306- Cholinergic Agonists/Anticholinergics

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306- Cholinergic Agonists/Anticholinergics
2012-10-07 21:28:21
306 Cholinergic Anticholinergics

Exam 3
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  1. Drugs that stimulate the PNS by mimicing parasympathetic neurotransmitter acetylcholine
  2. Cholinergic Receptor that Affects SMOOTH muscle
    Muscarinic receptors
  3. Cholinergic Receptor that Affects Skeletal Muscle
    Nicotinic Receptors 
  4. Effects of Cholinergic Agonists:
    ˜Cardiovascular: decrease P and BP, vasodilation, slows conduction of AV node

    ˜GI: increase tone and motility, increase peristalsis, relax sphincter muscles

    ˜GU: increase ureter tone, contract bladder and relax sphincter muscles, stimulate urination

    ˜Eye: constrict pupils, increase accommodation

    ˜Lungs: bronchial constriction, increase secretions

    ˜Glands: increase salivation, perspiration, and tears

    ˜Striated muscle: increase neuromuscular transmission, maintain muscle strength and tone
  5. Cholinergic drugs act _____ on the receptor
  6. What direct acting cholinergic agonist drug (targeted to muscarinic receptors) is used to increase gastric emptying
    Metoclopramide (Reglan)
  7. What direct acting cholinergic agonist drug (targeted to muscarinic receptors) constricts pupils and opens the canal of Schlemm to allow drainage of aqueous humor (fluid) to treat glaucoma by relieving intraocular pressure in eye.
    Pilocarpine (Pilocar)
  8. What direct acting cholinergic agonist drug (targeted to muscarinic receptors) increases urination
    Bethanechol chloride (Urecholine)
  9. Side effects of BETHANECHOL
    Blurred vision, miosis

    Hypotension, bradycardia, sweating

    • Increased salivation and gastric acid, nausea, vomiting,
    • diarrhea, abdominal cramps

  10. Condraindications of BETHANECHOL
    Bradycardia, hypotension, COPD, peptic ulcer, parkinsonism, hyperthyroidism
  11. Nursing Interventions for BETHANECHOL
    • Monitor BP and P.
    • Teach client to rise slowly.
    • Record fluid intake and output.
    • Monitor breath sounds.
    • Give 1 hour ac or 2 hours pc.
    • Monitor bowel sounds.

    • Monitor overdosing.
    • •SS: salivation, sweating, flushing, abdominal cramps
    • •Antidote: Atropine
  12. Functions and Effects of INDIRECT acting Cholinergic Agonists
    • Break down cholinesterase enzyme
    • •Into choline and acetic acid
    • Allow Ach to activate muscarinic and nicotinic cholinergic receptors

    • EFFECTS:
    • Stimulate skeletal muscles, increase tone
    • Greater GI motility, bradycardia, miosis
    • Bronchial constriction, promote urination
  13. Side Effects/Contraindications with INDIRECT acting cholinergic agonists
    • ˜SE:
    • bradycardia, asthma, peptic ulcers

    • Contraindications:
    • intestinal and urinary obstruction
  14. Examples of Reversible Cholinisterase Inhibitors
    • Neostigmine (Prostigmin) 
    • short-acting.

    • Pyridostigmine (Mestinon)
    • moderate-acting.

    • Ambenonium (Mytelase) 
    • long-acting.

    • Edrophonium (Tensilon)
    • short-acting and often used for diagnostic purposes.
  15. Uses for Reversible Cholinisterase Inhibitors
    • •Pupil constriction in glaucoma
    • •increase muscle strength in myasthenia gravis
  16. Side Effects of Reversible Cholinisterase Inhibitors
    Muscle cramps, twitching, bradycardia, increased bronchial secretions, and cramps
  17. Effects of Anitcholinergics
    • Heart: large doses increase P; small doses
    • decrease P
    • Lungs: bronchodilation, decrease secretions
    • GI: relax smooth muscle tone, decrease motility and peristalsis, decrease secretions
    • GU: relax detrusor muscle, increase sphincter constriction
    • Eye: dilate pupils, decrease accommodation
    • Glands: decrease salivation and perspiration
    • CNS: decrease tremors and rigidity
  18. Atropine (Action/SE/Contraindications)
    • •Increase P, decrease motility and peristalsis, decrease
    • salivary secretions

    • Side effects/adverse reactions
    • •Tachycardia, palpitations, nasal congestion, flushing,
    • photophobia, blurred vision, dry mouth and skin, abdominal distention, urinary
    • retention, impotence

    ****Contraindicated in GLAUCOMA
  19. Nursing Interventions for Atropine
    • •Monitor vital signs, urine
    • output, bowel sounds.

    • •Monitor safety: bedside rails,
    • driving motor vehicles.

    •Provide mouth care and eye drops.

    •Avoid hot environments.

    • •Avoid alcohol, cigarettes,
    • caffeine, and aspirin at bedtime.

    •Wear sunglasses in bright light. 
  20. Selected Anticholinergics for Parkinsonism
    • Benztropine (Cogentin)
    • Trihexyphenidyl HCl (Artane)

    • Action:
    • Decreases involuntary movement, tremors, muscle rigidity
  21. Antihistamines
    • Treats motion sickness
    • Scopolamine (Transderm Scōp)
    • Dimenhydrinate (Dramamine)

    • Side effects
    • •Dry mouth, visual disturbances, constipation, urinary retention, flushing, muscle weakness, tachycardia, hypotension