Cataract surgery- Miotics constrict iris, drawing it away from the lens
Post-op Urinary Retention- Stimulate GI and GU peristalsis
What is a cararact
Opacities in the lens of the eye which results in blurred vision
What is another name for indirect acting cholinergics
Anticholinesterases
What is the MOA of indirect acting cholinergics
inhibit the enzyme ACHE allow the accumulation of ACH
What are indirect acting cholinergic s used for
Myasthenia gravis, antidote for curare poisoning, glaucoma, alzheimer's disease
What do myasthenia gravis patients lack
Enough ACH to adequately stimulate NII receptors this causes skeletal muscle tone to be weak, difficulty standing, breathing, raising head, eyelids characteristically droop
What is indirect acting cholinergic used as a antidote for
Curare poisoning
What is curare
A NMB used in darts to immobilize prey
What does curare do
Blocks ACH at the NII receptor of skeletal muscle, producing paralysis
What does anticholinesterases do when curare is used
Inhibit ACHE, allowing ACH to accumulate at the NII receptor, thereby reversing the effects of NMB
What is alzheimer's disease
A progressive form of dementia that occurs later in life, with short term memory loss, believed to be caused by damage to the cholinergic pathways, not ACH
What are the types of indirect acting cholinergic's
Reversible inhibitors of ACHE
Irreversible inhibitors of ACHE
What is the DOA for reversible inhibitors of ACHE
10 min-36 hrs
What do reversible inhibitors of ACHE bind to
ACHE
How is the reversible inhibitors of ACHE strength
Bond is weak, after it wears off, ACHE is again able to metabolize ACH
What are reversible inhibitors of ACHE agents
Edrophonium
Neostigmine
Pyridostigmine
Physostigmine
What is the generic name for physostigmine
Antilirium
What is physostigmine
Cholinergic, indirect acting, reversible drug. Used as an antidote for anti-cholinergic poisoning
What are irreversible inhibitors of ACHE
Form an irreversible bond with ACHE
How is the bond with irreversible inhibitors of ACHE
Strong covalent bond can only be diminished by aging.
What is the DOA for irreversible inhibitors of ACHE
Very long 1-4 weeks
What are some irreversible inhibitors of ACHE agents
Isoflourophate
Echothiophate Iodide
What is the generic name for echothiophate iodide
phospholine iodied
What does echothiophate do
A Cholinergic, indirect acting, irreversible. For Glaucoma
What does adverse effects of cholinergic cause
Excess PANS stimulation
N/V/D
Miosis
Excessive sweating
Muscular tremors
Bronchoconstriction
Bradycardia and hypotension
What are the toxic effects of cholinergics
Muscular paralysis
Respiratory depression
Death
Muscarinic poisoning (Caused by the mushroom Amanita Muscaria)
What will the mushroom Amanita Muscaria cause
Symptoms are the same as for cholinergic poisoing
Death can occur within hours
The antidote for cholinergic poisoning is the anticholinergic drug
What are Anticholinergic drugs
Drugs which bind to muscarinic receptors also called parasympatholytics
What is the MOA of anticholinergic drugs
Competitive antagonism of ACH
Where are the oldest anticholinergic drugs from
The Belladonna Plant (Deadly nightshade)
What are types of Belladonna Alkaloids
Atropine
Hyroscyamine
Scopolamine
What are types of synthetic anticholinergics
Dicyclomine
Glycopyrrolate
Propantheline Bromide
Oxybutynin
Flavoxate
Tolterodine
What are the cardiovascular effects of anticholinergic drugs
ACH stimulates the vagus nerve, thus slowing the heart beat
Anticholinergic prevent the binding of ACH to cholinergic receptors in the heart
As the PANS decreases, the SANS increases producing Tachycardia
What are the cardiovascular use of anticholinergic drugs
Atropine may be given by injection or by ET tube for bradycardia
What are the respiratory effects of anticholinergic drugs
ACH increases respiratory secretions and caused bronchoconstriction
Anticholinergic's prevent the binding of ACH to cholinergic receptors on the respiratory tract
What are the respiratory uses of anticholinergic drugs
Atropine may be given pre-op to inhibit respiratory secretions which interfere with general anesthesia or intubations
Atropine may be given by nebulizer for asthma
What are the GI effects of anticholinergic's
ACH increases GI motility and secretions
Anticholinergics prevet the binding of ACH to cholinergic receptors in the bowel and stomach
This relaxes intestinal smooth muscle and inhibits GI secretions
What are the GI uses of anticholinergics
IBS
Adjunctin the treatment of peptic ulcer
What are the CNS effects of anticholinergics
ACH receptors are located in the brain
When blocked by anticholinergics, drowsiness and sedation occur
Respiratory depression and death occur as the dose becomes toxic
What are CNS uses of anticholinergics
Cold symptoms
Motion sickness
Parkinson's disease
What is Parkinson's disease
There is too much ACH and not enough DA in areas of brain responsible for movement
What are the GU effects of anticholinergics
ACH contract the bladder, voiding urine
Anticholinergics inhibit urinary peristalsis and the voiding of urine
Used for bladder spasms and enuresis
What are ocular effects of anticholinergics
ACH constricts the pupils, producing miosis
Anticholinergics block ACH, producing mydrias and cycloplegia
Used for retinal exams, iritis
What are adverse effects of anticholinergics
Drowsiness/dizziness
Dry mouth, constipation, dry skin
Blurred vision, mydriasis, photophobia
What are cholinesterase reactivators
Protopam
Reactivates ACHE after it has been inactivated by an irreversible inhibitor