Cholinergic Agonist Flashcards
cholinergic agonists enhances mimics which response system?
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
Bethanechol
used for urinary retention
Direct muscarinic
Cholinergic Agonist (mimics Parasympathetic Resp.)
Carbachol
use to induce miosis (pupil constriction)
Direct muscarinic
Cholinergic Agonist (mimics Parasympathetic Resp.)
Pilocarpine
Cevimeline
Treat dry mouth
Direct muscarinic
Cholinergic Agonist (mimics Parasympathetic Resp.)
Bupropion
Nicotine
Varenicline
used for smoking cessation
Direct nicotinic Receptor site
Cholinergic Agonist (mimics Parasympathetic Resp.)
Neostigmine
Pyridostigmine
Edrophonium
Treat Myasthenia Gravis (indirect)
Cholinergic Agonist (mimics Parasympathetic Resp.)
Galantamine
Rivastigmine
Donepezil
Use to TREAT Alzheimer’s Disease (no cure)
Indirect
Cholinergic Agonist (mimics Parasympathetic Resp.)
Cholinergic Drugs
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
Direct Acting Cholinergic Agonists (Muscarinic) THERAPEUTIC ACTION
Act at cholinergic receptor in the peripheral nervous system to mimic the effects of Ach and parasympathetic stimulation.
Direct Acting Cholinergic Agonists (Muscarinic) CONTRAINDICATION
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.
Direct Acting Cholinergic Agonists (Muscarinic) CAUTION
Pregnancy and lactation- no adequate studies on effects.
Use alternative method to breastfeed (formula)
Direct Acting Cholinergic Agonists (Muscarinic) ADVERSE EFFECTS
Bradycardia, Heart block, hypotension
Urinary urgency
Flushing or increased sweating
Increased salivation and involuntary defecation
Nausea, vomiting, cramps diarrhea
Direct Acting Cholinergic Agonists (Muscarinic) DRUG-RUG INTERACTIONS
Acetylcholinesterase inhibitors
Indirect acting cholinergic agonists would increase cholinergic effects if combined with direct acting
Direct Acting Cholinergic Agonists (Muscarinic) NURSING ASSESSMENT
For contraindications and cautions
Perform head to toe physical assessment
Vital signs
lung sounds
cardiac status
bowel sounds
bladder distention
intake and output
Direct Acting Cholinergic Agonists (Muscarinic) NURSING DX/PLANNING
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
Direct Acting Cholinergic Agonists (Muscarinic) IMPLEMENTATION
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
Direct Acting Cholinergic Agonists (Muscarinic) EVALUATION
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.
Direct Acting Cholinergic Agonists (Nicotinic) THERAPEUTIC ACTIONS
Bupropion: may act by weakly inhibiting neuronal reuptake of norepinephrine and dopamine
Nicotine: replacement therapy
Varenicline: acts as nicotine receptor partial agonist
Direct Acting Cholinergic Agonists (Nicotinic) CONTRAINDICATIONS
Hypersensitivity/allergy (absolute)
Seizure disorder (Bupropion)
Direct Acting Cholinergic Agonists (Nicotinic) CAUTIONS
Pregnancy and lactation–> try non pharmacologic method first
Direct Acting Cholinergic Agonists (Nicotinic) ADVERSE EFFECTS
Tachycardia, hypertension
Seizures, neuropsychiatric adverse effects, dizziness, strange dreams
Nausea, dry mouth
skin rash (stevens-Jonson syndrome)
Direct Acting Cholinergic Agonists (Nicotinic) DRUG-DRUG INTERACTIONS
Numerous
Direct Acting Cholinergic Agonists (Nicotinic) ASSESSMENT
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
Direct Acting Cholinergic Agonists (Nicotinic) IMPLEMENTATION
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.
Direct Acting Cholinergic Agonists (Nicotinic) EVALUATION
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.
Myasthenia Gravis
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
Indirect Acting Cholinergic Agonists Used to Treat Myasthenia Gravis
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
Alzheimer’s Disease
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
Indirect Acting Cholinergic Agonists
ACTIONS
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
Indirect Acting Cholinergic Agonists
INDICATIONS
Treatment after exposure to nerve gas
Myasthenia Gravis
Alzheimer’s disease
Indirect Acting Cholinergic Agonists
CONDRAINDICATIONS
Allergy (absolute)
Bradycardia (relative)
Intestinal or urinary tract obstruction (relative)
Indirect Acting Cholinergic Agonists
CAUTION
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
Indirect Acting Cholinergic Agonists
ADVERSE EFFECTS
Bradycardia, hypotension
Increased GI secretions and activity
Increased bladder tone
Relaxation of GI and genitourinary sphincters
Bronchoconstruction
Pupil construction
Indirect Acting Cholinergic Agonists
DRUG-DRUG INTERACTIONS
NSAIDs–> GI Bleeding
Cholinergic drugs –> increase cholinergic effects
Indirect Acting Cholinergic Agonists
IMPLEMENTATION
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
Indirect Acting Cholinergic Agonists
EVALUATION
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.
Indirect Acting Cholinergic Agonists
ASSESSMENT
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.
Indirect Acting Cholinergic Agonists
NURSING DIGNOSIS
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
