Ch. 21: Anticholinergic drugs

Question 1

What are other names for cholinergic-blocking drugs?

Answer 1

anticholinergics
parasympatholytics
antimuscarinic drugs

Question 2

T/F: anticholinergics inhibit ACh at nicotinic and muscarinic receptors in the PSNS

Answer 2

False: anticholinergics only inhibit at the muscarinic receptors (although at high doses they may have partial blocking effects)

Question 3

What are the major sites of action of anticholinergics and what are the effects?

Answer 3

heart - increased HR
respiratory tract - decreased secretions and bronchodilation
GIT - decreased secretions and motility
urinary bladder - increase sphincter constriction/relax bladder muscle
eye - pupil dilation and increased intraocular pressure
exocrine glands - decreased secretions

Question 4

What effect do anticholinergics have on the CNS? Based on this effect, what disease can be treated?

Answer 4

decrease muscle rigidity and diminish tremors –> treat Parkinson’s disease

Question 5

Explain how anticholinergics can both slow or increase the heart rate.

Answer 5

at low doses, anticholinergics SLOW the HR by their effect on the medulla
at high doses, anticholinergics block PSNS effects on SA and AV nodes –> INCREASED HR

Question 6

T/F: Anticholinergics are safe in any dose

Answer 6

False: anticholinergics have a narrow therapeutic index

Question 7

What is the nursing consideration for administering ophthalmic anticholinergics?

Answer 7

check the concentration of the medication 
apply presure (15-30 seconds) with a tissue to the inner canthus of the eye to minimize the possibility of systemic absorption

Question 8

What is a nursing consideration for administratin of anticholinergics to the older adult?

Answer 8

anticholinergics cause decreased sweating; therefore, older adults should be warned to avoid exposure to high temperatures

Question 9

What drug categories should not be administered with anticholinergics due to additive cholinergic effects?

Answer 9

antihistamines
phenothiazines
tricyclic antidepressants
MAO inhibitors

Question 10

Why are anticholinergics CI’d for use in patients with BPH?

Answer 10

anticholinergics cause urinary retention, which would increase in BPH

Question 11

How is overdose of anticholinergics managed? Select all that apply:

a. IV push of cholinergic drug
b. ECG monitoring
c. stomach emptying, usually with lavage and activated charcoal
d. fluid therapy
e. SC epinephrine

Answer 11

B, C, D

Question 12

Which of the following points should the nurse remind the older adult of when taking anticholinergics?

a. avoid exposure to high temperatures
b. limit liquid intake to avoid fluid overload
c. begin an exercise program to avoid adverse effects
d. stop the medication if excessive dryness of the mouth occurs

Answer 12

A

Question 13

Which of the following are CIs to the use of anticholinergics?

a. chronic bronchitis
b. PUD
c. irritable bowel syndrome
d. BPH

Answer 13

D

Question 14

Which of the following are adverse effects associated with the use of cholinergic blockers?

a. diarrhea
b. dry mouth
c. diaphoresis
d. decreased sensorium

Answer 14

B

Question 15

Which of the following effects will the nurse administering a cholinergic-blocking drug expect to see?

a. miosis
b. increased muscle rigidity
c. increased bronchial secretions
d. decreased GI motility and peristalsis

Answer 15

D

Question 16

During the assessment of a patient about to receive a cholinergic-blocking drug, the nurse should determine whether the patient is taking any drugs that may potentially interact with the anticholinergic. Which of the following drugs might these include?

a. antibiotics
b. narcotics
c. tricyclic antidepressants
d. anticonvulsants

Answer 16

C