Parasympathetic Nervous System, Cholinergic Agonists, and Anticholinergic Agents

Vocabulary flashcards for parasympathetic nervous system, cholinergic agonists, and anticholinergic agents lecture.

Acetyltransferase

Enzyme produced by cholinergic nerves in the parasympathetic nervous system

Acetylcholine

Neurotransmitter that works in the parasympathetic nervous system

Rest and Digest

The goal of the parasympathetic nervous system, focusing on conservation of energy

Increased GI motility and secretion

Effect of parasympathetic nervous system activation on the gastrointestinal system

Increased urination

Effect of parasympathetic nervous system activation on the urinary system

Decreased heart rate

Effect of parasympathetic nervous system activation on the cardiovascular system

Bronchoconstriction and increased pulmonary secretion

Effect of parasympathetic nervous system activation on the respiratory system

Pupil constriction

Effect of parasympathetic nervous system activation on the eyes

Cranial and sacral points

Origin of parasympathetic impulses in the central nervous system

Acetylcholinesterase

Enzyme that breaks down acetylcholine

Acetylcholinesterase Function

Prevents overstimulation of cholinergic receptor sites.

80 seconds

Approximate time it takes for acetylcholinesterase to deactivate acetylcholine

Nicotinic and Muscarinic

Two subtypes of cholinergic receptors

Muscarinic receptors

Activated by muscarine and found in visceral effector organs

Nicotinic receptors

Located in the central nervous system, adrenal medulla, autonomic ganglia, and neuromuscular junction

Atropine

Medication that can block muscarinic receptors

M1 receptors

Located on the sympathetic nervous system, salivary glands, and parietal cells; increase CNS excitation, memory, locomotor activity, and gastric acid secretion

M2 receptors

Affect the heart, causing a decrease in rate, force, and AV conduction

M3 receptors

Located on smooth muscle and exocrine glands, causing smooth muscle contraction (except vasodilation) and glandular secretion

NN

Nicotinic receptor subtype in the CNS and adrenal medulla, causing CNS excitation and release of adrenaline

NG

Nicotinic receptor subtype in autonomic ganglia, responsible for ganglionic transmission

NM

Nicotinic receptor subtype in skeletal muscle, causing contraction

Cholinergic agonists

Substances that cause increased activity of acetylcholine receptors

Parasympathomimetic

Term for cholinergic agonists because they cause a parasympathetic response

Direct-acting cholinergic agonists

Act at cholinergic receptors in the peripheral nervous system and mimic the effects of acetylcholine

Indirect-acting cholinergic agonists

Cause increased stimulation of acetylcholine receptor sites by reacting with acetylcholinesterase

Muscarinic receptors (direct acting)

Triggered by direct acting cholinergic agonists, leading to effects like slowed heart rate, decreased cardiac contraction, vasodilation, bronchoconstriction, increased GI movement, increased bladder tone, and pupil constriction

Bethenicol (DuVoid)

Therapeutic use is for nonobstructive postop or postpartum urinary retention and neurogenic bladder.

Acetylcholine chloride (Miochol-E)

Ophthalmic agent for eye procedures and glaucoma

Cevimeline and pilocarpine

Medications used for Sjogren's syndrome to increase secretions

Epilepsy, Parkinson's, pregnancy, and lactation

Contraindications for muscarinic direct acting cholinergic agonists

Bradycardia, hypotension, arrhythmias, heart block, GI issues, dehydration, flushing, and sweating

Adverse effects of muscarinic direct acting cholinergic agonists

Nicotine

Binds to nicotinic cholinergic receptors in the peripheral and central nervous system

Nicotine's effect on neurotransmitters

Releases dopamine, norepinephrine, acetylcholine, serotonin, GABA, glutamate, and endorphins

Nicotine replacement therapy

Aids in smoking cessation through patches, gum and pills

Bup and Chantix

Medications for smoking cessation that are also used to get people off of opioids and other addictive medications. The two medications need to be discussed in psych

Seizure disorder

Contraindication for Bup due to lowering the seizure threshold

Tachycardia, hypertension, airway irritation, seizures, neuropsychiatric events, nausea, dry mouth, dizziness, skin rash, and strange dreams

Adverse effects of nicotinic receptor-based cholinergic agonists

Insulin, propranolol, Tylenol, and caffeine.

Medications that will need to be reduced when somebody stops smoking.

Indirect acting parasympathomimetics

Acetylcholinesterase inhibitors. Prevent the breakdown of acetylcholinesterase at the synapse.

Reversible

Indirect Medication: Effects that pass with time as acetylcholinesterase is released and allowed to break down acetylcholine.

Irreversible

Indirect medication: Binds to acetylcholinesterase and has an effect for much longer. Not therapeutic.

Pyridostigmine (Mestanone), neostigmine (Bloxiverse), donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon)

Reversible indirect-acting cholinergic agonists

Nerve gas, mustard gas, and organophosphates

Irreversible indirect-acting cholinergic agonists

Myasthenia gravis

Autoimmune disease of the nicotinic acetylcholine receptors causing decreased muscle activity and control.

Reversal of non-depolarizing neuromuscular blocking agents

Secondary use for Neostigmine, besides myasthenia gravis.

