NUR 426 Lecture Notes - Lecture 2: Cardiac Arrhythmia, Psychoactive Drug, Agnosia

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13 Sep 2017
Cholinergic Drugs
Prototype: Bethanechol used for urinary retention direct acting
Prototype: Pyridostigmine used for myasthenia gravis indirect acting
Prototype: donepezil used for Alzheier’s disease – indirect acting
Indirect acting cholinergic drugs block acetylcholinesterase leading to increased Ach in synapse
Direct acting cholinergic drugs stimulate receptor directly
Works directly or indirectly
- Occupy postsynaptic cholinergic receptors (sites for acetylcholine) stimulate cholinergic
- React with acetylcholinesterase (AchE) and prevent it from breaking down
- Increase levels of Ach in synaptic cleft Ach stimulates the cholinergic receptors
Not limited to a specific site; therefore, associated with many undesirable systemic effects
Most common side effects are GI side effects
Direct-Acting Cholinergic: therapeutic action
Cholinergic (rest and digest)
- Sweat glands increased water
- Pupils constrict (miosis), accommodate
- Eyes, mouth increase water
- Heart - decrease rate, decrease BP, decrease contractility
- Bronchioles constrict
- Gut increase secretions, increase motility
- Bladder increased detrusor muscle tone sphincter relaxes (urination)
S salvation and sweating
L - Lacrimation
U Urination
D defecation
G GI cramps
E Emesis
M Miosis (constriction and muscle spasm)
Bethanechol (10-50mg po 2x/day 4x/day)
- Non-obstruction urinary retention (postop or postpartum); neurogenic bladder in adults or
children >8
Contraindications and cautions
Any condition that could be exacerbated by parasympathetic nervous system activation
- Bradycardia (will lower HR further), hypotension, coronary insufficiency
- Peptic ulcer disease, recent GI surgery
- Asthma (cause constriction)
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- Obstruction (bowel or bladder)
- Epilepsy
- Parkiso’s
- Hyperthyroidism
Caution in pregnancy and breast feeding
Drug interactions
Other cholinergic agents (ophthalmic or systemic)
Acetylcholinesterase inhibitors (neostigmine) additive effects; risk for toxicity
Anticholinergics decreased effectiveness
Adverse/side effects
- GI: N&V, cramps, diarrhea
- GI: increased gastric acid
- Flushing
- Sweating
- Tearing
- Urinary urgency
- Bradycardia
- Heart block
- Hypotension
Nursing considerations: Bethanchol
Assess: allergy; contraindicating conditions/cautions
Baseline VS for comparison
Urine output
PMH: peptic ulcer, urinary obstruction, asthma, severe bradycardia, hypotension, parkinsonism
Medication administration
- 10-50mg 3x/day to 4x/day
- Administer bethanecol by oral route 1-hour ac or 2 hours’ pc reduce GI effects
- I&O
- Vital signs; orthostatic BP
- Adverse effects: diarrhea, cramping, N, V, increased salivation or bronchial secretions,
blurred vision
- Monitor amylase, lipase, aspartate aminotransferase, bilirubin may increase slightly with
cholinergic agonist
Patient education
- Adequate fluid intake
- Caution: visual changes, night driving
Life span
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