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Describe the systhesis/breakdown on ACh.
- Acetyl CoA + choline = ACh
- ACh + cholinesterase = Choline (reuptake) and acetate (biproduct)
Where do parasympathetic fibers arise from?
Brainstem and Sacral region of spinal cord
Where do sympathetic fibers arise from?
Thoracic and lumbar regions of spinal cord
What is the most important mechanism for termination of NE action?
What neurotransmitter is involved with chilinergic drugs?
What is the most important mode of transmission termination of ACh?
Degradation of ACh
List 3 clinical uses for a muscarinic agonist.
- Treatment of post-op urinary retention (relaxes sphincter)
- Post-op GI atony (loss of tone)
- GERD (↑ GI motility)
Muscarinic Agonist drug
What is the route for Bethanechol?
Why does bethanecol have a poor ability to penetrate the blood brain barrier?
Quanternary ammonium compound
Bethanechol can have rapid effects, what nursing implications relate?
Have bed pan/restroom ready
What do you treat an overdose of bethanechol with?
Why should you never give bethanechol to someone with hyperthyroidism?
Bethanechol lowers heart rate and the body sees this as a problem so it realeases epi. People with hyperthyroidism are sensitive to chatecholamines (epi, NE, dopamine).
Cholinesterate Inhibitor drug
What are 3 clinical uses for neostigmine?
- Myasthenia gravis (strenghtens muscle contractions)
- Neurgenic/post op ileus
- Urinary retention
What is the preferred route for neostigmine?
IV, topical, IM (usually not oral because it is absorbed poorly)
What type of drug is atropine?
How does atropine work?
Competative antagonist (key in hole, but doesn't turn), blocks ACh.
Why is atropine given before SX?
Dries up secretions so you don't aspirate and prevents bradycardia.
Is Atropine lipid soluble?
How is Atropine removed from the body/metabolized?
Liver and Kidneys
Atopine is used in eye exams, why?
What is the mnemonic for atropine?
Dry as a bone, red as a beet, mad as a hatter.
What drugs do you not give with atropine?
Other muscarinic drugs like antihistamines, TCAs
What is an overdose of Atopine treated with?
Physostigmine or charcol
What do adrenergic agonist act like?
catecholamines: epi, NE, dopamine
What receptors will adrenergic drugs act on?
What are 3 clinical uses for adrenergic agonist?
- Severe Asthma
- Cardiac Arrest
Is epi administered orally?
NO, it breaks down too easily
is Epi selective or non-selective?
Where should Epi be administered?
In a large vein, if you miss the small vein the epi can cause tissue necrosis. This is why you should always check the patency of the IV line before you start it.
How do you remember which beta is lungs and which is heart?
- One heart (B1)
- Two lungs (B2)
What is a common medication for hypertension? why?
Propanolol, it is a beta blocker and reduced the load on the heart. Used for chronic heart issues, not acute. It can actually have acute heart problems as a side effect.
Both propanolol and metoprolol are oral, which one is also IV?
Is Metoprolol selective or non selective?
Selective for B1
Why is giving someone propranolol containdicated for a person with diabetes?
Propranolol can cause hypoblycemia because of inhibition of glycogenolysis and it suppresses tachycardia, a warning sign of hypoglycemia in diabetic patients.
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