Effects of Parasympathetic Stimulation
-Miosis
-Stimulated saliva flow
-Decreased HR
-Bronchoconstriction
-Stimulates peristalsis & secretion
-Bladder Constriction
Parasympathetic Response
-Dilation of blood vessels
-Pupil constriction
-Decreased HR and BP
-Decreased respirations and O2 consumption
-Digestion
Physiology of PNS Stimulation
-Cholinergic nerves synthesize acetylcholine
-Acetylcholine is released from the nerves where it can bind to cholinergic receptors in target organs
What do Cholinergic agnosit drugs do
-Inhibit action of acetylcholinesterase
-Stimulate cholinergic receptors
-Mimic effects of acetylecholine
Direct acting cholenergic drugs to know
-Carbachol
-Pilocarpine
-Bethanechol
-Succinylcholine
Indirect acting cholinergic drugs to know
-Donepezil
-Edrophonium
-Pyridostigminne
-Revastigmine
Trade name of Donepezil
Aricept
Trade name of Rivastigmine
Exelon
Indications for Cholinergic Drugs
-GI Indications: increased GI motility, increased gastric secretions, dry mouth
-GU Indications: Urinary retention
-Opthalmic indications: glaucoma-reduced intraocular pressure, occular surgery
-Cardiovascular indiciation: reduced HR, vasodilation
-Neuro: Myasthenia Gravis, Alzheimer’s disease
What is the purpose of Bethanechol
-Direct Acting Cholinergic Agonist
-Stimulate muscarinic receptors in bladder
What is Bethanechol used for
-Acute post-op and postpartum urinary retention
-Increase tone of detrusor muscle
Adverse Effects of Bethanechol
-Syncope
-Hypotension with reflex tachy
-Seizures
-Asthmatic attacks
What is the purpose of Donepezil
Acetylcholinesterase inhibitor
What is Donepezil used for
-Alzheimer’s Disease
Adverse Effects of Donepezil
-Risk for GI Bleeds and ulcers
-Bradycardia
-Syncope
-Hypotension with reflex tachy
What is mematine
A non-cholinergic drug that is used for alzheimers and blocks the NMDA receptor to reduce degeneration of cognitive function
What is the purpose of Pyridostigmine
-Indirect acting cholenergic drug
-Inhibits acetylecholinsterase
What is Pyridostigmine used for
-Improve muscle strength and reduce symptoms of Myasthenia Gravis
-Reverse neuromuscluar blocking drugs
What is Edrophonium
An indirect acting cholinergic drug used to diagnose Myasthenia Gravis
What are Adverse Effects of Pyridostigmine
-GI Upset
-Excessive salivation
What is the antidote for a cholinergic crisis
Atropine followed by pralidoxime
What does the acronymn SLUDGEM stand for
-S: Salivation
-L: Lacrimation
-U: Urinary Incontinence
-D: Diarrhea
-G: GI Cramps
-E: Emeiss
-M: Miosis
What causes a cholinergic crisis
-Overstimulation of muscarinic and nicorinic receptors
-Related to inhabition of acetylcholinesterase
-Exposure to nerve gas, pesticides, and insecticides
Nursing considerations for Cholinergic Agonist
-Monitor CBC
-Don’t give cholinergic drugs if patient has a bowel obstruction
What do blocking anticholinergic drugs do
Block acetylcholine at muscarinic receptors in PNS
What are anticholinergic effects
-Sedation, dizziness, confusion, hallucinations
-Urinary Retention
-Dry throat, mouth, and constipation
-Feeling hot, decreased sweating
-Tachycardia
-Blurred vision, dry eyes
Nine Anticholinergic drugs to know
-Atropine
-Belladonna
-Scopolamine
-Benztropine
-Dicyclomine
-Oxybutynin
-Tolterodine
-Ipratropium
-Benztropine
Indications for Anticholinergic drugs
-Changes to HR
-Opthalmic
-Bronchospasms, asthma, COPD
-Pre-op to reduce salivary secretions
-GI antispasmodic
-Overactive bladder
-Parkinson Disease
Contraindications of Anticholinergic drugs
-Allergy
-Angle closure glaucome
-Acute asthma attack
-Myasthenia gravis
-GI obstructions
Adverse effects of Anticholinergic drugs
-Dry mouth
-Blurred vision
-Delerium in older adults
-tachycardia
Nursing interventions for anticholinergic drugs
-Chew gum
-Wear sunscreen
-Drink plenty of water
-Prevent heat stroke
Anticholinergic drug reactions
-Amantadine
-Antihistamines
-Tricyclic antidepressants
-Digoxin
What is the purpose of Atropine
-Blocks acetylcholine at muscarinic receptors
-Relax muscle in prostate and bladder
What is Atropine used for
-Pre-op reduce secretions
-Cardiac emergencies
-Antitode for mushroom poisoning
Adverse Effects of Atropine
-Heart rate issues
-Eye Issues
-Nervousness
What is the trade name of Dicyclomine
Bentyl
What is the purpose of Dicyclomine
Binds to muscarinic receptors blocks PNS
What is Dicyclomine used for
Irritable Bowel Syndrome
Adverse effects of Dicyclomine
-Dizziness
-Dry mouth
-Vision blurred
-Nausea
What is the purpose of Scopolamine
Anti-muscarinic receptors in brain
What is Scopolamine used for
Motion Sickness
Adverse Effects of Scoplomaine
-Dry Mouth
-Drowsiness
-Vision blurred
What is the trade name of Oxybutynin
Ditropan
What is the purpose of Oxybutynin
Anti-muscarinic receptors in bladder
What is oxybutynin used for
Overactive bladder
Adverse effects of oxybutynin
-Dry mouth
-Dizziness
-Constipation