Cholinergic-Blocking Drugs Flashcards
Atropine
Chemical Classification
Belladonna Alkaloid
Atropine
Functional Classification
Antidysrhythmic, Anticholinergic Parasympatholytic, Antimuscarinic
Atropine
Mechanism of Action
Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, heart rate by blocking vagal stimulation in heart; dries secretion by blocking vagus
Atropine
Uses
Bradycardia <40-50bpm, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning, blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with GU, biliary surgery, bronchodilator, AV heart block
Atropine
Contraindications
Hypersensitivity to belladonna alkaloids, closed-angle glaucoma, GI obstructions, myasthenia gravis, thyrotoxicosis, ulcerative colitis, prostatic hypertrophy, tachycardia/tachydysrhythmias, asthma, acute hemorrhage, severe hepatic disease, myocardial ischemia, paralytic ileus
Atropine
Side Effects
CNS: headache, dizziness, involuntary movement, confusion, psychosis, anxiety, COMA, flushing, drowsiness, insomnia, weakness; delirium (geriatric patients)
CV: hypo/hypertension, paradoxical bradycardia, angina, PVCs, TACHYCARDIA, ectopic ventricular beats
EENT: blurred vision, photophobia, glaucoma, eye pain, pupil, dilation, nasal congestion
GI: dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation, PARALYTIC ILEUS, abdominal distention, altered taste
GU: retention, hesitancy, impotence, dysuria
INTEG: rash, urticaria, contact dermatitis, dry skin, flushing
MISC: suppression of lactation, decreased sweating
Atropine
Nursing Considerations
ASSESS:
- I&O ratio; check for urinary retention, daily output
- ECG for ectopic ventricular beats, PVC, tachycardia in cardiac patients
- For bowel sounds, constipation
- Respiratory status: rate, rhythm, cyanosis, wheezing, dyspnea, engorge neck veins
- INCREASED INTRAOCULAR PRESSURE: eye pain, nausea, vomiting, blurred vision, increased tearing
- Cardiac rate: rhythm, character, BP continuously
- Allergic reaction: rash, urticaria
PERFORM/PROVIDE:
-Sugarless hard candy, gum, frequent rinsing of mouth dryness
Atropine
Overdose Treatment
O2, artificial ventilation, ECG; administer DOPamine for circulatory depression; administer diazepam or thiopental for seizures; assess need for antidysrhythmics
Tolterodine (Detrol)
Functional Classification
Overactive bladder product
Tolterodine (Detrol)
Chemical Classification
Muscarinic receptor antagonist
Tolterodine (Detrol)
Mechanism of Action
Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
Tolterodine (Detrol)
Uses
Overactive bladder (urinary frequency, urgency), urinary incontinence
Tolterodine (Detrol)
Contraindications
hypersensitivity, uncontrolled closed-angle glaucoma, urinary retention, gastric retention
Tolterodine (Detrol)
Side Effects
CNS: anxiety, paresthesia, fatigue, Dizziness, Headache; increasing dementia, memory impairment
CV: chest pain, hypertension, QT PROLONGATION
EENT: vision abnormalities, xerophthalmia
GI: Nausea, Vomiting, Anorexia, abdominal pain, constipation, dry mouth, dyspepsia
GU: dysuria, urinary retention, frequency, UTI
INTEG: rash, pruritus
RESP: bronchitis, cough, pharyngitis, upper respiratory tract infection
SYST: ANGIOEDEMA, STEVENS-JOHNSON SYNDROME
Tolterodine (Detrol)
Nursing Considerations
ASSESS:
- URINARY PATTERNS: distention, nocturia, frequency, urgency, incontinence
- SERIOUS SKIN DISORDERS: angioedema, Steven-Johnson syndrome; allergic reactions: rash; if this occurs, product should be discontinued
- LFTs at baseline, periodically
- QT PROLONGATION: ECG, ejection fraction; assess for chest pain, palpitations, dyspnea
