suekeecholinergicdrugs018

suekeecholinergicdrugs018 - Cholinergics and Cholinergics...

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Unformatted text preview: Cholinergics and Cholinergics and Anticholinergics Susan Hampson Spring 2010 The Nervous System The Nervous System CNS ◦ Central nervous system; includes brain and spinal cord PNS ◦ Peripheral nervous system; includes somatic, autonomic divisions ◦ Autonomic further divided Sympathetic Parasympathetic Autonomic Nervous System Autonomic Nervous System Parasympathetic Division ◦ “Rest and digest” ◦ Activated under non­stressful or normal conditions ◦ Perform housekeeping chores of the body ◦ Conserve energy Cholinergics Cholinergics Drugs that stimulate parasympathetic nervous system (PNS) Mimic parasympathetic neurotransmitter acetylcholine Cholinergic receptors Muscarinic receptors Affect smooth muscles Affect smooth muscles Nicotinic receptors Affect skeletal muscles Affect skeletal muscles Effects of Cholinergics Effects of Cholinergics Parasympathetic responses. Effects of Cholinergics (cont’d) Effects of Cholinergics (cont’d) : Cardiovascular decrease Pulse and BP, vasodilation, slows conduction of AV node GI increase tone and motility, increase peristalsis, relax : sphincter muscles GU: contract bladder, increase ureter tone, relax sphincter muscles, stimulate urination Eye: pupil constriction, increase accommodation Lungs: bronchial constriction, increase secretions Glands: increase salivation, perspiration, tears Striated muscle: increase neuromuscular transmission Cholinergic Drugs Cholinergic Drugs Direct Acting ◦ Work on receptors to activate a tissue response Indirect Acting ◦ Inhibit action of enzyme cholinesterase(ChE) ◦ Can be reversible or irreversible inhibitors Direct­Acting Cholinergics Direct­Acting Cholinergics Selective to muscarinic receptors Located in smooth muscles Heart, GI, GU, glands Examples Metoclopramide (Reglan) Use: increases gastric emptying Use: increases gastric emptying Pilocarpine (Pilocar) Use: constricts pupils Use: constricts pupils Bethanechol chloride (Urecholine) Use: increases urination Use: increases urination Bethanechol Bethanechol Side effects/adverse reactions Hypotension, bradycardia Blurred vision, miosis Excessive salivation, sweating, increased gastric acid, nausea, vomiting, diarrhea, abdominal cramps Bronchoconstriction Contraindications Bradycardia, hypotension, COPD, peptic ulcer, parkinsonism, hyperthyroidism Bethanechol (cont’d) Bethanechol (cont’d) Nursing interventions Monitor BP, P, teach client to arise slowly Record fluid intake and output Monitor breath sounds Give 1 hour before or 2 hours after meals Monitor bowel sounds Monitor for overdosing Signs and symptoms: salivation, sweating, Signs and symptoms: salivation, sweating, flushing, abdominal cramps Antidote: atropine Antidote: atropine Pilocarpine Pilocarpine Used to treat glaucoma, xerostomia Routes are topical, oral Is a direct acting cholinergic Adverse effects local or systemic depending on route of administration Cholinergic Crisis Cholinergic Crisis Over­stimulation at a neuromuscular junction due to excess of acetylcholine Muscles stop responding to the bombardment of Ach. Result is flaccid paralysis, respiratory failure, increased sweating, salivation, increase in bronchial secretions along with miosis Indirect­Acting Cholinergics Indirect­Acting Cholinergics Functions ◦ Break down cholinesterase enzyme into choline and acetic acid ◦ Allow Ach to activate muscarinic and nicotinic cholinergic receptors Effects ◦ Stimulate skeletal muscles, increase tone ◦ GI motility, bradycardia, miosis ◦ Bronchial constriction, promote urination Side effects: bradycardia, asthma, peptic ulcers Contraindications: intestinal and urinary obstruction Indirect­Acting Cholinergics Indirect­Acting Cholinergics (cont’d) Reversible cholinesterase inhibitors Uses Pupil constriction in glaucoma Increase muscle strength in myasthenia Increase muscle strength in myasthenia gravis Neostigmine (Prostigmin) Pyridostigmine (Mestinon) Edrophonium (Tensilon) Side effects Muscle cramps, twitching, bradycardia, Muscle cramps, twitching, bradycardia, increase bronchial secretions Indirect Acting Cholinergic: