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NRS 155 Intro to Pharm > Cholinergic Agonist > Flashcards

Cholinergic Agonist Flashcards

1
Q

cholinergic agonists enhances mimics which response system?

A

Parasympathetic NS (Rest and digest)
Pupil constriction (miosis)
Increased salivation
Vasodilation- decreased heart rate and BP
Bronchoconstriction- Increase respiration (narrow airways)
Increased peristalsis (digestion)
Bile release
Urination

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2
Q

Bethanechol

A

used for urinary retention
Direct muscarinic
Cholinergic Agonist (mimics Parasympathetic Resp.)

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3
Q

Carbachol

A

use to induce miosis (pupil constriction)
Direct muscarinic
Cholinergic Agonist (mimics Parasympathetic Resp.)

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4
Q

Pilocarpine
Cevimeline

A

Treat dry mouth
Direct muscarinic
Cholinergic Agonist (mimics Parasympathetic Resp.)

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5
Q

Bupropion
Nicotine
Varenicline

A

used for smoking cessation
Direct nicotinic Receptor site
Cholinergic Agonist (mimics Parasympathetic Resp.)

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6
Q

Neostigmine
Pyridostigmine
Edrophonium

A

Treat Myasthenia Gravis (indirect)
Cholinergic Agonist (mimics Parasympathetic Resp.)

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7
Q

Galantamine
Rivastigmine
Donepezil

A

Use to TREAT Alzheimer’s Disease (no cure)
Indirect
Cholinergic Agonist (mimics Parasympathetic Resp.)

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8
Q

Cholinergic Drugs

A

Chemicals that act at the same site a the neurotransmitter acetylcholine (ACh)

No limited to a specific site –> associated with many undesirable systemic effects

Works directly or indirectly on ACh receptors

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9
Q

Direct Acting Cholinergic Agonists (Muscarinic) THERAPEUTIC ACTION

A

Act at cholinergic receptor in the peripheral nervous system to mimic the effects of Ach and parasympathetic stimulation.

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10
Q

Direct Acting Cholinergic Agonists (Muscarinic) CONTRAINDICATION

A

Hypersensitivity/allergy (absolute)
making parasympathetic effects worse (bradycardia, hypotension) (relative)

Decreased peristalsis –> peptic ulcer disease, intestine obstruction, recent GI Surgery

Asthma–> Bronchoconstriction

Bladder obstruction –> due to increased urination.

Epilepsy and parkinsonism will exacerbate condition due to effect on Ach in the brain.

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11
Q

Direct Acting Cholinergic Agonists (Muscarinic) CAUTION

A

Pregnancy and lactation- no adequate studies on effects.

Use alternative method to breastfeed (formula)

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12
Q

Direct Acting Cholinergic Agonists (Muscarinic) ADVERSE EFFECTS

A

Bradycardia, Heart block, hypotension
Urinary urgency
Flushing or increased sweating
Increased salivation and involuntary defecation
Nausea, vomiting, cramps diarrhea

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13
Q

Direct Acting Cholinergic Agonists (Muscarinic) DRUG-RUG INTERACTIONS

A

Acetylcholinesterase inhibitors

Indirect acting cholinergic agonists would increase cholinergic effects if combined with direct acting

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14
Q

Direct Acting Cholinergic Agonists (Muscarinic) NURSING ASSESSMENT

A

For contraindications and cautions
Perform head to toe physical assessment
Vital signs
lung sounds
cardiac status
bowel sounds
bladder distention
intake and output

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15
Q

Direct Acting Cholinergic Agonists (Muscarinic) NURSING DX/PLANNING

A

Impaired comfort related to GI effects
Alerted cardiac output related to CV effects
Impaired urinary elimination related to GU effects

Injury risk related to blurred vision and changes in visual acuity
Diarrhea related to GI effects
Knowledge deficit regarding drug therapy

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16
Q

Direct Acting Cholinergic Agonists (Muscarinic) IMPLEMENTATION

A

Ensure proper administration of ophthalmic preparations

Administer oral drug on an empty stomach
Monitor patient response closely

Provide safety precautions if the patient reports poor visual acuity –>atropine = antidote

Monitor urinary output

Provide thorough patient teaching–> when to take, how to take

17
Q

Direct Acting Cholinergic Agonists (Muscarinic) EVALUATION

A

Monitor patient responses to the drug (improvement in bladder function, increased salivation, miosis)

Monitor for adverse effects (cardiovascular changes, GI stimulation, urinary urgency, respiratory distress

Evaluate the effectiveness of the teaching plan

Monitor the effectiveness of comfort and safety measures and compliance with the regimen.

18
Q

Direct Acting Cholinergic Agonists (Nicotinic) THERAPEUTIC ACTIONS

A

Bupropion: may act by weakly inhibiting neuronal reuptake of norepinephrine and dopamine

Nicotine: replacement therapy

Varenicline: acts as nicotine receptor partial agonist

19
Q

Direct Acting Cholinergic Agonists (Nicotinic) CONTRAINDICATIONS

A

Hypersensitivity/allergy (absolute)
Seizure disorder (Bupropion)

20
Q

Direct Acting Cholinergic Agonists (Nicotinic) CAUTIONS

A

Pregnancy and lactation–> try non pharmacologic method first

21
Q

Direct Acting Cholinergic Agonists (Nicotinic) ADVERSE EFFECTS

A

Tachycardia, hypertension
Seizures, neuropsychiatric adverse effects, dizziness, strange dreams
Nausea, dry mouth
skin rash (stevens-Jonson syndrome)

22
Q

Direct Acting Cholinergic Agonists (Nicotinic) DRUG-DRUG INTERACTIONS

A

Numerous

23
Q

Direct Acting Cholinergic Agonists (Nicotinic) ASSESSMENT

A

History, amount of tobacco used
baseline, determine dose and duration of treatment

assess mood, sleep, suicidal thoughts and behaviors

assess vital signs, heart and lung sounds, ECG/EKG

Perform head to toe physical assessment
Assess for contraindications and cautions

24
Q

Direct Acting Cholinergic Agonists (Nicotinic) IMPLEMENTATION

A

Ensure proper administration of nicotine replacement preparation

check medication interactions
may be taken with or without food

Monitor patients response closely –>reducing cravings?

