Pharm

They act like neurotransmitter acetylcholine or may inhibit release of enzyme acetylcholinesterase.

• Uses:
• Urinary retention (causes contraction of bladder smooth muscles)
• Tx of Glaucoma (produces miosis-constriction of the iris)
• Myasthenia gravis- this is rapid fatigue in skeletal muscles bcuz of lack of ACH.

• Nausea/diarrhea, ABD cramping
• Salivation
• flushing of the skin
• Cardiac arrhythmias
• Muscle weakness

• Topical administration A/R:
• Reduction of visual acuity
• Headache

• Peeps with:
• Asthma
• Peptic ulcer disease
• Coronary artery disease
• Hyperthyroidism

Bethanecol is contraindicated in those w/ mechanical obstruction of the GI or genitourinary tracts.

Opthalmic cholinergic preparations - peeps w/ secondary glaucoma, iritis, corneal abrasion, or any acute inflammatory disease of the eye

• Used cautiously in peeps with:
• Hypertension
• Epilepsy
• Cardiac arrythmias
• bradycardia
• recent coronary occlusion
• megacolon

Aminoglycoside antibiotics(anti-infective) = INCREASED neuromuscular blocking effect

Corticosteroids(tx of inflammation/respiratory problems) =DECREASED effect of the CHOLINERGIC

• Primary health care provider examines the eye
• Review the health care provider's dx and comments
• Take pt health hx, evaluate pt's ability 2 carry out ADLs

• After preadm assessment
• Nurse= Monitor 4 drug toxicity or cholinergic crisis, Check eye & area around eye daily 4 evidence of redness, inflammation, and excessive secretions
• when giving eye drops read rx label carefully when instilling
• chck name of drug, dosage, strength
• Using PILOCARPINE ocular system=question pt if they can self administer disc while in hospital
• change the PILOCARPINE ocular system every 7days unless Dr. directs otherwise

• Assess 4 signs of muscle weakness examples:
• drooling
• inability 2 chew or swallow
• drooping eyelids
• inabliltiy 2 perform repetitive movements
• difficulty breathing
• extreme fatigue

• After administration:
• Nurse=document any increase in symptoms of the A/R B4 giving each dose, Assess pt 4 presence or absence of the symptoms of MYASTHENIA GRAVIS b4 each dose
• Sustained-released tablets are available that allow less frequent dosing & help pt 2 have longer undisturbed periods during night

• Palpate ABD in pelvis area 2 determine if distention is present:
• Rounded
• Swelling over pelvis usually indicates retention & distended bladder

• Ongoing assessment:
• Nurse= I&0s, notify dr. if pt fails 2 void after administration, palpate bladder 2 determine its size

Place the call light & any other items the pt might need, such as urinal or bedpan w/in easy reach

Monitor 4 drug toxicity or cholinergic crisis.

• Cholinergic crisis includes:
• Severe ABD cramping
• diarrhea
• excessive salivation
• muscle weakness
• rigidity&spasm
• clenching of the jaw
• NURSE REPORT THIS 2 DR ASAP CUZ PT NEEDS ANTIDOTE ATROPINE 0.4 T0 0.6 GIVIN BY IV

• Disturbed sensory perception- visual
• Drug-induced myopia may occur after instillation of drops 4 glaucoma
• Assist client in/out of bed or ambulating & remove obstacles that may be a fall risk 4 pt.

• Diarrhea:
• Make sure bedside commode, bedpan, or bathroom, are readily available
• Keep record of fluid I&O and number, consistency, frequency of stools if diarrhea is present

• Warn the pt the eye drops may sting when instilling in eye & is normal
• Advise pt. 2 observe caution while driving or performing that requires vision
• Local irritation and headache may occur @ the beginning of therapy

Notify the Dr. provider if ABD cramping, diarrhea, or excessive salivation occurs

• Instruct pt 2 remove & replace system every 7days (ciz when u first put it in their is some short term vision impairment) or instructed by Dr.
• Check unit 4 placement b4 retiring @ night & in the morning on arising

Nurse = notify dr. if eye secretions are excessive or irritation occurs

• Recognize symptoms of overdosage and underdosage
• Instruct pt 2 keep a record of response 2 drug therapy (time of day, increased or decreased muscle strength, fatigue) & 2 bring recor 2 each appt.
• Tell client they must wear medic alert tag indicating they hv myasthenia gravis

• Ambenonium(mytelase)
• Edrophonium (enion, tensilon)
• Guanidine
• Pyridostigmine bromide(mestinon regonol)

Behtanechol chloride (duvoid urecholine)

• Carbachol topical (miostat)
• pilocarpine HCI (pilopine)