-
Key facts about cholinergic agonists (4)
[Ex: Bethanechol (Duvoid, Myotonachol), pilocarpine (Isopto Carpine, Pilocar)]
- 1. directly stimulate cholinergic receptors
- 2. mimic the action of acetylcholine
- 3. metabolized by cholinestrerases in plasma and liver
- 4. excreted in urine
-
When to use cholinergic agonists (5)
[Ex: Bethanechol (Duvoid, Myotonachol), pilocarpine (Isopto Carpine, Pilocar)]
- glaucoma
- atonic bladder
- postoperative and postpartum urinary retention
- abdominal distention and GI atony
- salivary gland hypofunction
-
When NOT to use cholinergic antogonists (6)
[Ex: Bethanechol (Duvoid, Myonachol), pilocarpine (Isopto carpine, Pilocar)]
- prostate enlargement
- possible urinary or G obstruction
- hyperthyroidism
- bradycardia or AV conduction defects
- Asthma
- Coronary artery disease
-
Adverse reactions of cholinergic agonists
[Ex: Bethanechol (Ducoid, Myonachol), pilocarpine (Isopto Carpine, Pilocar)]
hypotension, h/a, sweating, increased salivation, abdominal cramps, nausea, vomiting, diarrhea, blurred vision, urinary frequency, decreased HR, SOB
-
key nursing actions for cholinergic agonists (5)
[Ex: Bethanechol (Duvoid, Myonachol), pilocarpine (Isopto Carpine, Pilocar)]
- assess urinary status
- assess bowel sounds and abdomen
- Administer P.O. or subQ; never give I.V. or I.M.
- Observe pt for 20-60 min after subQ administration
- Monitor for toxicity; administer atropine as an antidote as prescribed
-
Key facts about acetylcholinestrase inhibitors (3)
[Ex: Ambenonium (Mytelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine (Antilirium), pyridostigmine (Mestinon, Regonol)
- inhibit acetylcholinesterase, the enzyme that inactivates acetylcholine; as acetylcholine builds up it stimulates the cholinergic receptors
- metabolized in plasma
- excreted in urine
-
When to use acetylcholinesterase inhibitors
[Ex: amenonium (MYetelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine, Antilirium), pyridostigmine (Mestinon, Regonol)
- myastenia gravis
- glaucoma
- anticholinergic poisoning
- paralytic ileus
-
When NOT to use acetylcholinesterase inhibitors
[Ex: amenonium (Myetelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine, Antilibrium), pyridostigmine (Mestinon, Regonol)
Possible urinary or GI obstruction
-
Adverse reactions of acetylcholinesterase inhibitors [Ex: amenonium (Myetelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine, Antilibrium), pyridostigmine (Mestinon, Regonol)
N/V/D, dyspnea, arrhythmias, insomnia, h/a, anorexia, seizures, insomnia, prutitis, urinary frequency, and noturia
-
Key nursing actions for acetylcholinesterase inhibitors (4)
[Ex: amenonium (Myetelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine, Antilibrium), pyridostigmine (Mestinon, Regonol)
- assess the pt's neuromuscular status before and during therapy
- monitor for drug toxicity; administer atropine as an antidote as prescribed
- Monitor vital signs and breath sounds every 4 hr
- Take seizure precautions
-
Key facts about Alzheimer's drugs (3)
[Ex: donepezil (Aricept), galantamine (Razadyne), memantine (Namenda), rivastigmine (Exelon)]
- Inhibit cholinesterase, leading to elevated acetylcholine levels in the cortex
- Metabolized in the liver
- Excreted in feces and urine
-
When to use Alzheimer's treatment drugs (2)
[Ex: donepezil (Aricept), galantamine (Razadyne), memantine (Namenda), rivastigmine (Exelon)]
- Mild to moderate Alzheimer's-type dementia
- Moderate to severe Alzheimer's-type dementia (memantine)
-
When NOT to use Alzheimer's treatment drugs (5)
[Ex: donepezil (Aricept), glantamine (Razadyne), memantine (Namenda), rivastigmine (Exelon)]
- Sick sinus syndrome
- GI bleeding
- Seizures
- Asthma
- Severe hepatic and renal impairment
