Cholinergic Drugs Flashcards
Bethanechol (Urecholine)
Functional Classification
Urinary Tract Stimulant, Cholinergic
Bethanechol (Urecholine)
Mechanism of Action
Stimulates muscarinic ACH receptors directly; mimics effects of parasympathetic nervous system stimulation; stimulates gastric motility, micturition; increases lower esophageal sphincter pressure
Bethanechol (Urecholine)
Uses
Urinary retention (postoperative, postpartum), neurogenic atony of bladder with retention
Bethanechol (Urecholine)
Contraindications
Hypersensitivity, severe bradycardia, asthma, severe hypotension, hyperthyroidism, peptic ulcer, parkinsonism, seizure disorders, CAD, COPD, coronary occlusion, mechanical obstruction, peritonitis, recent urinary/GI surgery, GI/GU obstruction
Bethanechol (Urecholine)
Side Effects
CNS: dizziness, headache, malaise
CV: hypotension, bradycardia, reflex tachycardia, CARDIAC ARREST, CIRCULATORY COLLAPSE
EENT: miosis, increased salivation, lacrimation, blurred vision
GI: Nausea, Bloody Diarrhea, Belching, Vomiting, Cramps, Fecal Incontinence
GU: urgency
INTEG: rash, urticaria, flushing, increased sweating
RESP: ACUTE ASTHMA, DYSPNEA, BROCHOCONSTRICTION
Bethanechol (Urecholine)
Nursing Considerations
ASSESS:
- URINARY PATTERNS: retention, urgency
- BP pulse: observe after parenteral dose for 1 hr
- I&O ratio: check for urinary retention, urge incontinence
- TOXICITY: bradycardia, hypotension, bronchospasm, headache, dizziness, seizures, respiratory depression; product should be discontinued if toxicity occurs
Bethanechol (Urecholine)
Overdose Treatment
Atropine 0.6-1.2mg IV or IM
Donepezil (Aricept)
Functional Classification
Anti-Alzheimer’s agent
Donepezil (Aricept)
Chemical Classification
Reversible Cholinesterase Inhibitor
Donepezil (Aricept)
Mechanism of Action
Elevate acetylcholine concentrations (cerebral cortex) by slowing degradation of acetylcholine released in cholinergic neurons; does not alter underlying dementia
Donepezil (Aricept)
Uses
Mild to severe dementia with Alzheimer’s disease
Donepezil (Aricept)
Contraindications
Hypersensitivity to this product or piperdine derivatives
Donepezil (Aricept)
Side Effects
CNS: dizziness, Insomnia, somnolence, Headache, fatigue, abnormal dreams, syncope, SEIZURES, drowsiness, agitation, depression, confusion, fever, hallucinations
CV: ATRIAL FIBRILLATION, hypo/hypertension, SINUS BRADYCARDIA, AV BLOCK
GI: Nausea, Vomiting, anorexia, Diarrhea, abdominal pain, GI BLEEDING, weight loss
GU: urinary frequency, UTI, incontinence
INTEG: rash, flushing, diaphoresis, bruising
META: hyperlipidemia
MS: cramps, arthritis, arthralgia
RESP: rhinitis, URI, cough, pharyngitis, dyspnea
Donepezil (Aricept)
Nursing Considerations
ASSESS:
- BP: hypo/hypertension, heart rate
- Mental Status: affect, mood, behavior changes, depression, complete suicide assessment; neurologic status
- GI status: nausea, vomiting, anorexia, diarrhea; monitor weight
- GU status: urinary frequency, incontinence, I&O
PERFORM/PROVIDE
-Assistance with ambulation during beginning therapy; dizziness, ataxia may occur
Memantine
Functional Classification
Anti-Alzheimer agent
Memantine
Chemical Classification
NMDA-receptor antagonist
Memantine
Mechanism of Action
Antagonist action of CNS NMDA receptors that may contribute to the symptoms of Alzheimer’s disease
Memantine
Uses
Moderate to severe dementia in Alzheimer’s disease
Memantine
Contraindications
Children, hypersensitivity
Memantine
Side Effects
CNS: Dizziness, Confusion, somnolence, headache, hallucinations CV: hypertension GI: vomiting, constipation HEMA: anemia INTEG: rash MISC: back pain, fatigue, pain RESP: coughing, dyspnea
Memantine
Nursing Considerations
ASSESS:
-Alzheimer’s dementia: affect, mood, behavioral changes; hallucinations, confusion, attention, orientation, memory
PERFORM/PROVIDE
-Assistance with ambulation during beginning therapy; dizziness may occur
Pyridostigmine
Functional Classification
Cholinergic; anticholinesterase
Pyridostigmine
Chemical Classification
Tertiary amine carbamate
Pyridostigmine
Mechanism of Action
Inhibits destruction of acetylcholine, which increases concentration at sites where acetylcholine is released; this facilitates the transmission of impulses across the myoneural junction
Pyridostigmine
Uses
Nondepolarizing muscle relaxant antagonist, myasthenia gravis, pretreatment for nerve gas exposure (military only)
Pyridostigmine
Contraindications
Bradycardia; hypotension; obstruction of intestine, renal system; bromide, benzyl alcohol sensitivity; adrenal insufficiency; cholinesterase inhibitor toxicity
Pyridostigmine
Side Effects
CNS: dizziness, headache, sweating, weakness, SEIZURES, incoordination, PARALYSIS, drowsiness, LOC
CV: tachycardia, dysrhythmias, bradycardia, AV block, hypotension, ECG changes, CARDIAC ARREST, syncope
EENT: miosis, blurred vision, lacrimation, visual changes
GI: Nausea, Diarrhea, Vomiting, Cramps, Increased Salivary and Gastric Secretions, Peristalsis
GU: urinary frequency, incontinence, urgency
INTEG: rash, urticaria, flushing
RESP: RESPIRATORY DEPRESSION, BRONCHOSPASM, CONSTRICTION, LARYNGOSPASM, RESPIRATORY ARREST
SYST: CHOLINERGIC CRISIS
Pyridostigmine
Nursing Considerations
ASSESS:
- MYASTHENIA GRAVIS: fatigue, ptosis, diplopia, difficulty swallowing, SOB, hand/gait before, after product; improvement should be seen after 1 hr
- VS, respiration q8hr
- I&O ratio; check for urinary retention or incontinence
- TOXICITY: bradycardia, hypotension, bronchospasm, headache, dizziness, seizures, respiratory depression; product should be discontinued if toxicity occurs
Pyridostigmine
Overdose Treatment
Discontinue product, atropine 1-4mg IV
Bethanechol (Urecholine)
Chemical Classification
Synthetic Choline Ester
