30 Questions
3 Cholinergic activities
Nerves and receptors of PNS, ACh binds to cholinergic Rc and stimulates PNS, Acetylcholinesterase inactivates ACh
what is the neurotransmitter of the PNS?
ACH, Muscarinic,
PNS receptors where do they attach and what action takes place when active?
pupil of eye = miosis (constrict) bronchi = SM contracts Heart = chronotropic decrease (HR decrease) blood vessels = Vasodilation
Parasympatholytics Block the PNS & Parasympathomimetics stimulate PNS
True
PNS, what are the receptors?
what are the two types of cholinergic drugs?
direct and indirect
what are the two subsets of indirect acting cholinergic drugs
reversible and irreversible
Act ________ on the muscarinic receptor Increase GI secretions, motility, increase urinary tract function, and pupillary miosis Parasympathomimetics Acetylcholine, Pilocarpine, and Bethanechol (Urecholine)** Uses Glaucoma Urinary retention
Also called anticholinesterases is a ___________ acting agent Inhibit the enzyme ACH-esterase which results in an increase in ACH at cholinergic receptor sites Two types Reversible Used to treat Myasthenia gravis and Alzheimer’s Disease Pyridostigmine and neostigmine (MG) Aricept (donepezil) and Exelon (rivastigmine) (AZ) Irreversible Form long bonds which increases duration of action Echothiophate used topically for glaucoma Pesticides and chemical warfare In large doses can cause severe toxicity
WHAT DOES the Mnemonic DUMBELS stand for?
Diarrhea Urination Miosis Bronchoconstriction Excitation (skeletal muscle and CNS) Lacrimation??? Salivation and sweating
Describe Anticholinergic drugs
Also called parasympatholytics Bind to the muscarinic Rc and block the action of Ach Affects different systems within the body (Cardio, GI, Respiratory, etc) Increase HR, decrease GI motility and secretions, and promote urinary retention, dilate the pupil of the eye
_____________________Cause skeletal muscle relaxation by blocking acetylcholine, and therefore, the transmission of nerve impulses at the neuromuscular junction
Two types: Non-depolarizing and depolarizing Administered IV Adverse effects include respiratory paralysis and Malignant hyperthermia Used before and after SXs, facilitate tracheal intubation, and tetanus therapy
Neuromuscular blockers (NMBs)
Depolarizing NMB
Succinylcholine
Non-depolarizing NMB
Vecuronium and tubocurarine
MOA for Spasmolytics
MOA:
Reduce the reflex impulse conduction within the spinal cord to disrupt the painful muscle contractions.
Used for muscle strain and overexertion
3 types of sweat glands
Eccrine Found on non-hairy areas (soles of feet, forehead) Under cholinergic control Muscarinic receptors (stimulated by Ach) Apocrine Found on hairy areas (Beard, axilla, and urogenital) Under sympathetic/adrenergic control Alpha-1 receptors (stimulated by NE, EPI) Mixed apo-eccrine
Match the following
Neuromuscular Blocker = used to treat opioid dependency Suboxone (buprenorphine & naloxone) = directing acting cholinergic agent Tylenol (acetaminophen) = causes malignant hyperthermia bethanechol = max of 4000 mg per day
3 Name the antihistamines
Benadryl (diphenhydramine) Claritin (loratadine) Allegra (fexofenadine)
Identify the agent that reactivates acetylcholinesterase to help with cholinergic poisoning
Cholinesterase regenerators reverse the poisoning issues Pralidoxime (PAM)
What is the benefit of taking Celebrex (celecoxib) over Motrin (ibuprofen)?
Gastrointestinal Safety: Celebrex is known as a selective COX-2 inhibitor, which means it primarily targets the cyclooxygenase-2 enzyme responsible for inflammation and pain without significantly affecting COX-1, which plays a role in protecting the stomach lining.
Which drug has a standing order in the State of Texas for opioid use?
neuromuscular blockers
bethanechol
Suboxone (buprenorphine & naloxone) = used to treat opioid dependency bethanechol = directing acting cholinergic agent neuromuscular blocking agents, such as succinylcholine (a depolarizing neuromuscular blocker) = causes malignant hyperthermia Tylenol (acetaminophen) = max of 4000 mg per day
List the anticholinergics
Anticholinergic drugs are a class of medications that block the action of acetylcholine, a neurotransmitter that plays a role in various bodily functions, including muscle contractions and the regulation of certain organs. Anticholinergics are used for a variety of medical purposes, such as relieving symptoms of conditions like overactive bladder, motion sickness, gastrointestinal disorders, and more. Here are some common anticholinergic drugs:
Atropine
Scopolamine
Oxybutynin (e.g., Ditropan)
Tolterodine (e.g., Detrol)
Solifenacin (e.g., Vesicare)
Darifenacin (e.g., Enablex)
Trospium (e.g., Sanctura)
Glycopyrrolate (e.g., Robinul)
Ipratropium (e.g., Atrovent)
Tiotropium (e.g., Spiriva)
Benztropine (e.g., Cogentin)
Trihexyphenidyl (e.g., Artane)
Dicyclomine (e.g., Bentyl)
Propantheline (e.g., Pro-Banthine)
Identify the irreversible, indirect acting agents
Identify the reversible indirect acting agents
Identify the agent that reactivates acetylcholinesterase to help with cholinergic poisoning
Pralidoxime (PAM)
Describe the MOA of Theo-Dur, Singulair, umeclindium, and vilanterol
Important for allergic airway disease
Products of arachidonic acid metabolism. (INFLAMATION)
Released from various cells (mast cells and eosinophils)
Associated with asthma pathophysiology.
Released from nasal mucosa in response to allergic rhinitis
Antagonist at the cysteinyl leukotriene receptor found in human airway to improve signs and symptoms of asthma and allergic rhinitis
H1RA paradoxical effects (benadryl)
in kids they can get wired rather than drowsey
Gen-1 Vs Gen-2 H1RA difference
Gen one guaranteed to make you sleepy, Brompheniramine Chlor-Trimeton (chlorpheniramine) Benadryl (diphenhydramine) Hydroxyzine Promethazine
Gen 2 Claritin (loratadine) Allegra (fexofenadine) Zyrtec (cetirizine) Clarinex (desloratadine) Xyzal (levocetirizine)
Which agents are used to treat nasal congestions?
Flonase (fluticasone propionate), Nasonex (mometasone), Rhinocort AQ (budesonide), Nasacort AQ (triamcinolone), Flonase Sensimist (fluticasone furoate)
Side effects Nasal irritation, epistaxis, sneezing, cough increases, adrenal suppression
Test your knowledge on cholinergic activities, PNS neurotransmitters, receptors, and cholinergic drugs. Questions include identifying PNS receptors, actions upon activation, types of cholinergic drugs, and the effects of parasympatholytics and parasympathomimetics.
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