-
Adverse reactions of Alzheimer's treatment drugs
[Ex: donepezil (Aricept), glantamine (Razadyne), memantine (Namenda), Rivastigmine (Exelon)]
- insomnia, fatigue, dizziness, confusion, ataxia, depression, syncope, bradycardia, nausea, comiting, diarrhea, anorexia, and abdominal pain
- Hepatotoxicity (donepezil)
- Hypertension (memantine)
-
Key nursing actions for Alzheimer's treatment drugs
[Ex: donepezil (Aricept), glantamine (Razadyne), memantine (Namenda), Rivastigmine (Exelon)]
- Establish a functional baseline
- Notify the surgeon about the use of Alzheimer's treatment drugs if surgery is planned
- Teach the pt that these drugs will not cure, only slow the progression of the disease
- Administer donepezil daily HS
-
Key facts about anticholinergics [Ex: atropine, belladonna, gylcopyrrolate, benztropine (Cogentin), dicyclomine (Antispas, Bentyl), oxybutynin (Ditropan)]
- Interrupt parasympathetic nerve impulses in the CNS and ANS and prevent acetylcholine from stimulating cholinergic erceptors
- Metabolized in the liver
- Excreted in feces and urine
-
When to use anticholinergics [Ex: atropine, belladonna, glycopyrrolate (Robinul), benztropine (Cogentin), dicyclomine (Antispas, Bentyl), oxybutynin (Ditropan)]
- Reduce oral , gastric, and respiratory secretions
- Reverse heart lock
- Paralyze ciliary muscles
-
When NOT to use anticholinergics [Ex: donepezil (Aricept), glantamine (Razadyne), memantine (Namenda, Rivastigm,ine (Exelon)]
- Angle-closure glaucoma, uncontrolled tachycardia, urinary or GI tract obstruction, COPD, severe ulcerative colitis, myasthenia gravis, acute or severe hemorrhage, and unstable cardiovascular status
- Breat-feeding women
-
Adverse reactions for anticholinergics [Ex: atropine, belladonna, glycopyrrolate (Robinul), benztropine (Cogentin), dicyclomine (Antispas, Bentyl), oxybutynin (Ditropan)]
Comonly dose-related
-
Key nursing actions for anticholinergics[Ex: atropine, belladonna, glycopyrrolate (Robinul), benztropine (Cogentin), dicyclomine (Antispas, Bentyl), oxybutynin (Ditropan)]
- Administer before meals
- Monitor fr adverse reactions
- Teach the pt to consult the practitioner before taking non-prescription drugs
- Advise the pt on how to reduce dry mouth and constipation
- Monitor intake and output
-
Key facts about catecholamines [Ex: Dobutamine (Dobutrex), dopamine (Intropin), epinepherine (Adrenalin), isoproterenol (Isuprel), norepinephrine (Levophed)]
- Stimulate nervous ssytem by combining with either alpha-adrenergic or beta-adrenergic receptors
- Metabolize primarily in the liver
- Excreted in urine
-
When to use catecholamines [Ex: Dobutamine (Dobutrex), dopamine (Intropin), epinepherine (Adrenalin), isoproterenol (Isuprel), norepinepherine (Levophed(]
- Bradycardia, heart blocks, and decreased cardiac output
- Acute hypotension and shock
- Acute drug-induced allergic reaction
-
When NOT to use catecholamines [Ex: Dobutamine (Dobutrex), dopamine (Intropin), epinepherine (Adrenalin), isoproterenol (Isuprel), norepinepherine (Levophed)]
- Acute MI or tachyarrhythmias
- During pregnancy
- With caution in pt with diabetes, atherosclerosis, Raynauds-disease, and cardiac insufficiency
-
Adverse reactions of catecholamines [Ex: Doutamine (Dobutrex), dopamine (Intropin), epinepherin (Adrenalin), isoproterenol (Isuprel), norepinepherine (Levophed)]
- Arrhythmias, tachycardia, angina
- Restlessness, anxiety, dizziness
- H/a, hypertension, stroke
-
Key nursing actions of catecholamines [Ex: Dobutamine (Dobutrex), dopamine (intropin), epinepherine (Adrenalin), isopreterenol (Isuprel), norepinepherine (Levophed)]
- Monitor ECG, hemodynamic parameters, vital signs and urine output
- Corect hypovolemia
