1. What are Cholinergic drugs?
    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.
  2. What are the A/R of Cholinergic drugs?
    • Nausea/diarrhea, ABD cramping
    • Salivation
    • flushing of the skin
    • Cardiac arrhythmias
    • Muscle weakness

    • Topical administration A/R:
    • Reduction of visual acuity
    • Headache
  3. Who are Cholinergic drugs contraindicated in?
    • 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
  4. What are the precautions in Cholinergic drugs?
    • Used cautiously in peeps with:
    • Hypertension
    • Epilepsy
    • Cardiac arrythmias
    • bradycardia
    • recent coronary occlusion
    • megacolon
  5. what drug interactions does CHOLINERGIC drugs have?
    Aminoglycoside antibiotics(anti-infective) = INCREASED neuromuscular blocking effect

    Corticosteroids(tx of inflammation/respiratory problems) =DECREASED effect of the CHOLINERGIC
  6. What are the Preadministration assessment of Cholinergic drugs used for Glaucoma?
    • 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
  7. What is the preadministration assessment 4 Cholinergics used 4 Myasthenia Gravis?
    • 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
  8. What are the preadministration assessment 4 Cholinergics used 4 urinary retention?
    • 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
  9. What is the ongoing assessment of Cholinergic drugs?
    Monitor 4 drug toxicity or cholinergic crisis.

    • Cholinergic crisis includes:
    • Severe ABD cramping
    • diarrhea
    • excessive salivation
    • muscle weakness
    • rigidity&spasm
    • clenching of the jaw
  10. What is the monitoring & managing nursing duties of cholinergic drugs?
    • 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
  11. What should you teach the patient & family when using Cholinergic drugs 4 glaucoma?
    • 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
  12. What should you teach the patient & family about Pilocarpine ocular system?
    • 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
  13. What would you teach patient and family about taking these drugs 4 Myasthenia gravis?
    • 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
  14. What are the Cholinergic drugs used 4 myasthenia gravis?
    • Ambenonium(mytelase)
    • Edrophonium (enion, tensilon)
    • Guanidine
    • Pyridostigmine bromide(mestinon regonol)
  15. What cholinergic drugs are used 4 tx of urinary cholinergics?
    Behtanechol chloride (duvoid urecholine)
  16. What are cholinergic drugs used 2 tx glaucoma?
    • Carbachol topical (miostat)
    • pilocarpine HCI (pilopine)
Card Set
Unit 29