receptors
What is direct-acting cholinergic drugs?
Direct-acting cholinergic agonists occupy receptor sites for this neurotransmitter on the membranes of the effector cells of postganglionic cholinergic nerves
What is ACh?
This is the predominant neurotransmitter released when nicotine binds to nicotinic cholinergic receptors
What is dopamine?
Indirect-acting cholinergic drugs work in the body by reacting chemically with this enzyme in the synaptic cleft to prevent the breakdown of ACh
What is acetylcholinesterase?
Cholinergic drugs are used to help with management of these four diseases
What is Myasthenia Gravis, Alzheimer's disease, glaucoma, and urinary retention?
This is the most prevalent adverse effect of taking direct acting cholinergics
What is cardiac electrical suppression (heart block, bradycardia)?
If patient reports GI upset symptoms with taking indirect-acting cholinergic agonists, the patient should be recommended to do this
what is Eat something when taking the drug?
This division of cholinergic drugs prevents acetylcholinesterase from breaking down acetylcholine released from the neuron vesicles
What is indirect-acting cholinergic agonist
Bethanechol is most commonly used for this complication and works by increasing the muscle tone of the bladder
What is urinary retention?
These are three administration routes for nicotine replacement therapy
What is patch, gum, lozenge, nasal spray, inhaler?
(only need three)
This drug is used to manage myasthenia gravis, is an antidote to neuromuscular junction blockers, and increases survival after exposure to nerve gas
Hint: longer duration of action and is the preferred drug for management of myasthenia gravis in some cases as it does not need to be taken as frequently.
What is Pyridostigmine (Mestinon, Reginol)?
This is a diagnostic test used to evaluate whether myasthenia gravis or cholinergic drug toxicity are causing symptoms. If symptoms get better with administration of edrophonium, myasthenia gravis is the issue, if symptoms worsen it is cholinergic toxicity.
What is tensilon test?
Adverse effects of nicotine replacement therapy include these two symptoms
What is tachycardia and hypertension?
Patients taking cholinergic drugs for the management of Alzheimer's symptoms should be informed that this drug will not cure the patient, but rather have what effect
What is slow symptoms of the disease?
Cholinergic agonists act at the same site of this neurotransmitter and increases the activity of these receptor sites that are found throughout the body
Hint: two part question, but has the same answer
What is ACh or acetylcholine?
Pilocarpine treats dry mouth in patients with this syndrome
What is Sjogren's syndrome?
These are three symptoms of nicotine withdrawal
What is negative emotional state, anxiety, increased stress, irritability, depression, restlessness, difficulty concentrating, difficulty sleeping, strain in relationship to others?
(only needs 3 present)
This drug is used for the management of Alzheimer dementia, including severe dementia
Hint: can be given once a day
What is donepezil (Aricept)?
These two drugs are used as an antidote for irreversible indirect-acting cholinergic agonists
Hint: one of these drugs is used as an antidote for general cholinergic drug toxicity; one is specific to nerve gas
What is Pralidoxime and atropine?
There are many systemic effects that can occur from cholinergic drugs, what are four major bodily systems that are affected
What is cardiovascular system, integumentary system, GI system, GU system?
Patient teaching of any drug is considered effective when the patient can recite back these four aspects of a medication
What is the drug, dosage, adverse effects, and proper administration?
Cholinergic agonists mimics the action of this division of the autonomic nervous system and are thus also called what?
Hint: two part question
What is parasympathetic and parasympathomimetic?
The direct acting cholinergic agonist used to treat elevated intraocular pressure in patients with glaucoma or ocular hypertension
What is Pilocarpine?
The action of nicotine replacement therapy is to decrease these kinds of symptoms
What is withdrawal symptoms?
This is considered a weapon and is an irreversible indirect-acting cholinergic agonist. When inhaled, the drug permanently binds to acetylcholinesterase which leads to ACh accumulation leading to slowed heart rate, constricted pupils and bronchi, and contracted muscles which immobilizes the diaphragm and eventually stops breathing
What is nerve gas?
This is the acronym used in cholinergic toxidrome to identify when symptoms are muscarinic
what is SLUDGE?
(salivation, lacrimation, urination, delectation, GI cramping, emesis)
This adverse effect leading to aspiration may occur when taking oral pilocarpine due to increased salivary secretions
What is dysphagia?
Patients taking direct acting cholinergic agonists (muscarinic) should monitor these fluid values to see their effects on the urinary system
What is intake and output?
These are the systemic effects of cholinergic drugs pertaining to the eyes, heart, and digestive system
Hint: one effect for each (eyes, heart, digestive system)
what is pupil constriction, decreased HR, and increased gastric secretions?
Acetylcholinesterase inhibitors should be avoided if a patient is taking direct-acting cholinergic agonists because of what increased risk
What are cholinergic effects?
Three examples of nicotine cessation products
What is bupropion, habitrol, nicoderm CQ, nicorette, nicotrol, or varenicline (chatix)?
(only need three)
This drug is used for the reversal of toxicity from nondepolarizing neuromuscular junction blocking drugs that are used to paralyze muscles for surgery
Hint: must be given every few hours to maintain therapeutic effect as duration of action is only 2-4 hours
What is neostigmine (Bloxiverz)?
This is the acronym used in cholinergic toxidrome to identify when symptoms are nicotinic
What is MTWTF?
(muscle cramps, tachycardia, weakness, twitching, fasciculations (muscle twitching))
These are the general side and adverse effects of cholinergic drugs
Hint: there are 7, they were mentioned in class
What is flushing, sweating, salivation, GI upset, drowsiness, sedation, and blurred vision?
This respiratory disease could be exacerbated by the increased parasympathetic effect, overriding the protective sympathetic bronchodilation
What is asthma?