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Drugs that stimulate the PNS by mimicing parasympathetic neurotransmitter acetylcholine
Cholinergic
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Cholinergic Receptor that Affects SMOOTH muscle
Muscarinic receptors
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Cholinergic Receptor that Affects Skeletal Muscle
Nicotinic Receptors
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Effects of Cholinergic Agonists:
Cardiovascular: decrease P and BP, vasodilation, slows conduction of AV node
GI: increase tone and motility, increase peristalsis, relax sphincter muscles
GU: increase ureter tone, contract bladder and relax sphincter muscles, stimulate urination
Eye: constrict pupils, increase accommodation
Lungs: bronchial constriction, increase secretions
Glands: increase salivation, perspiration, and tears
Striated muscle: increase neuromuscular transmission, maintain muscle strength and tone
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Cholinergic drugs act _____ on the receptor
directly
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What direct acting cholinergic agonist drug (targeted to muscarinic receptors) is used to increase gastric emptying
Metoclopramide (Reglan)
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What direct acting cholinergic agonist drug (targeted to muscarinic receptors) constricts pupils and opens the canal of Schlemm to allow drainage of aqueous humor (fluid) to treat glaucoma by relieving intraocular pressure in eye.
Pilocarpine (Pilocar)
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What direct acting cholinergic agonist drug (targeted to muscarinic receptors) increases urination
Bethanechol chloride (Urecholine)
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Side effects of BETHANECHOL
Blurred vision, miosis
Hypotension, bradycardia, sweating
- Increased salivation and gastric acid, nausea, vomiting,
- diarrhea, abdominal cramps
Bronchoconstriction
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Condraindications of BETHANECHOL
Bradycardia, hypotension, COPD, peptic ulcer, parkinsonism, hyperthyroidism
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Nursing Interventions for BETHANECHOL
- Monitor BP and P.
- Teach client to rise slowly.
- Record fluid intake and output.
- Monitor breath sounds.
- Give 1 hour ac or 2 hours pc.
- Monitor bowel sounds.
- Monitor overdosing.
- •SS: salivation, sweating, flushing, abdominal cramps
- •Antidote: Atropine
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Functions and Effects of INDIRECT acting Cholinergic Agonists
- FUNCTION:
- Break down cholinesterase enzyme
- •Into choline and acetic acid
- Allow Ach to activate muscarinic and nicotinic cholinergic receptors
- EFFECTS:
- Stimulate skeletal muscles, increase tone
- Greater GI motility, bradycardia, miosis
- Bronchial constriction, promote urination
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Side Effects/Contraindications with INDIRECT acting cholinergic agonists
- SE:
- bradycardia, asthma, peptic ulcers
- Contraindications:
- intestinal and urinary obstruction
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Examples of Reversible Cholinisterase Inhibitors
- Neostigmine (Prostigmin)
- short-acting.
- Pyridostigmine (Mestinon)
- moderate-acting.
- Ambenonium (Mytelase)
- long-acting.
- Edrophonium (Tensilon)
- short-acting and often used for diagnostic purposes.
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Uses for Reversible Cholinisterase Inhibitors
- •Pupil constriction in glaucoma
- •increase muscle strength in myasthenia gravis
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Side Effects of Reversible Cholinisterase Inhibitors
Muscle cramps, twitching, bradycardia, increased bronchial secretions, and cramps
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Effects of Anitcholinergics
- Heart: large doses increase P; small doses
- decrease P
- Lungs: bronchodilation, decrease secretions
- GI: relax smooth muscle tone, decrease motility and peristalsis, decrease secretions
- GU: relax detrusor muscle, increase sphincter constriction
- Eye: dilate pupils, decrease accommodation
- Glands: decrease salivation and perspiration
- CNS: decrease tremors and rigidity
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Atropine (Action/SE/Contraindications)
- •Increase P, decrease motility and peristalsis, decrease
- salivary secretions
- Side effects/adverse reactions
- •Tachycardia, palpitations, nasal congestion, flushing,
- photophobia, blurred vision, dry mouth and skin, abdominal distention, urinary
- retention, impotence
****Contraindicated in GLAUCOMA
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Nursing Interventions for Atropine
- •Monitor vital signs, urine
- output, bowel sounds.
- •Monitor safety: bedside rails,
- driving motor vehicles.
•Provide mouth care and eye drops.
•Avoid hot environments.
- •Avoid alcohol, cigarettes,
- caffeine, and aspirin at bedtime.
•Wear sunglasses in bright light.
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Selected Anticholinergics for Parkinsonism
- Benztropine (Cogentin)
- Trihexyphenidyl HCl (Artane)
- Action:
- Decreases involuntary movement, tremors, muscle rigidity
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Antihistamines
- Treats motion sickness
- Scopolamine (Transderm Scōp)
- Dimenhydrinate (Dramamine)
- Side effects
- •Dry mouth, visual disturbances, constipation, urinary retention, flushing, muscle weakness, tachycardia, hypotension
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