Pharmacology mod 2 Flashcards
Explain therapeutic actions and uses of cholinergic drugs.
- Act at cholinergic receptors in the peripheral nervous system to mimic the effects of ACh and parasympathetic stimulation
THINK COLON
o Chemicals that act at the same site as neurotransmitter acetylcholine (Ach)
o ACTION:
▪ often called parasympathomimetic drugs because their actions mimic the action of the parasympathetic NS
▪ Not limited to a specific site; therefore, associated w/ many undesirable systemic effects
▪ Work either directly or indirectly on ACh receptors
Discuss nursing implications related to safe administration of cholinergic drugs, including medication-related assessments, expected drug effects, timing of administration, adverse drug effects, contraindications, and relevant practice factors.
- Urinary retention (Bethanechol)
-Induce miosis (Carbachol)
-Treat dry mouth (Cevimeline & Pilocarpine)
Absolute: Allergy
Relative:
- Any condition that would be exacerbated by parasympathetic effects (bradycardia, hypotension)
- Peptic ulcer disease, intestinal obstruction or recent GI surgery
- Asthma
- Bladder obstruction
- Epilepsy and parkinsonism
Caution:
Pregnancy and lactation
Drug-Drug Interactions:
Acetylcholinesterase inhibitors
- Nausea, vomiting, cramps, diarrhea
- Increase salivation
- Involuntary defecation
- Bradycardia, heart block, hypotension
- Urinary urgency
- Flushing or increased sweating
Assessment:
History: Allergy Pregnancy and lactation
Physical:
VS, lung sounds, cardiac status, bowel sounds, bladder distention, and I&O
Diagnosis:
- 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
- Impaired comfort
- Knowledge deficit
Planning:
-The patient will receive the best therapeutic effect from the drug therapy.
-The patient will have limited adverse effects from the drug therapy.
-The patient will have an understanding of the drug therapy, adverse effects to anticipate, and measures to relieve discomfort and improve safety.
[Planning is the same for every drug]
Implementation:
- Ensure proper administration of ophthalmic preparations
- Administer oral drug on an empty stomach
- Monitor patient response closely
- Monitor urinary output
- Provide safety precautions if the patient reports poor visual acuity
- Comfort measures
- Provide teaching
Evaluation:
- Evaluate response to drug
- Evaluate the effectiveness of the teaching plan
- Evaluate the effectiveness of comfort and safety measures
- Evaluate the compliance with the regimen
Explain therapeutic actions and uses of anticholinergic drugs.
-Blocks the vagal effect leading to relaxation of smooth muscle in bronchi (bronchodilation)
Discuss nursing implications related to safe administration of anticholinergic drugs, including medication-related assessments, expected drug effects, timing of administration, adverse drug effects, contraindications, and relevant practice factors.
-Maintenance treatment of COPD
*Not as effective compared to sympathomimetics
Contraindication
-Absolute: Allergy.
-Acute bronchospasm requiring immediate intervention.
Caution
-Any condition aggravated by the anticholinergic effects
D-D Interactions
-Other anticholinergics
-Dry mouth, hoarseness, sore throat.
-Dizziness, headache, fatigue, nervousness, palpitations, and urinary retention; with systemic absorption
-Paradoxical bronchoconstriction.
Assessment:
-History: Allergy to drug, acute bronchospasm. Pregnancy/lactation, conditions exacerbated by anticholinergics.
-Physical: Respiratory, Cardiac, Skin, CNS: A&O and reflexes, Urinary output, and V.S.
Nursing Conclusions:
-Impaired comfort
-Knowledge deficit
Implementation:
-Void prior to med administration; b/c GU effects.
-Safety measures for CNS effects.
-Comfort measures: Small, frequent meals; sugarless lozenges.
- Humidification; Adequate hydration
-Patient teaching
Evaluation:
-Response to drug
-Effectiveness of comfort and safety measures and plan.
-Effectiveness of teaching plan.
-Compliance.
Acetylcholinesterase
enzyme that breaks down acetylcholine
Alzheimer disease
causes protein deposits in the brain
Cholinergic Agonist
drugs that mimic the effects of the neurotransmitter
acetylcholine
Miosis
Very constricted pupils
Myasthenia gravis
a chronic autoimmune disease
Parasympathomimetic
drug that activates the parasympathetic nervous
system
Belladonna
deadly nightshade
Cycloplegia
paralysis within the eye
Mydriasis
dilated pupil
Parasympathetic NS
REST AND DIGEST
Sympathetic NS
FIGHT OR FLIGHT
