Cholinergic Medications - CH 16

Cholinergic meds affect what part of the nervous system?

Autonomic nervous system, specifically the parasympathetic system

What drugs are rest and digest and which are fight and flight?

Rest - Cholinergic

Fight - Adrenergic

Effects of cholinergic medications are going to be ____ of the adrenergic medications

Opposite

What is the main neurotransmitter in the cholinergic system?

Acetylcholine

What does a cholinergic agonist do?

Acetylcholine/drug triggers the receptor

What do anticholinergic drugs do?

It blocks the action of acetylcholine on receptor

What is cholinesterase?

Enzyme that causes the breakdown of acetylcholine

What is anticholinesterase?

Blocks the enzyme that breaks down acetylcholine

How does the parasympathetic nervous system effect the organs?

Constricts pupils

Constrictions bronchioles and increases secretions

Decreases heart rate

Dilates blood vessels (decreases BP)

Increases peristalsis

Contracts bladder

Increases salivation

What do cholinergic agonists do?

Constrict pupils (Miosis)

Decrease HR and BP

Decrease AV conduction

Vasodilation

Increases peristalsis

Contracts bladder (promotes urination)

What are three cholinergic agonists?

Metoclopramide, Pilocarpine, and Bethanechol chloride

What is metoclopramide do?

Used to increase gastric emptying and gut motility

Treats GERD and nausea

What does pilocarpine do?

Constricts pupils, allows for drainage of fluid to treat glaucoma

What does bethanechol do?

Used to increase urination (contracts bladder and helps with urinary retention)

Increases GI motility

What are the side effects/adverse reactions of bethanechol?

Blurred vision, miosis

Hypotension, bradycardia, sweating

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

Bronchoconstriction

What are contraindications of bethanechol

Bradycardia, hypotension, COPD, peptic ulcer, parkinsonism, hyperthyroidism

What is a trick to predict side effects?

Think of what you expect, but make it WORSE!
Ex. if med is going to constrict pupils, i know it may cause blurred vision!

Nursing interventions for a pt taking bethanechol

Monitor BP and HR

Teach pt to rise slowly

Record fluid intake and output

Monitor breath sounds

Monitor bowel sounds

What is the antidote for bethanechol overdose?

Atropine (Anticholinergic)

What are indirect acting cholinergic agonists?

They break down cholinesterase enzyme into choline and acetic acid

They allow acetylcholine to activate cholinergic receptors

What are the effects of indirect-acting cholinergic agonists?

Stimulate skeletal muscles, increase tone

Greater GI motility, bradycardia, miosis

Bronchial constriction, promote urination

What are the side effects of indirect-acting cholinergic agonists?

Bradycardia, asthma, peptic ulcers

What are the contrindications of indirect acting cholinergic agonists?

Intestinal and urinary obstruction

Why are indirect cholinergic agonists good for autoimmune disease?

They help with muscle strength because of boost of acetylcholine

What are reversible cholinesterase inhibitors?

Drugs that increase acetylcholine levels in the body

Inhibits things but comes back to normal

What are the uses of reversible cholinesterase inhibitors?

Pupil constriction in glaucoma

Increase muscle strength in myasthenia gravis

What are examples of reversible cholinesterase inhibitors?

Neostigmine (short acting)

Pyridostigmine (moderate-acting)

Ambenonium chloride (long-acting)

Edrophonium (Short-acting)

What is the antidote for atropine toxicity?

Physiostigmine

What are side effects of cholinesterase inhibitors?

Muscle cramps, twitching, bradycardia, increased bronchial secretions, and cramps

What are irreversible cholinesterase inhibitors?

prevents the breakdown of acetylcholine in the body in the irreversible way

How long do the effects of irreversible cholinesterase inhibitors last?

Days to weeks

What do irreversible cholinesterase inhibitors do?

produce pupillary constriction

What must be regenerated before the drug diminishes?

Enzyme cholinesterase

What are anticholinergic effects?

Increase HR

Bronchodilation

Decrease peristalsis

Relax bladder

Dilate eyes

Decrease salivation
Decrease tremors and rigidity

Lower doses = ____

fewer side effects

What is the antidote to toxicity caused by cholinesterase inhibitors and organophosphate ingestion?

Anticholinergics

What type of drug is atropine?

Anticholinergic

What is the action for atropine?

Increases pulse, decreases motility and peristalsis, decreases salivary secretions

what are the side effects/adverse reactions of atropine?

tachycardia, palpitations, nasal congestion, flushing, blurred vision, dry mouth, abdominal distention, urinary retention

What is a contraindication of atropine

glaucoma

What are 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 alcohol, cigarettes, caffeine, and aspirin

Wear sunglasses in bright light

What is the anticholinergic agent for parkinsonism?

benztropine

What is the action of benztropine?

Decreases involuntary movement, tremors, muscle rigidity

What are the side effects of benzotropine?

Anticholinergic effects

What are the uses for benztropine?

Parkinson’s disease

Pseudoparkinsonism

What does tolterodine do?

(Anticholinergic) Decreases urinary frequency, urgency, and incontinence

Selectively blocks cholinergic receptors in the urinary bladder

What will increase drug levels for tolterodine?

Grapefruit juice

What are the side effects of tolterodine?

Drymouth, headache, dizziness, constipation

What are adverse reactions of tolterodine?

Bronchitis, visual abnormalities, chest pains, hypertension

What are anticholinergic agents for treating motion sixkness?

Scopolamine, Dimenhydrate, Cyclizine, Meclizine

Side effects for anticholinergic agents for motion sickness

dry mouth, constipation, urinary retention, visual disturbances, urinary retention, muscle weakness, tachycardia, hypotension