Module 2 Cholinergic Agonists, Anticholinergic Agents Flashcards
What are the two sections of the nervous system
- Central nervous system
- peripheral nervous system
What two structures make up the central nervous system?
- Brain
- spinal card
What two components make up the peripheral nervous system?
- Somatic (skeletal muscle)
- autonomic
What two components make up the autonomic system?
- Parasympathetic (PNS)
- sympathetic (SNS)
What are the two components of sympathetic (SNS)?
- Alpha
- beta
What is the parasympathetic nervous system also known as and what are its characteristics when activated?
- “Rest and digest”
- mitosis (pupil constriction)
- salivation
- vasodilation
- decreased heart rate and blood pressure
- bronchoconstriction
- increase in respiratory secretions and peristalsis
-Bile release
-Urination
What is the sympathetic nervous system also known as and what are its characteristics when activated?
- “Fight or flight”
- mydriasis (pupil dilation)
- dry mouth
- vasoconstriction
- increased heart rate and blood pressure
- Bronchodilation
- decrease in respiratory secretions and peristalsis
- hepatic (glucose release)
- urination blocked
What are cholinergic drugs?
- Chemicals that act at the same site as the neurotransmitter acetylcholine (ACh)
Define the action of cholinergic drugs?
- Often called parasympathomimetic drugs because their action mimics the action of the parasympathetic nervous system
- not limited to a specific site
- work either directly or indirectly on ACh receptors
What are the precautions of children, adults, and older adults when taking cholinergic agonist agents?
- Children: increased risk of adverse effects, dosages should be based on weight
- Adults: caution against driving while on medication, no adequate studies on effects during pregnancy and lactation, use alternative method to breastfeeding
- Older adults: more likely to have adverse effects and toxic levels, start on lower dosage and monitor closely, institute safety precautions
Define direct-acting cholinergic agonists
- Occupy receptor sites for ACh on the membranes of the effector cells of the postganglionic cholinergic nerves
- cause increased stimulation of the cholinergic receptor
Define indirect-acting cholinergic agonists
- React with the enzyme acetylcholinesterase and prevent it from breaking down the ACh released from the nerve
- produce effects indirectly by producing increase in level of ACh in the synaptic cleft, leading to increased stimulation of cholinergic receptor site
List four direct-acting cholinergic agonists (muscarinic)
- Bethanechol
- Carbachol
- Cevimeline
- Pilocarpine
What is the action and indications of direct-acting cholinergic agonists (muscarinic)?
- Act at cholinergic receptors in the PNS to mimic the effects of ACh and parasympathetic stimulation
- indications: urinary retention (bethanechol), induce miosis (carbachol), treat dry mouth (cevimeline and pilocarpine)
What are contraindications and cautions regarding direct-acting cholinergic agonists (muscarinic)?
- Contraindications: hypersensitivity, conditions exacerbated by parasympathetic effects (bradycardia, hypotension), peptic ulcer disease, asthma, bladder obstruction, epilepsy, Parkinsonism
- cautions: pregnancy and lactation
Identify adverse effects and drug-drug interactions fur direct-acting cholingenc agonists (muscarinic)
- Adverse effects: nausea, vomiting, cramps, diarrhea, increased salutation, involuntary defecation, bradycardia, heart block, hypotension, urinary urgency, flushing, increased sweating
- drug-drug interactions: acetylcholinesterase inhibitors
How do you assess direct-acting cholinergic agonists (muscarinic)?
- Assess for continindications and cautions
- perform a physical assessment
- vitals, lung sounds, cardiac status, bowel sounds, bladder distention
What are factors that would be implemented into the nursing diagnosis/planning for DACAM?
- Impaired comfort related to GI effects
- altered 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
What would you implement to a patient or patient family about DACAM?
- Ensure proper administration
- administer oral drug on an empty stomach
- monitor patient response closely
- monitor urinary output
- provide safety precautions if the patient reports pour visual acuity
Define three direct-acting cholinergic agonists (nicotinic)
- Bupropion
- nicotine
- varenicline
What is the therapeutic action of bupropion?
- May act by weakly inhibiting neuronal rep take of norepinephrine and dopamine
What is the therapeutic action of nicotine?
- Replacement therapy
What is the therapeutic action of varenicline?
- Acts as nicotine receptor partial agonist
What are the contraindications and cautions with DACA nicotinic?
- Hypersensitivity/allergy
- seizure disorder (bupropion)
- cautions: pregnancy and lactation
What are the adverse effects and drug-drug interactions of DACA nicotinic?
- Adverse effects: tachycardia, hypertension, seizures, neuropsychiatric adverse effects, dizziness, strange dreams, nausea, dry mouth, skin rash
- drug-drug: numerous
What is established in the assessment of DACA nicotinic?
- Assess for contraindications and cautions
- perform a physical assessment
- assess amount of tobacco use
- assess vitals, heart and lung sounds, ECG
- assess mood, sleep, suicidal thoughts, and behaviors
What is established in the nursing diagnosis of DACA nicotinic?
- Impaired comfort related to GI effects
- altered cardiac output related to CV effects
- injury risk related to seizures or neuropsychiatric side effects
- knowledge deficit regarding drug harpy
What is established in the implementation of DACA nicotinic?
- Ensure proper administration of nicotine replacement preparations
- check for medication interactions
- may be taken with or without food
- monitor patient response closely
- provide safety precautions if the patient reports neuropsychiatric events or seizure activities
What is myasthenia gravis and what are some symptoms?
