CHOLINERGIC DRGUS AND ANTI-CHOLINERGIC DRUGS
(1) What is the indication for Scopolamine?
(2) x. What are the potential adverse effects seen when a patient takes Scopolamine?
(If you get this correct, 200 more points will be added)!
(1) Scopolamine
- Anti-muscarinic receptors in brain
- Used for: Motion sickness
(2)
-Dry mouth
- drowsiness
- Vision blurred
What is Oxybutynin used to treat?
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Oxybutynin (Ditropan)
- Anti-muscarinic receptors in bladder
- Used for Overactive bladder
vi. What are important patient teaching points that should be shared with a patient taking anti-cholinergic drugs?
(If you get this correct, 300 more points will be added)!
If you are out in high temperatures and taking anti-cholinergic drugs you are at risk for heat stroke.
- Drink plenty of fluid, stay out of sauna or hot tubs
- Take medications with plenty of fluid
- Elderly pts taking anti-cholinergics can experience hallucinations, agitation, confusion, and somnolence
- Alcohol use with anticholinergics can increase drowsiness
- Dry moth heled by regular oral hygiene, drink lots of water, suck on heard candy.
- You can experience sensitivity to light, wear sunglasses
vi. What are important patient teaching points that should be shared with a patient taking anti-cholinergic drugs?
(If you get this correct, 300 more points will be added)!
- If you are out in high temperatures and taking anti-cholinergic drugs you are at risk for heat stroke.
- Drink plenty of fluid, stay out of sauna or hot tubs
- Take medications with plenty of fluid
- Elderly pts taking anti-cholinergics can experience hallucinations, agitation, confusion, and somnolence
- Alcohol use with anticholinergics can increase drowsiness
- Dry moth heled by regular oral hygiene, drink lots of water, suck on heard candy.
- You can experience sensitivity to light, wear sunglasses
vii. What are the indications for Atropine?
(If you get this correct, 300 more points will be added)!
Atropine
- Blocks acetylcholine at muscarinic receptors
- Relax muscle in prostate and bladder
- Used for: Pre-op reduce secretions, Cardiac emergencies, Antidote for mushroom poisoning
viii. What adverse effects can be seen with the use of Atropine?
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- Heart rate issues
- Eye issues
- Nervousness
- Weakness
- Confusion
- Paralytic ileus
- Heat prostration
- Urinary retention
vi. What is the name of a acetylcholinesterase inhibitor that is used for Alzheimer patients?
- Donepezil (Aricept)
ii. What are the common adverse effects of anti-cholinergic drugs?
- Dry mouth
-Blurred vision
-Photophobia
- Constipation
- Urinary retention
- Tachycardia
- Populations more effected by anticholinergic drugs: infants, children with downs syndrome, spastic paralysis or brain damage, and older adults: delirium.
iii. What are the names of 5 commonly prescribed anti-cholinergic drugs and what are their indications?
(If you get this correct, 200 more points will be added)!
- Atropine
- Scopolamine
- Benztropine
- Dicyclomine
- Tolterodine
iv. What adverse effects can be seen if a patient overdoses on anti-cholinergic drugs?
- Hyperthermia (hot, dry, flushed skin)
- Dry mouth
- Mydriasis
- Delirium
- Tachycardia
- Paralytic ileus
- Urinary retention
- Seizure, coma, respiratory arrest may occur
v. What should a nurse monitor when taking care of a patient who is taking an anti-cholinergic medication?
(If you get this correct, 100 more points will be added)!
- Based on system affected:
-Respiratory: look for cough, nervousness, GI upset, H/A, dizziness
-GI: can cause constipation, increase fluid intake
- Skin: less sweating leads to overheating or heat exhaustion especially with exercise, hot tubs Fluid
- There are lifespan considerations for these drug’s: very young and elderly pts
ii. Where are Cholinergic receptors found in the body?
Location and Function of Muscarinic Receptors
M1:
-Autonomic Ganglia
-Gastric Glands
-Brain
M2:
-Heart
M3:
-GI Tract and Gallbladder
-Pupils
-Glands
-Blood Vessels
iii. What are the names of the cholinergic receptors?
-Nicotinic receptor
-Muscarinic receptor
viii. What is the name of a Cholinergic drug used to diagnosis myasthenia gravis?
-Edrophonium (Tensilon)
x. What are important nursing education points to share with patients taking a Cholinergic drug?
For Donepezil:
- Take as prescribed at Bedtime
- Place disintegrating tablet on tongue, allow to dissolve, then drink water
- Follow-up blood work is needed
- Eat small frequent meals to help with nausea and vomiting
For Bethanechol:
- Take this medicine on an empty stomach
- Report difficulty urinating to provider
- Report belching, substernal pressure, or pain to provider.
i. What are the autonomic effects of anti-cholinergic drugs?
- Urinary retention
- Dry throat, dry mouth, constipation
- Feeling hot, decreased sweating
- Tachycardia
- Blurred vision, dry eyes
- Sedation, dizziness, confusion, hallucinations
i. What autonomic response can you expect if Cholinergic receptors are stimulated?
-Parasympathetic Nervous system activated (rest)
-Dilation of blood vessels
-pupil constriction
-decreased HR and BP
-decreased respirations and o2 consumption
-digestion
iv. What are the names of 4 direct acting Cholinergic drugs and how are they used?
- Carbachol
- Pilocarpine
- Bethanechol
- Succinylcholine
v. What are the names of 4 indirect acting Cholinergic drugs and how are they used?
- Donepezil (Aricept)
- Edrophonium
- Pyridostigminne
- Rivastigmine (Exelon)
vii. What is the name of a cholinergic drug used to treat myasthenia gravis and how does the drug work?
Pyridostigmine (Mestinon)
-Indirect acting cholinergic drug
- Inhibits acetylcholinesterase
-Used for: improve muscle strength and reduce symptoms of MG, Reverse Neuromuscular Blocking Drugs, Severe overdose of Tricyclic Antidepressants, Toxic exposure to chemical warfare drugs
ix. What is a Cholinergic crisis, what are symptoms, how is it treated?
Antidote—Atropine followed by Pralidoxime.
-Overstimulation of the muscarinic and nicotinic receptors
- Related to inhibition of Acetylcholinesterase
- Exposure to nerve gas, pesticides, insecticides.
Salvation
Lacrimation
Urinary incontinence
Diarrhea
GI cramps
Emesis
Miosis