acetylcholine
the neurotransmitter responsible for transmission of nerve impulses to effector cells in the parasympathetic nervous system
acetylcholinesterase
the enzyme responsible for the breakdown of acetylcholine (also referred to as cholinesterase)
Alzheimer's disease
a disease of the brain that is characterized by progressive mental deterioration manifested by confusion, disorientation, and loss of memory, ability to calculate, and visual-spatial orientation
atony
a lack of normal muscle tone
cholinergic crisis
severe muscle weakness and respiratory paralysis due to excessive acetylcholine; often seen in patients with myasthenia gravis as an adverse effect of drugs used to treat the disorder
cholinergic receptor
a nerve receptor that is stimulated by acetylcholine
miosis
the contraction of the pupil
muscarinic receptors
cholinergic receptors that are located postsynaptically in the effector organs such as smooth muscle, cardiac muscle, and glands supplied by parasympathetic fibers. stimulated by alkaloid muscarine a substance isolated from mushrooms
Nicotinic receptors
cholinergic receptors located in the ganglia (where presynaptic and postsynaptic nerve fibers meet) of both the parasympathetic nervous system and the sympathetic nervous; so named because they can be stimulated by the alkaloids nicotine
parasympathomimetics
drugs that mimic the parasympathethic nervous system; also referred to as cholinergic agonists.
parasympathetic nervous system
branch of the autonomic nervous system opposite the sympathetic
cholinergic drugs
primarily use for their effects on the GI tract, bladder and eye.
cholinergic drugs GI/bladder effects
stimulate the intestine and bladder which results in increased gastric secretions, gastrointestinal motility and urinary frequency
cholinergic drugs Eye effects
stimulate constriction of the pupil (miosis) and helps decrease intraocular pressure.
cholinergic drugs other effects
increased salivation and sweating, reduced heart rate and vasodilation, and causing the bronchi of the lungs to constrict and the airways to narrow
dosage effects
low doses stimulate the muscarininc receptors (desired), high doses stimulate the undesirable adverse effects of the nicotinic receptors
bethanechol (Urecholine)
Muscarinic (direct-acting) cholinergic agonist used postoperative and postpartum, functional urinary retention, bladder muscle atony
direct-acting cholinergic agonists
bind directly to cholinergic receptors and activate them
indirect-acting cholinergic agonists
stimulate the postsynaptic release of acetylcholine at the receptor site, then allows acetylcholine to bind to and stimulate the receptor.
cholinesterase inhibitors
work by inhibiting the action of acetylcholinesterase (the enzyme responsible for breaking down acetylcholine). There are two types reversible and irreversible
reversible cholinesterase inhibitors
bind to cholinesterase for a short period of time
irreversible cholinesterase inhibitors
bind to cholinesterase have a long duration of activity and the body must generate new cholinesterase enzymes to override the effects of the irreversible drug.
indirect-acting drug effects
cause skeletal muscle contraction and are used for the diagnosis and treatment of myasthenia gravis.
physostigmine (Antilirium)
indirect-acting anticholinesterase considered the antidote for anticholinergic poisoning as well as poisoning by irreversible cholinesterase inhibitors such as insecticides and tricyclic antidepressant overdose
donepezil (Aricept)
cholinesterase inhibitors used to treat Alzheimers, it increases acetycholine levels to help enhance and maintain memory and learning capabilities
contraindications of cholinergic drugs
known drug allergy, GI or GU tract obstruction, bradycardia, defects in the cardiac impulse conduction, hyperthyroidism, epilepsy, hypotension, or COPD.
adverse effects of cholinergic drugs
bradycardia, tachycardia, hypotension, hypertension, syncope, conduction abnormalities, HA, dizziness, convulsions, ataxia, abdominal cramps, increased secretions, N&V, diarrhea, increased bronchial secretions, bronchospasm, lacrimation, sweating, salivat
cholinergic crisis symptoms
circulatory collapse, hypotension, bloody diarrhea, shock and cardiac arrest. Early signs: abdominal cramps, salivation, flushing of the skin, N&V
SLUDGE
cholinergic poisoning, stands for
Salivation
Lacrimation
Urinary continence
Diarrhea
GI cramps
Emesis
interactions with cholinergic drugs
anticholinergics (atropine), antihistamines, and adrenergic agonists may antagonize and lead to a reduced response
pyridostigmine (Mestinon)
indirect-acting anticholinesterase use in myasthenia gravis and antidote for neuromuscular blocker toxicity
causes increased bladder tone and motility
what does bethanechol (urecholine) do?
peptic ulcer
what is a contraindication of bethanechol (urecholine)?
atropine (generic)
what is the antidote for accidental overdose of a cholinergic drug?
to aid in the diagnosis of myasthenia gravis?
what does edrophonium (Tensilon) do?
hypotension, syncope, dyspnea
what are some symptoms of cholinergic crisis?
B. Increased gastrointestinal motility
Cholinergic (parasympathomimetic) drugs have which therapeutic effect?
A. Urinary retention
B. Increased gastrointestinal motility
C. Mydriasis
D. Vasoconstriction
B. Lowering intraocular pressure in patients with glaucoma
Cholinergic (parasympathomimetic) drugs are indicated for which situation?
A. Treating a postoperative patient who has bradycardia
B. Lowering intraocular pressure in patients with glaucoma
C. Inhibiting muscular activity in the bladder
D. Preventing sali
B. urinary atony.
During postoperative teaching, the nurse explains that the patient is receiving bethanechol (Urecholine) to treat
A. postoperative hypotension.
B. urinary atony.
C. respiratory atelectasis.
D. postoperative ischemic colitis.
D. Headache
Which is an adverse effect of bethanechol (Urecholine)?
A. Constipation
B. Hypertension
C. Tachycardia
D. Headache
B. increase levels of acetylcholine in the brain by blocking its breakdown.
The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to
A. relieve anxiety and restless behavior of the patient.
B. increase levels of acetylcholine in the brain by blocking its breakdow
B. Take the medication 30 minutes before meals.
When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is most appropriate?
A. Increase fluid and fiber in the diet to prevent constipation.
B. Take the medicatio
C. Alzheimer's disease
The provider has ordered donepezil (Aricept) for the patient, and the patient states "I have no idea why I take this medication." What is the most common diagnosis associated with the administration of donepezil (Aricept)?
A. Parkinson's disease
B. Bladde