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What are Cholinergic drugs?
They act like neurotransmitter acetylcholine or may inhibit release of enzyme acetylcholinesterase.
- Urinary retention (causes contraction of bladder smooth muscles)
- Tx of Glaucoma (produces miosis-constriction of the iris)
- Myasthenia gravis- this is rapid fatigue in skeletal muscles bcuz of lack of ACH.
What are the A/R of Cholinergic drugs?
- Nausea/diarrhea, ABD cramping
- Salivation flushing of the skin
- Cardiac arrhythmias
- Muscle weakness
- Topical administration A/R:
- Reduction of visual acuity
Who are Cholinergic drugs contraindicated in?
- Peeps with:
- Peptic ulcer disease
- Coronary artery disease
is contraindicated in those w/ mechanical obstruction of the GI or genitourinary tracts.
Opthalmic cholinergic preparations -
peeps w/ secondary glaucoma, iritis, corneal abrasion, or any acute inflammatory disease of the eye
What are the precautions in Cholinergic drugs?
- Used cautiously in peeps with:
- Cardiac arrythmias
- recent coronary occlusion
what drug interactions does CHOLINERGIC drugs have?
Aminoglycoside antibiotics(anti-infective) = INCREASED neuromuscular blocking effect
Corticosteroids(tx of inflammation/respiratory problems) =DECREASED effect of the CHOLINERGIC
What are the Preadministration assessment of Cholinergic drugs used for Glaucoma?
- Primary health care provider examines the eye
- Review the health care provider's dx and comments
- Take pt health hx, evaluate pt's ability 2 carry out ADLs
- After preadm assessment
- Nurse= Monitor 4 drug toxicity or cholinergic crisis, Check eye & area around eye daily 4 evidence of redness, inflammation, and excessive secretions
- when giving eye drops read rx label carefully when instilling
- chck name of drug, dosage, strength
- Using PILOCARPINE ocular system=question pt if they can self administer disc while in hospital
- change the PILOCARPINE ocular system every 7days unless Dr. directs otherwise
What is the preadministration assessment 4 Cholinergics used 4 Myasthenia Gravis?
- Assess 4 signs of muscle weakness examples:
- inability 2 chew or swallow
- drooping eyelids
- inabliltiy 2 perform repetitive movements
- difficulty breathing
- extreme fatigue
- After administration:
- Nurse=document any increase in symptoms of the A/R B4 giving each dose, Assess pt 4 presence or absence of the symptoms of MYASTHENIA GRAVIS b4 each dose
- Sustained-released tablets are available that allow less frequent dosing & help pt 2 have longer undisturbed periods during night
What are the preadministration assessment 4 Cholinergics used 4 urinary retention?
- Palpate ABD in pelvis area 2 determine if distention is present:
- Swelling over pelvis usually indicates retention & distended bladder
- Ongoing assessment:
- Nurse= I&0s, notify dr. if pt fails 2 void after administration, palpate bladder 2 determine its size
Place the call light & any other items the pt might need, such as urinal or bedpan w/in easy reach
What is the ongoing assessment of Cholinergic drugs?
Monitor 4 drug toxicity or cholinergic crisis.
- Cholinergic crisis includes:
- Severe ABD cramping
- excessive salivation
- muscle weakness
- clenching of the jaw
- NURSE REPORT THIS 2 DR ASAP CUZ PT NEEDS ANTIDOTE ATROPINE 0.4 T0 0.6 GIVIN BY IV
What is the monitoring & managing nursing duties of cholinergic drugs?
- Disturbed sensory perception- visual
- Drug-induced myopia may occur after instillation of drops 4 glaucoma
- Assist client in/out of bed or ambulating & remove obstacles that may be a fall risk 4 pt.
- Make sure bedside commode, bedpan, or bathroom, are readily available
- Keep record of fluid I&O and number, consistency, frequency of stools if diarrhea is present
What should you teach the patient & family when using Cholinergic drugs 4 glaucoma?
- Warn the pt the eye drops may sting when instilling in eye & is normalAdvise pt. 2 observe caution while driving or performing that requires vision
- Local irritation and headache may occur @ the beginning of therapy
Notify the Dr. provider if ABD cramping, diarrhea, or excessive salivation occurs
What should you teach the patient & family about Pilocarpine ocular system?
Nurse = notify dr. if eye secretions are excessive or irritation occurs
- Instruct pt 2 remove & replace system every 7days (ciz when u first put it in their is some short term vision impairment) or instructed by Dr.
- Check unit 4 placement b4 retiring @ night & in the morning on arising
What would you teach patient and family about taking these drugs 4 Myasthenia gravis?
- Recognize symptoms of overdosage and underdosage
- Instruct pt 2 keep a record of response 2 drug therapy (time of day, increased or decreased muscle strength, fatigue) & 2 bring recor 2 each appt.
- Tell client they must wear medic alert tag indicating they hv myasthenia gravis
What are the Cholinergic drugs used 4 myasthenia gravis?
- Edrophonium (enion, tensilon)
- Pyridostigmine bromide(mestinon regonol)
What cholinergic drugs are used 4 tx of urinary cholinergics?
Behtanechol chloride (duvoid urecholine)
What are cholinergic drugs used 2 tx glaucoma?
- Carbachol topical (miostat)
- pilocarpine HCI (pilopine)