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pharm final 2

ch 19

bethanechol ☺cholinergic ☻CI: intestinal or urinary tract obstruction, severe bradycardia, HoTN, COPD, asthma, PUD, parkinsonism ♥used to treat urinary retention - stimulates muscarinic receptors, promotes contraction of bladder, ↑GI secretions and peristalsis, pupil constriction, bronchoconstriction ♦s/e: n/v/d, abd cramps, salivation, sweating, flushing, frequent urination, blurred vision, miosis a/e: HoTN, bradycardia, muscle weakness, acute asthma attack, heart block, circulatory collapse, cardiac arrest
NC bethanechol (cholinergic agonist, direct acting) ☺urine output should be >1500 mL/day ☻give cholinergic agonists 1 hr ac or 2 hr pc, may be given with meals if pt complains of GI upset ♥check serum amylase, lipase, aminotrasferase, and bilirubin levels - they may ↑slightly ♦↑bronchial secretions ♣teach: report severe dizziness, HR <60, rise slowly, report dyspnea
antidote for cholinergic OD ☺atropine sulfate 0.6-1.2 mg ☻early signs of OD are flushing, salivation, sweating, nausea, abd cramps ♥cholinergic crisis - OD - s/s: muscle weakness, and ↑salivation
donepezil (Aricept) ch 23 ☺AChE inhibitor ☻↑ACh by inhibiting AChE to treat mild to moderate phase of Alzheimer's
antidote for irreversible and reversible cholinesterase inhibitors ☺pralidoxime (Protopam) ☻used to treat OD for myasthenia gravis ♥treates OD of organophosphate pesticides that cause muscle paralysis
atropine ☺treats bradycardia ☻CI: narrow angle glaucoma, obstructive GI disorders, paralytic ileus, ulcerative colitis, tachycardia, BPH, myasthenia gravis, myocardial ischemia, hypersensivity ♥caution: renal or hepatic failure, COPD, HF ♦uses: preop to reduce salivation, ↑HR, dilate pupils, action: occupies ACh receptors, ↑HR by blocking vagus stimulation, dilates pupil by blocking iris sphincter muscle
s/e of atropine ↓sweating (anhydrosis), dry mouth, nausea, HA, constipation, dry skin, flushing, mydriasis (dilation), blurred vision, anxiety, photophobia, palpitations, urinary retention a/e: tachycardia, HoTN, life threatening vfib, Stevens-Johnsons syndrome, coma
NC atropine ☺baseline vs, assess urine output ☻phenothiazines and antidepressants increase effect of anticholinergics ♥report tachycardia ♦absence of bowel sounds may indicate paralytic ileus ♣use bed alarms, can cause excitement or confusion ♠provide mouth care for dry mouth
NC atropine continued •admin IV undiluted or diluted in 10 mL of sterile water, rate of admin is 1 mg/min ◘teach: avoid hot envir and excess exertion, check OTC labels and avoid anything that is CI for narrow angle glaucoma, use sunglasses after eye exam for photophobia
never give anticholinergics to narrow angle glaucoma pts or BPH pts
Antiparkinson-anticholinergic drugs ☺atropine was found to ↓ motor manifestations of tremors and rigidity ☻also affect the CNS as well as the PNS ♥thrihexyphenidyl (Artane), biperiden (Akineton), bezotropine (Cogentin) - may be used in addition to levodopa/carbidopa to treat parkinsons or used alone to treat pseudoparkinsonism from the s/e of antipsychotics
tolterodine tartrate (Detrol) ☺CI: urinary retention, gastric retention, narrow angle glaucoma, lactation, ☻caution: CVD, bladder outflow obstruction, pyloric stenosis or other GI obstructions, paralytic ileus, ulceratvie colitis, renal or hepatic dysfunction ♥DI: ↑effects with phenothiazines, and TCAs, grapefruit juice may ↑effect ♣uses: decrease urinary frequency, urgency, and incontinence
s/e of tolterodine dry mouth, eyes and skin, HA, dizziness, vertigo, nervousness, n/v/d, abd pain, constipation, dyspepsia, flatulence, dysuria, wt gain, arthralgia, urine retention a/e: bronchitis, visual abnormalities, HTN
rivastigmine (exelon) ☺CI: liver and renal dx, urinary tract obstructions, ortho HoTN, bradycardia ☻caution: asthma, COPD, seizures, PUD ♥DI: ↑effect of theophylline, general anesthesia, cimetidine, NSAIDs ↑GI effects, tabacco ↑clearance of drug, TCAs ↓effect ♦uses: improves memory loss
NC rivastigmine (exelon) ☺assess memory and judgement losses from family - declining interest in people or home, trouble with simple activities, wanders from home ☻observe for hyperactivity, hostility, wandering ♥note motor function ♦can family cope? ♣maintain consistency in care ♠assist with amb ☺watch for bradycardia and HoTN ☻teaching: purpose of drug therapy, clarify dosing schedule, safety, rise slowly, monitor liver function
NC rivastigmine (exelon) continued ♣s/e: anorexia, n/v/d, constipation, abd pain, GI bleed, dizziness, depression, peripheral edema, dry mouth, dehydration, restless leg syndrome, nystagmus ♠a/e: seizures, bradycardia, ortho HoTN, cataracts, MI, HF, hepatotoxicity, SI, S-J syndrome
Created by: nursingTSJC2013



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