- Administer through a large vein to prevent extravasation. Always administer wtih an infusion pump
- Monitor for a sudden drop in BP after stopping the drug
-
Key facts about noncatecolamines [Ex: Albuterol (Proventil), ephedrine, isoetharine, mephentermine, metaproterenol (Alupent), phenylephrine (neo-Synephrine), terbutaline (Brethine)]
- Stimulate sympathetic nervous system by directing stimulating alpha or beta receptors or indirectly afecting adrenergic receptors
- metabolized in the liver
- excreted in urine
-
When to use noncatecholamines [Ex: Albuterol (Proventil), ephedrine, isoetharine, mephentermine, metaproterenol (Alupent), phenylephrine (neo-Synephrine), terbutaline (Brethine)]
- Hypotension and severe shock
- Preterm labor
- Bronchodilation treatment
- Nasal congestion
-
When NOT to use noncatecholamines [Ex: Albuterol (Proventil), ephedrine, isoetharine, mephentermine, metaproterenol (Alupent), phenylephrine (neo-Synephrine), terbutaline (Brethine)]
- Teachyarrhythmias, hypotension, coronary artery disease, history of stroke, angle-closure glaucoma, and thyrotoxicosis
- With caution in elderly pts and those wit diabetes, hyperthyroidism, angina, or a history or seizures
-
Key nursing actions for noncatecholamines [Ex: Albuterol (Proventil), ephedrine, isoetharine, mephentermine, metaproterenol (Alupent), phenylephrine (neo-Synephrine), terbutaline (Brethine)]
- If given via inhalation, administer the bronchodilator inhaler, wait 2 minutes and administer the corticosteroid inhaler
- Monitor respiratory status
-
Key facts about alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cafergot), phenoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (minipress), terazosin (Hytrin)]
- interrupt the action of epinepherine and norepinepherine at the alpha-receptors
- Metabolized by the liver
- Excreted in feces
-
When to use alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cafergot), phenoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (minipress), terazosin (Hytrin)]
- peripheral vascular disorders
- Raynauds's disease
- Vascular headaches
- Adrenergic excess
-
When NOT to use alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cafergot), phemoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (mniipress), terazosin (Hytrin)]
- MI
- Coronary insufficiency
- Evidence or coronary artery disease
- Pregnancy
-
Adverse rections of alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cafergot), phenoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (minipress), terazosin (Hytrin)]
Orthostatic hypotension, tachycardia, dizziness, arrhythmias, ergotism (characterized by numbness, tingling or fingers and toes, weakness, and blindness)
-
Key ursing actions of alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cagergot), phenoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (minipress), terazosin (Hytrin)]
- Monitor BP ro signs of orthostatc hypotension,as appropriate
- Instruct pt to change position slowly to minimize othostatic hypotension
- Administer drug with milk or food
- If pt experiences a shock-like state, place in the Trendelenburg position, notify practitioner, and begin emergency resuscitation, as appropriate
-
Key facts about beta-adrenergic blockers [Ex: aceutolol (Sectral), atenolol (Tenormin), metroprolol (Lopressor), carvedilol (Coreg), labetalol (Trandate), levobunolol (Betagan), propanolol (inderal)]
- Prevent stimulation of sympathetic nervous system
- Usually metabolized in the liver
- Excreted in feces and urine
-
When to use beta-adrenergic blockers [Ex: acebutolol (Sectral), atenolol (Tenormin), metroprolol (Lopressor), carvedilol (Coreg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
- Hypertension
- Angina
- Tachydysrrhythmias
- Migraines
- MI