Antidote for neuromuscular junction blockers and exposure to nerve gas

Secondary use for pyridostigmine, besides myasthenia gravis.

Alzheimer's disease

Progressive loss of acetylcholine producing neurons in the brain cortex.

Confusion, difficulty completing familiar tasks, memory loss, and poor judgment

Symptoms of Alzheimer's disease

Liver and kidney impairment

Need to pay attention because the dose may need to be changed

GI bleeding

Adverse effect due to increased risk with NSAIDs

Cholinergic crisis

Overdose of medications causing the need to withdraw all cholinergic drugs and give atropine.

Weaponized nerve gas and pesticides (organophosphates)

Irreversible, indirect acting cholinergic agonists

Atropine

Antidote for an indirect acting cholinergic agonist that's irreversible, blocks cholinergic activity.

Pralidoxime (Protopam chloride)

Helps to free up acetylcholinesterase after atropine has stopped the cholinergic activity.

SLUDGE

Salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, and emesis. Symptoms of Cholinergic toxicity/poisoning.

Shortness of breath, hypotension, cardiac arrest, and bradycardia

Signs of cholinergic crisis

Antagonizes cholinergic drugs

Drug drug interactions resulting in decreased responses

Increased responsiveness

Drug interactions when there are other cholinergic drugs.

GI upset, diarrhea, and increased salivation

Adverse effects for children taking cholinergic drugs.

Flushing and sweating, salivation, GI upset, and urinary urgency

Adverse effects in adults taking cholinergic drugs.

Central nervous system, cardiovascular, GI, respiratory, and urinary effects

Effects that Elderly adults are likely to experience, while taking cholinergic drugs.

Nursing Considerations

Know if the patient have any allergies or have they had any problems with these medications. Do they have any issues with their GI or GU.

Nursing Considerations

Spread the doses evenly apart and make sure to give them on the same time every single day, to optimize the effects of the medication.

Cholinergic antagonists

Block or inhibit the actions of acetylcholine in the parasympathetic nervous system.

Atropine, Detrol, Ditropan XL, scopolamine, benztropine, ipratropium, and dicyclomine

Examples of Cholinergic antagonists

Anticholinergics and parasympatholytics

Other names for cholinergic blocking drugs

Prevent binding

Therapeutic actions of Cholinergic blocking drugs

Increased heart rate and contraction

Large dose affect of anticholinergics on the cardiovascular system

Decreased bronchial secretions and open bronchial airways

Respiratory affect, caused by a large dose of anticholinergics

Drowsiness and disorientation and hallucinations

Central nervous system affect, caused by a large dose of anticholinergics

Dilated pupils and decreased accommodation

Eye affect, caused by a large dose of anticholinergics

Decreases secretions and also smooth muscle tone

GI tract affect, caused by a large dose of anticholinergics

Relaxes detrusor muscle

Genitourinary affect, caused by a large dose of anticholinergics

Bradycardia and dysrhythmias

Undesirable Cardiovascular Effect of anticholinergics.

Excitation causing disorientation, hallucinations, and even delirium.

Undesirable CNS Effect of anticholinergics.

Dilated pupils, decreased visual accommodation, and it can actually increase intraocular pressure.

Undesirable Eye Effect of anticholinergics.

Thickening and drying of respiratory secretions that can actually cause a mucus plug

Undesirable Respiratory Effect of anticholinergics.

Decreased salivation and dry mouth and constipation

Undesirable GI tract Effect of anticholinergics.

Blocks muscarinic receptors in the parasympathetic and sympathetic nervous systems, but not nicotinic receptors

Atropine Function

Advanced life support/ bracycardia or prevent a vagal response

Therapeutic Uses of Atropine

Scopolamine

transderm patch that helps with motion sickness,n/v.

Ditropan

blocks m recptors urinary bladder to prevent overactive bladder

Benign prostate hyperplasia and Glaucoma

Contraindications for patients one anti-cholinergics.

Overdose on atropine

Reversing one side effect leads to the need of reversing the added side effect.

Hypertension and Tachycardia

Cardiovascular side effects while on anticholinergics

Cycloplegia

Paralysis of ciliary muscles or blurred vision.

Heat Intolerance

Heat Intolerance, because you cant sweat.

Benign prostate hyperplasia

Contraindication to Ditropan or Detrol

Heat stroke

Can occur in elderly patients taking anticholinergics due to inability to sweat

Cholinergic Toxicity

When you have too many acetylcholines.

Atropine overdose

Treated with physostigmine, a cholinesterase inhibitor (though discontinued in the US)

Chew hard candy and frequent mouth care

Used with dry mouth which is used while aticholinergic

Sucking on hard candy

Instructions to make sure they can make saliva, while on Anti cholinergics

Atropine Dosage

One milligram up to a three milligram dosage, for bradycardia

Take as often as need to

For cholinergic poisoning doses, take as often till SLUDGE is gone.

Muscarinic and nicotinic

Two types of cholinergic receptors

Acetylcholine

Only neurotransmitter in the parasympathetic nervous system

Acetylcholinesterase

Enzyme that breaks down acetylcholine

Muscarinic

Receptor in visceral effector organs