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pharm test 3

Pharm cholinergic-blocking agents ch. 20

cholinergic blocking agents drugs that block or inhibit the actions of ACh in the parasympathetic nervous system
mechanism of action -competitive antagonists -compete with ACh -block ACh at the muscarininc receptors in the PSNS, as a result ACh is unable to bind to the receptor site & cause a cholinergic effect
Chemical Class -atropine -belladonna -hyoscyamine -scopolamine
atropine used to dry up before surgery (dry secretions); also used to make the heart speed up
belladonna usually used for motion sickness
hyoscyamine and scopolamine used for GI
DRUG EFFECTS CV: small doses--decrease HR; large doses-- increase HR CNS: small doses-- decrease muscle rigidity & tremors; large doses-- drowsiness, disorientation, hallucinations
DRUG EFFECTS EYE: dilated pupils (mydriasis); decreased accomodation d/t paralysis of ciliary muscles (cycloplegia) GI: relax smooth muscle tone, decrease intestinal & gastric secretions, decrease motility & peristalsis
DRUG EFFECTS GENITOURINARY: relaxed detrusor muscle, increased constriction of internal sphincter--urinary retention as a result GLANDULAR: decreased bronchial secretions, salivation, & sweating RESP: decreased bronchial secretions, dilated bronchial airways
side effects -blind as a bat -red as a beet -bloated as a toad -mad as a hatter -hot al hell
INDICATIONS: CNS -decreased muscle rigidity & muscle tremors -Parkinson's disease -drug induced extrapyramidal reactions
INDICATIONS: CV they affect the heart's conduction system -at low doses: slows the HR -high doses: increase HR
INDICATIONS: atropine used primarily for CV disorders -sinus node dysfuntion -sinus bradycardia w/ hemodynamic compromise -sympathetic 2nd degree heart block
INDICATIONS: RESPIRATORY blocking cholinergic stimulation of the PSNS allows unopposed action of the SNS, results: -decreased secretions from nose, mouth, pharynx, & bronchi -relaxed smooth muscle in bronchi & bronchioles -decreased airway resistance -bronchodilation
INDICATIONS: RESPIRATORY respiratory agents are used to treat: -exercise induced bronchospasms -chronic bronchitis -asthma -chronic obstructive pulmonary disease
INDICATIONS: GI PSNS controls gastric secretions & smooth muscles that produce gastric motility; blockade of PSNS results in: -decreased secretions -relaxation of smooth muscle -decreased GI motility & peristalsis
INDICATIONS: GI GI agents are used to treat: -peptic ulcer disease -irritable bowel syndrome -GI hypersecretory states
INDICATIONS: GENITOURINARY -relaxed detrusor muscles of the bladder -increased constriction of the internal sphincter -reflex neurogenic bladder -incontinence
other anticholinergics glycopyrrolate (robinul): control secretions, especiall pre-op; just liek atropine in that it dries up secretions pre-op
Interactions -antihistamines, phenothiazines, tricyclic antidepressants, MAOIs -when given with cholinergic blocking agents, cause additive cholinergic effects, resulting in increased effects
Nursing Implications if pt. has GI or GU obstruction you do not want to use anticholinergics
If you have glaucoma should you take anticholinergics? NO; DO NOT TAKE IF YOU HAVE GLAUCOMA
nursing implication dry mouth may occur; can be handled by chewing gum, frequent mouth care, and hard candy
what is the antidote for atropine overdose? physostigmine
monitor for side effects -constipation -tremors -hallucinations -urinary retention -fever -tachycardia -confusion -sedation -hot, dry skin -CNS depression: occurs with large doses of atropine
the nurse is providing education about anticholinergic drug therapy to an elderly pt. an important point to emphasize would be to avoid exposure to high temperatures
when giving anticholinergic drugs, the nurse keeps in mind that contraindications include benign prostatic hyperplasia
when assessing for adverse effects of anticholinergic drug therapy, the nurse would expect to find that the patient complains of which effect? dry mouth
the nurse administering a cholinergic-blocking drug to a patient who is experiencing drug-induced extrapyramidal effects would assess for which therapeutic effect? decreased muscle rigidity
during assessment of pt. about to receive a cholinergic blocking drug, the nurse should determine whether the pt. is taking any drugs that may potentially interact with the anticholinergic tricyclic antidepressants
a pt. has been given a perscription for transdermal scopolamine patches for motion sickness for use during a vacation cruise. the nurse will include which instructions? -apply patch 3-4 hrs. before boarding the ship -patch should be placed on a nonhairy area just behind your ear -change patch every 3 days -rotate the application sites
Created by: lissy11