Indirect Acting Cholinergic: Neostigmine Treat Myasthenia Gravis Antidote of neuromuscular blocking agents Treat urinary retention, paralytic ileus Has both oral and parenteral forms Frequent dosing required with oral use Dosage titrated to response Works by inhibiting AChE at post synaptic neurons. Result is increase in amount of Ach available Neostigmine cont’ Neostigmine cont’ Adverse Effects ◦ Cholinergic crisis ◦ Common: nausea, vomiting, diarrhea, abdominal cramps Cholinergic Side Effects: Cholinergic Side Effects: SLUDGE Salivation Lacrimation Urinary incontinence Diarrhea GI cramps Emesis Anticholinergic Drugs Anticholinergic Drugs Inhibit action of Ach by occupying receptor sites Also called parasympatholytics or cholinergic blocking agents Use of an anticholinergic allows the SYMPATHETIC nervous system to dominate Anticholinergics (cont’d) Anticholinergics (cont’d) Effects of anticholinergics Heart: large doses increase Pulse; small doses decrease Pulse 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, perspiration Clinical Uses for Clinical Uses for Anticholinergics GI disorders: decrease gastric acid secretion and intestinal motility. Reduce diarrhea and cramping in IBS (Bentyl) Ophthalamic procedures: cause mydriasis or cycloplegia (Cyclogel) Clinical Uses cont’ Clinical Uses cont’ Accelerate HR (Atropine) Presurgical: decrease respiratory secretions (Robinul) Asthma: dilate bronchi (Atrovent) Incontinence: prevent involuntary bladder contraction (Ditropan, Enablex) Anticholinergics (cont’d) Anticholinergics (cont’d) Atropine Action Increase Pulse, decrease motility and Increase Pulse, decrease motility and peristalsis, decrease salivary secretions Side effects/adverse reactions Tachycardia, palpitations, nasal congestion, Tachycardia, palpitations, nasal congestion, flushing, photophobia, blurred vision, dry mouth and skin, abdominal distention, urinary retention, impotence Contraindicated in glaucoma Anticholinergics (cont’d) Anticholinergics (cont’d) Atropine ◦ Nursing interventions Monitor vital signs, urine output, bowel sounds Monitor vital signs, urine output, bowel sounds Safety: use bedside rails, caution against Safety: use bedside rails, caution against driving motor vehicles Provide mouth care and eye drops Provide mouth care and eye drops Avoid hot environments Avoid hot environments Avoid alcohol, cigarettes, caffeine, and aspirin Avoid alcohol, cigarettes, caffeine, and aspirin at bedtime Warn to wear sunglasses in bright light Warn to wear sunglasses in bright light Antiparkinsonism Anticholinergics Antiparkinsonism Anticholinergics Selected anticholinergics for parkinsonism Benztropine (Cogentin) Trihexyphenidyl HCl (Artane) Action Decrease involuntary movement, tremors, Decrease involuntary movement, tremors, muscle rigidity Antiparkinsonism Anticholinergics Antiparkinsonism Anticholinergics (cont’d) Side effects Similar to anticholinergics Use Parkinson’s disease Pseudoparkinsonism Antihistamines Antihistamines Antihistamine ◦ Treats motion sickness ◦ Scopolamine (Transderm Scōp) ◦ Dimenhydrinate (Dramamine) ◦ Side effects Dry mouth, visual disturbances, constipation, Dry mouth, visual disturbances, constipation, urinary retention, flushing, muscle weakness, tachycardia, hypotension Case Study Case Study A client who is in the immediate postoperative state has developed bradycardia with a heart rate of 48. Atropine has been ordered. Critical Thinking Compare the actions and effects of cholinergic and anticholinergic drugs. In which clients would atropine be contraindicated? Practice Question #1 Practice Question #1 Which problem would be the highest priority in caring for the client who has had atropine? A. Anxiety B. Constipation C. Urinary retention D. Impaired oral mucous membrane Practice Question #2 Practice Question #2 Which nursing action would be most appropriate for the client who is taking atropine? A. Give the drug with meals. B. Monitor the client’s vital signs. C. Auscultate breath sounds for rales. D. Observe for orthostatic hypotension. ...
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suekeecholinergicdrugs018 - Cholinergics and Cholinergics...

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