ch 19
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| 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
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| 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
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| 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
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| donepezil (Aricept) ch 23 | ☺AChE inhibitor
☻↑ACh by inhibiting AChE to treat mild to moderate phase of Alzheimer's
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| 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
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| 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
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| 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
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| 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
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| 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
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| never give anticholinergics to | narrow angle glaucoma pts or BPH pts
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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nursingTSJC2013
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