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Ch. 14 The Autonomic Nervous System
Hoehn - Marieb Human Anatomy & Physiology, 12th edition
Hoehn, Haynes, Abbott12th EditionMarieb Human Anatomy & PhysiologyISBN: 9780138242732Not the one you use?Change textbook
Chapter 14, Problem 13

Tiffany, a 21-year-old college student, is having trouble sleeping, cries frequently, and has recurrent thoughts of suicide. An antidepressant is prescribed. Like many such drugs, this antidepressant has anticholinergic side effects. What side effects might Tiffany experience in the first week of treatment?

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Step 1: Understand that anticholinergic side effects occur because the drug blocks the action of acetylcholine, a neurotransmitter involved in the parasympathetic nervous system, which controls 'rest and digest' functions.
Step 2: Identify common anticholinergic side effects, which typically include dry mouth, blurred vision, constipation, urinary retention, and sometimes increased heart rate (tachycardia).
Step 3: Recognize that these side effects result from reduced parasympathetic activity, leading to decreased secretions (like saliva and mucus), reduced smooth muscle contractions in the gut and bladder, and pupil dilation.
Step 4: Apply this knowledge to Tiffany's case by listing the likely symptoms she might experience during the first week of treatment, such as dry mouth, difficulty urinating, constipation, blurred vision, and possibly increased heart rate.
Step 5: Note that these side effects are usually temporary and may diminish as the body adjusts to the medication, but Tiffany should report any severe or persistent symptoms to her healthcare provider.

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Key Concepts

Here are the essential concepts you must grasp in order to answer the question correctly.

Anticholinergic Side Effects

Anticholinergic side effects occur when a drug blocks the action of acetylcholine, a neurotransmitter involved in many bodily functions. Common symptoms include dry mouth, blurred vision, constipation, urinary retention, and dizziness. These effects often appear early in treatment with certain antidepressants.
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Mechanism of Antidepressants with Anticholinergic Properties

Some antidepressants, especially tricyclic antidepressants, block acetylcholine receptors in addition to affecting mood-related neurotransmitters. This dual action can improve depressive symptoms but also causes anticholinergic side effects. Understanding this helps predict and manage early treatment symptoms.
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Early Treatment Side Effect Management

Side effects like those caused by anticholinergic activity often appear in the first week of antidepressant therapy and may diminish over time. Recognizing these effects allows clinicians to provide supportive care, adjust dosages, or switch medications to improve patient adherence and comfort.
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As the aroma of freshly brewed coffee drifted by dozing Henry's nose, his mouth started to water and his stomach began to rumble. Explain his reactions in terms of ANS activity.

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Mr. Johnson suffers from urinary retention and a hypoactive urinary bladder. Bethanechol, a drug that mimics acetylcholine's autonomic effects, is prescribed to manage his problem. First explain the rationale for prescribing bethanechol, and then predict which of the following adverse effects Mr. Johnson might experience while taking this drug (select all that apply): dizziness, low blood pressure, deficient tear formation, wheezing, increased mucus production in bronchi, deficient salivation, diarrhea, cramping, excessive sweating, undesirable erection of penis.

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A 32-year-old woman complains of intermittent aching pains in the medial two fingers of both hands. During such episodes, the fingers become blanched and then blue. Her history is taken, and it is noted that she is a heavy smoker. The physician advises her that she must stop smoking and states that she will not prescribe any medication until the patient has discontinued smoking for a month. What is this patient's condition, and why was she told to stop smoking?

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