- Chronic muscular disease caused by a defect in neuromuscular transmission
- autoimmune disease; patients make antibodies to ACh receptors, causing gradual destruction of them
- symptoms: progressive weakness and lack of muscle control with periodic acute episodes
What are 3 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 than neostigmine
- edrophonium: diagnostic agent for myasthenia graves
Define Alzheimer’s disease
-A progressive disorder involving neural degeneration of the cortex
- leads to a marked loss of memory and the ability to carry on activities of daily living
List 3 indirect-acting cholinergic agonists used to Trent Alzheimer’s disease
- Galantamine: available in solution for swallowing ease
- rivastigmine: available in solution for swallowing ease
- donepezil: has once-a-day dosing; available in rapid dissolving tablet
Identify the action of indirect-acting cholinergic agonists
- Blocks AChE at the synaptic cleft, which allows the accumulation of ACh released from the nerve endings and leads to increased and prolonged stimulation of ACh
What are the indications of indirect-acting cholinergic agonists?
- Myasthenia gravis
- Alzheimer’s
- treatment after exposure to nerve gas
What are the contraindications of IACA’s?
- Allergy
- bradycardia
-Intestinal or urinary tract obstruction
What are the cautions of IACA’s?
- Hx of any condition that could be exacerbated by cholinergic stimulation such as asthma, coronary disease, peptic baker, arrhythmias, epilepsy, Parkinsonism
- hepatic or renal dysfunction
- pregnancy and lactation
What ere adverse effects of IACA’s?
- Bradycardia, hypotension
- increased GI secretions
- increased bladder Jones
- bronchoconstriction
- pupil constriction
What drugs may interact with IACA’s?
-NSAIDs, cholinergic drugs
How do you assess IACAs?
- Assess for contraindications and cautions
- perform physical exam
- assess orientation, reflexes, ability to perform daily life tasks
What is the nursing diagnosis for IACAs?
- Altered thought process related to CNS effects
- impaired comfort related to GI effects
- decreased cardinal output
- knowledge deficit regarding any therapy
- diarrhea
What are implementations for IACAs?
- Administer IVs slowly
- maintain atropine on standby
- administer oral drugs with meals
- monitor alzhemiers patient for progress
- provide patient teaching
What is in the evaluation of IACAs?
- Monitor patient response to drug
- monitor for adverse effects
- evaluate the effectiveness of teaching plan
- monitor comfort measures
What are the uses of anticholinergic agents?
- Decreases parasympathetic activities to allow the sympathetic system to become more dominant
- decrease GI activity and secretions (treat ulcers and hyperactive bowel)
- Broncodilation (treat COPD bronchospasm)
- relax bladder
- decrease secretions before anesthesia
- treatment of nausea, vomiting, and motion sickness
What are the actions of anticholinergic agents?
- Used to block the effects of acetylcholine
-Lyse, or block the effects of the PNS
Where are anticholinergic agents derived from?
- The plant Belladonna
What do anticholinergic agents block?
- Muscarinic effectors in the PNS
- Cholinergic receptors in the SNS
Which receptors do anticholinergic agents not block?
- Nicotonic receptors
What are the effects of blocking the parasympathetic system?
- Increase in heart rate
- decrease in GI activity
- decrease in urinary bladder tone and function
- pupil dilation
- cycloplegia (paralysis of the ciliary muscle of the eye)
Identify 9 anticholinergic agents
- Atropine
- dicyclomine
- glycopyrrolate
-Ipratropium - meclizine
- oxybutynin chloride
- scopolamine
- tiotropium
- tolterodine
What are indications of anticholinergic agents?
- Decrease secretions
- decrease bronchospasm
- restore cardiac rate and blood pressure
- pylorospasm and hyperactive bowel
- relax uterine hypertonicity
- atropine
What are cautions of anticholinergic agents?
- Cardiac arrhythmias, tachycardia, myocardial ischemia
- impaired liver or kidney function
- pregnancy and lactation
- hypertension
- spasticity
What are adverse effects of anticholinergic agents?
- Blurred vision
- mydriasis
- cycloplegia
- photophobia
- palpitations
- dry mouth
- urinary retention
- constipation
What other drugs have antichulinergic activities?
- Antihistamines
- antiparkinsonism drugs
-MAOIs - TCAs
What drugs do anticholinergic drugs have interactions with?
- Any other drug with anticholinergic activity
- phenothiazines
- herbal therapies
What should a nurse assess for anticholinergic drugs?
- Contradictions and cautions
- perform a physical assessment
- assess neurological status, level of orientation, effect, reflexes, and papillary response
- monitor vital signs and cardiopulmonary status; escalate lung sounds
- assess abdomen; ausculate bowel sounds; evaluate bladder and bowel patterns; monitor urinary output; palpate bladder for detention
What is the nursing diagnosis/planning for anticholinergic drugs?
- Impaired comfort related to GI, CNS, GU, and cardiovascular effects
- altered cardiac output related to cardiovascular effects
- constipation related to GI effects
- urinary retention
- injury risk related to CNS effects
- thermal injury risk related to decrease in ability to sweat
- nonadhearance related to drug adverse effects
- knowledge of drug temps
What implementation should be given to patients about anticholinergic drugs?
- Ensure proper administration of the drug
- provide comfort measures to help patient calculate drug effects
- monitor patient response closely, including blood pressure, urinary output, cardiac output
- offer support and encouragement to help the patient deal with the drug regimen
What should be included in the evaluation of anticholinergic drugs?
- Monitor patient response to the drug
- Monitor for adverse effects
- evaluate effectiveness of treatment plan
- monitor the effectiveness of comfort measures and adherence to the regimen
What other drugs have anticholinergic activity?
- Antihistamines (relief of allergy symptoms)
- diphenhydramine: Benadryl
- loratadine: Claritin
- cetirizine: Zyrtec - Antiparkinsonism drugs
- procyclidine
- trihexyphenidyl
- orphenadrine
3.MAOI
4.TCAs - Phenothiazines (antipsychotics)
- Herbal therapies
