Term
| Cholinergic-Blocking Drugs |
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Definition
aka cholinergic blockers, anticholinergics, parasympatholytics, antimuscarinics
drugs that block or inhibit the actions of acetycholine in the parasympathetic nervous system (PSNS)
Therapeutic index small - appropriate response to overdose/toxicity essential |
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Term
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Definition
atropine
belladonna
hyoscyamine
scopolamine |
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Term
| List of sythetic/semisynthetic |
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Definition
| benztropine dicyclomine homatropine isapropamide oxybutynin clidinium glycopyrrolate ipratropium methscopolamine propantheline trihexyphenidyl many others |
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Term
| Drug Effects of Cholinergic Blockers |
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Definition
I. cardiovascular: small doses: decrease hr; large doses: increase hr
II. CNS: small doses: decrease muscle rigidity and tremors; large doses: cause drowsiness, disorientation, hallucinations
III. Eye: Dilate pupils (Mydriasis), decrease accommodation by paralyzing ciliary muscles (cycloplegia)
IV. GI - relax smooth muscle tone of GI tract, decrease intestinal and gastric secretions, decrease motility and peristalsis
V. GU: relax detrusor muscle of bladder, increase constriction of internal sphincter, these two effects may result in urinary retention
VI. Glandular: decrease bronchial secretions, salivation and sweating
VII. Respiratory: decrease bronchial secretions, dilate bronchial airways |
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Term
| Cholinergic Blockers - Adverse Effects **** |
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Definition
I. Cardiovascular - increased HR, dysrhythmias, tachycardia, palpitations
II. CNS: excitation, restlessness, irritability, disorientation, hallucinations, delirium, ataxia, drowsiness, sedation, confusion
III. eye: dilated pupils causing blurred vision, increased intraocular pressure
IV. GI: decreased salivation, gastric secretions and motility (causing constipation)
V. GU: urinary retention
VI. Glandular: decreased sweating
VII. decreased bronchial secretions |
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Term
| A 22 year old woman has been invited on an ocean cruise, but she suffers from severe motion sickness. She has a prescription for transdermal scopolamine, but is not sure how it works or how to use it. |
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Definition
| Scopolamine for prevention of motion sickness is available as a transdermal patch and should be applied just behind the ear to a dry, nonhairy, nonirritated area, 4=5 hours before travel. The patch is changed every 72 hrs. Old patch removed and site cleansed of med. residue. Rotation of sites recommended to decrease irritation. |
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Term
| A 78 year old woman has a new prescription for tolterodine (Detrol) as part of the treatment for urinary urgency and frequency. What adverse effects should she be aware of before she takes this medication? |
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Definition
| Although tolterodine has few incidents of adverse effects, the drug may cause dry mouth, constipation and blurred vision |
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Term
| A 55 year old pt has been admitted to telemetry unit. Suddenly heart monitor shows he has a HR of 35 beats/min. Nurse finds him groggy with apical pulse of 38 beats/min and BP of 98/32 mm Hg. Atropine is ordered as a standby treatment for symptomatic bradycardia of less than 40. How will it be given? |
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Definition
| the atropine will be given IV 0.5 to 1 mg, to a max of 3mg, until HR returns to normal sinus rhythm and pt is not symptomatic |
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Term
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Definition
| decreased muscle rigidy and muscle tremors in : Parkinson's disease; drug-induced extrapyramidal reactions |
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Term
| Indications Cardiovascular |
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Definition
affect the heart's conduction system by
low doses: slow HR
high doses: block inhibitory vagal effects on SA and AV node pacemaker cells increasing HR |
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Term
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Definition
Used primarily for cardiovascular disorders
a. diagnosis of sinus node dysfunction
b. symptomatic second degree heart block
c. severe sinus bradycardia with hemodynamic compromise (advanced life support) |
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Term
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Definition
Blockig the cholinergic stimulation of the PSNS allows unopposed action of the SNS
Results: decreased secretions from nose, mouth, pharynx, bronchi; relaxed smooth muscles in bronchi and bronchioles; decreased airway resistance; bronchodilation |
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Term
| Indications Gastrointestinal |
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Definition
1. PSNS controls gastric secretions and smooth muscles that produce gastric motility
2. blockade of PSNS results in:
a. decreased secretions
b. relaxation of smooth muscle
c. decreased GI motility and peristalsis
3. Gastrointestinal drugs are used to treat:
a. irritable bowel disease
b. GI hypersecretory states |
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Term
| Indications: Genitourinary |
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Definition
1. reflex neurogenic bladder
2. incontinence |
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Term
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Definition
1. acute pancreatitis: reduces gastric and pancreatic secretions
2. preoperatively: reduces salivary secretions |
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Term
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Definition
antihistamines, phenothiazines, tricyclic antidepressants, MAOIs
When given with cholinergic blocking drugs, cause additive cholinergic effects, resulting in increased effects |
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Term
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Definition
assess for allergies, presence of BPH, glaucoma, tachycardia, MI, HF, hiatal hernia, GI or GU obstruction
2. overdosing can cause life-threatening problems
3 blurred vision may cuse problems with driving or operating machinery
4. may have sensitivity to light
5.when giving ophthalmic solutions, apply pressure to inner canthus to prevent systemic absorption |
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Term
| Antidote for atropine overdose |
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Definition
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Term
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Definition
in elderly, higher risk for heat stroke b/c of effects on heat regulating mechanisms
have pts avoid high temps and strenuous exercise
adequate fluid and salt intake |
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Term
| Report the following to dr |
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Definition
| urinary hesitancy and/or retention; constipation, palpitations, tremors, confusion, sedation, or amnesia, excessive dry mouth (esp if they have chronic lung infections or disease), or fever |
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Term
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Definition
For Parkinson's disease: fewer tremors, decreased salivation and drooling
For pts with urologic problems: improved urinary patterns, less hypermotility, increased time between voiding |
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Term
| What are the contraindications to scopolamine? |
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Definition
| narrow-angle glaucoma, acute asthma or other respiratory distress, myasthenia gravis, acute cardiovascular instability, and GI or GU tract obstruction or other acute GI or GU illness --- can cause eyes to dilate...wear sunglasses |
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Term
| Atropine is indicated for |
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Definition
| preoperatively, to dry secretions; symptomatic bradycardia; ventricular asystole; antidote for anticholinesterase inhibitor toxicity |
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Term
| dicyclomine (Bentyl) is indicated for |
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Definition
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Term
| scopolamine is indicated for |
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Definition
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Term
| glycopyrrolate is indicated for |
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Definition
| preoperatively, to dry secretions |
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Term
| tolterodine is indicated for |
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Definition
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