Arrange to adjust dose accordingly–> decrease, discontinue treatment

Provide safety precautions if the patent reports neuropsychiatric events or seizure activity

provide thorough patient teaching–>dose, proper placement, education on patch.

25
Q

Direct Acting Cholinergic Agonists (Nicotinic) EVALUATION

A

Monitor patient response to the drug (improvement in smoking cessation and stability of moods/behaviors)

Monitor for adverse effects (cardiovascular changes, GI discomfort, seizures, neuropsychiatric effects)

Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for and specific measures to avoid them, proper administration of drug)

Monitor fir the effectiveness of comfort and safety measures and adherence to the regimen.

26
Q

Myasthenia Gravis

A

Chronic muscular disease caused by a defect in neuromuscular transmission

Autoimmune disease; patient makes antibodies to Ach receptors, causing gradual destruction of them

Symptoms: progressive weakness and lack of muscle control with periodic acute episodes

27
Q

Indirect Acting Cholinergic Agonists Used to Treat Myasthenia Gravis

A

Neostigmine: Has a strong influence at the neuromuscular junction

Pyridostigmine: has a longer duration of action (MOST OFTEN PRESCRIVBED)

Edrophonium: Diagnostic agent for Myasthenia Gravis –> Symptoms should improve if symptoms worsen they are in Cholinergic Crisis

28
Q

Alzheimer’s Disease

A

A progressive disorder involving neural degeneration in the cortex

Leads to a marked loss of memory and the ability to carry on actives of daily living

Cause of the disease is UNKNON
There is a progressive loss of ACh-producing neurons and their target neurons

29
Q

Indirect Acting Cholinergic Agonists
ACTIONS

A

Blocks AchE at the synaptic cleft which allows the accumulation of Ach released for the nerve endings and leads to increased and prolonged stimulation of ACh

30
Q

Indirect Acting Cholinergic Agonists
INDICATIONS

A

Treatment after exposure to nerve gas
Myasthenia Gravis
Alzheimer’s disease

31
Q

Indirect Acting Cholinergic Agonists
CONDRAINDICATIONS

A

Allergy (absolute)
Bradycardia (relative)
Intestinal or urinary tract obstruction (relative)

32
Q

Indirect Acting Cholinergic Agonists
CAUTION

A

Any condition that could be exacerbated by cholinergic stimulation (asthma, coronary disease, peptic ulcer, arrhythmias, epilepsy, or parkinsonism(

Hepatic or renal dysfunction

Pregnancy and lactation–> preterm labor, adverse drug effects on baby

33
Q

Indirect Acting Cholinergic Agonists
ADVERSE EFFECTS

A

Bradycardia, hypotension
Increased GI secretions and activity
Increased bladder tone
Relaxation of GI and genitourinary sphincters
Bronchoconstruction
Pupil construction

34
Q

Indirect Acting Cholinergic Agonists
DRUG-DRUG INTERACTIONS

A

NSAIDs–> GI Bleeding

Cholinergic drugs –> increase cholinergic effects

35
Q

Indirect Acting Cholinergic Agonists
IMPLEMENTATION

A

If given intravenously, administer it slowly

Maintain atropine sulfate on standby (antidote)

Discontinue the drug of excessive salivation, diarrhea, emesis, or frequent urination

administer the oral drug with meals

Mark the patients chart and notify the surgeon if the patient is to undergo surgery

Monitor the patent being treated for Alzheimer disease for any progress

Arrange supportive care and comfort measures

Provide thorough patient teaching–> safty precautions

36
Q

Indirect Acting Cholinergic Agonists
EVALUATION

A

Monitor patent responses to the drug (improvement in condition being treated)

Monitor for adverse effects (GI upset, CNS changes, cardiovascular changes, GU changes)

Evaluate the effectiveness of the teaching plan (patient can name drug, dose, adverse effects to watch for and specific measures to avoid them, and proper administrations)

Monitor the effectiveness of comfort measures and adherence to the regimen.

37
Q

Indirect Acting Cholinergic Agonists
ASSESSMENT

A

Assess for contraindications and cautions
Perform a head to toe physical exam

Assess orientation, affect, reflexes, ability to carry on activities of daily living

Assess vital signs, ECG as appropriate, urinary output and renal/liver function test.

38
Q

Indirect Acting Cholinergic Agonists
NURSING DIGNOSIS

A

Altered thought processes related to CNS effects

Impaired comfort related to GI effects

Decreased cardiac output related to blood precure changes, arrhythmias, and vasodilation

Knowledge deficit regarding drug therapy

Injury risk related to CNS effects

Diarrhea related to GI stimulatory effects

NRS 155 Intro to Pharm (3 decks)

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