Drugs Affecting the ANS Cholinergic Drugs

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