- Glaucoma
- Acute anxiety reaction
- Mild to severe heart failure
- Left ventricular dysfunction after MI
-
When NOT to use beta-adreneregic blockers [Ex: acebutolol (Secral), atenolol (Tenormin), Metroprolol (Lopressor), carvedilol (Croeg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
- Bradyarrhythmias
- COPD
- Heart block
- Asthma
-
Adverse reactions for beta-adrenergic blockers [Ex: acebutolol (Secral), atenolol (Tenormin), Metroprolol (Lopressor), carvedilol Coreg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
- Bradycardia
- bronchospasm
- nausea
- vomiting
- diarhea
- hypotension
-
Topics for pt discussion for beta-adrenergic blockers [Ex: acebutolol (Sacral), atenolol (Tenormin), Metroprolol (Lopressor), carvedilol (Coreg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
- medication regimen, including proper administration
- Methods to assess pulse and blood pressure
- Signsa dn symptoms of adverse reactions
- avoidace of over-the-counter drugs
- Importance of carrying identification about disease and drug regimen
- Follow-up care
-
Key nursing actions for beta-adrenergic blockers [Ex: acebutolol (Sacral), atenolol ( Tenormin), Metroprolol (Lopressor), carvedilol (Coreg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
- Assess pulse rate: withhold drug andnotify practitioner if rate is below 50 BPM (or according to hospital policy)
- Advise pt receiving long-term therapy not to discontinue the drug suddenly because of the risk of MI or arrhythmias
-
Key facts about nonolarizing drugs [Ex: Cisatracurium (Nimbex), pancuronium, vecuronium (Norcuron)
- Complete with acetylcholine at cholinergic receptor sites of skeletal muscle membrane, thereby blocking acetylcholine transmitter action and preventing muscle membranes from depolarizing
- Partially metabolized in the liver
- excreted in urine
-
When to use nonpolarizing drugs [Ex: Cisatracurium (Nimbex), pancuronium, vecuronium (Norcuron)]
prolonged or nermediate muscle relaxation for surgery or ET intubation
-
When NOT to use nonpolarizing drugs [Ex: Cisatracurium (Nimbex), pancurium, vecuronium (Norcuron)]
- Hypersensitivity
- Neonates
- Pregnancy
- Breast-feeding
-
Adverse effects of nonpolarizing drugs [Ex: Cisatracurium (Nimbex), pancurium, vecuronium (Norcuron)]
- APnea
- hypotension
- skin reactions
- bronchospasms
- excessive bronchial or salivary excretions
-
Key nursing actions for nonpolarizing drugs [Ex: Cisatracurium (Nimbex), pancurium, vecuronium (Norcuron)]
- monitor for adverse reactions
- Have O2 and ET and suction equipment available
- Monitor respirations frequently until the pt is fully recovered
- Suction the pt as needed
- Frequently check the mechanical ventilator settingsand function to ensure proper functioning
- Always administer with sedation or general anesthesia
-
Key facts about depolarizing drugs [Ex: succinylcholine (Anectine, Quelicin)]
- Cause persistenet depolarization followed by muscel fasciculations and paralysis or flaccidity
- Metabolized in the liver and plasma
- Excreted in urine
-
When to use depolarizing drugs [Ex: succinylcholine (Anectine, Quelicin)]
Skeletal muscle relaxation for surgery or mechanical ventilation
-
When NOT to use depolarizing drugs [Ex: succinylcholine (Anectine, Quelicin)]
- Hypersensitivity
- Genetic disorder or plasma pseudocholinesterase
- Hx of malignant hyperthermia
- Myopathies associated with elevated creatine phosphokinase levels
- acute angle-closure glaucoma
- Penetrating eye injuries
-
Adverse effects of depolarizing drugs [Ex: succinylcholine (Anectine, Quelicin)]
- Prolonged apnea and cardiovascular effects
- Hypotension
- Muscular pain
- Increased intraocular pressure
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