Drugs Affecting the  Autonomic Nervous System Cholinergic Agents and Cholinergic Blocking Agents
Cholinergic Agents <ul><li>Drugs that stimulate the parasympathetic nervous system (PSNS) </li></ul><ul><li>The PSNS is th...
Cholinergic Agents <ul><li>Also known as </li></ul><ul><li>cholinergic agonists </li></ul><ul><li>or </li></ul><ul><li>par...
Instructors may wish to use  EIC Image #56: The Parasympathetic and  Sympathetic Nervous Systems  and  Their Relationships...
Cholinergic Agents <ul><li>Mimic the effects of the PSNS neurotransmitter </li></ul><ul><li>Acetylcholine (ACh) </li></ul>
Cholinergic Receptors <ul><li>Two types, determined by: </li></ul><ul><li>Location </li></ul><ul><li>Action once stimulate...
Nicotinic Receptors <ul><li>Located in the ganglia of both the  PSNS and SNS </li></ul><ul><li>Named “nicotinic” because c...
Muscarinic Receptors <ul><li>Located postsynaptically: </li></ul><ul><ul><li>Smooth muscle </li></ul></ul><ul><ul><li>Card...
Instructors may wish to  insert EIC Image #57:  The Sympathetic, Parasympathetic,  and Somatic Nervous Systems   <ul><li>T...
Adrenergic Agents:  Mechanism of Action <ul><li>Direct-acting (agonist) </li></ul><ul><ul><li>Bind to cholinergic receptor...
Adrenergic Agents:  Mechanism of Action <ul><li>Indirect-acting </li></ul><ul><ul><li>Inhibit the enzyme “cholinesterase” ...
Indirect-Acting Cholinergic Agents (Cholinesterase Inhibitors) <ul><li>Reversible </li></ul><ul><ul><li>Bind to cholineste...
Drug Effects of Cholinergic Agents <ul><li>Effects seen when the PSNS is stimulated. </li></ul><ul><li>The PSNS is the “re...
Drug Effects of Cholinergic Agents <ul><li>“SLUDGE” </li></ul><ul><li>S alivation </li></ul><ul><li>L acrimation </li></ul...
Drug Effects of Cholinergic Agents <ul><li>Stimulate intestine and bladder </li></ul><ul><ul><li>Increased gastric secreti...
Drug Effects of Cholinergic Agents <ul><li>Cardiovascular effects </li></ul><ul><ul><li>Decreased heart rate </li></ul></u...
Drug Effects of Cholinergic Agents <ul><li>At recommended doses, the cholinergics primarily affect the MUSCARINIC receptor...
Drug Effects of Cholinergic Agents <ul><li>DESIRED EFFECTS:  from muscarinic receptor stimulation </li></ul><ul><li>Many u...
Cholinergic Agents:  Therapeutic Uses <ul><li>Direct-Acting Agents </li></ul><ul><li>Reduce intraocular pressure </li></ul...
Cholinergic Agents:  Therapeutic Uses <ul><li>Direct-Acting Agent—bethanechol </li></ul><ul><li>Increases tone and motilit...
Cholinergic Agents:  Therapeutic Uses <ul><li>Indirect-Acting Agents </li></ul><ul><li>Cause skeletal muscle contractions ...
Cholinergic Agents:  Therapeutic Uses <ul><li>Indirect-Acting Agent—donepezil (Aricept) </li></ul><ul><li>Used in the trea...
Cholinergic Agents: Side Effects <ul><li>Side effects are a result of overstimulation  of the PSNS. </li></ul><ul><li>Card...
Cholinergic Agents:  Side Effects <ul><li>Side effects are a result of  overstimulation of the PSNS. </li></ul><ul><li>Res...
Cholinergic Agents:  Interactions <ul><li>Anticholinergics, antihistamines, sympathomimetics </li></ul><ul><li>Antagonize ...
Cholinergic Agents:   Nursing Implications <ul><li>Keep in mind that these agents will stimulate the PSNS and mimic the ac...
Cholinergic Agents:  Nursing Implications <ul><li>Medications should be taken as ordered  and not abruptly stopped.  </li>...
Cholinergic Agents:  Nursing Implications <ul><li>Encourage patients with myasthenia gravis to take medication 30 minutes ...
Cholinergic Agents:  Nursing Implications <ul><li>Atropine is the antidote for cholinergics.  It should be available in th...
Cholinergic Agents:  Nursing Implications <ul><li>Monitor for side effects, including: </li></ul><ul><li>Increased respira...
Cholinergic Agents:  Nursing Implications <ul><li>Monitor for therapeutic effects: </li></ul><ul><li>Alleviated signs and ...
Cholinergic Blocking Agents <ul><li>Drugs that block or inhibit the actions of acetylcholine (ACh) in the parasympathetic ...
Cholinergic Blocking Agents: Mechanism of Action <ul><li>Competitive antagonists </li></ul><ul><li>Compete with ACh </li><...
Cholinergic Blocking Agents: Mechanism of Action <ul><li>Once these drugs bind to receptors, they inhibit nerve transmissi...
Instructors may wish to use  EIC Image #58:  Site of Action of Cholinergic Blockers Within the PSNS
Cholinergic Blocking Agents: Chemical Class <ul><li>Natural Synthetic/Semisynthetic </li></ul><ul><li>atropine anisotropin...
Drug Effects of  Cholinergic Blocking Agents <ul><li>Cardiovascular </li></ul><ul><ul><li>Small doses:  decrease heart rat...
Drug Effects of  Cholinergic Blocking Agents <ul><li>Eye </li></ul><ul><ul><li>Dilated pupils (mydriasis) </li></ul></ul><...
Drug Effects of  Cholinergic Blocking Agents <ul><li>Genitourinary </li></ul><ul><ul><li>Relaxed detrusor muscle </li></ul...
Cholinergic Blocking Agents: Therapeutic Uses <ul><li>CNS   </li></ul><ul><li>Decreased muscle rigidity and muscle tremors...
Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Cardiovascular </li></ul><ul><li>Affect the heart’s conduction syste...
Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Atropine   </li></ul><ul><li>Used primarily for cardiovascular disor...
Cholinergic Blocking Agents: Therapeutic Uses  <ul><li>Respiratory </li></ul><ul><li>Blocking the cholinergic stimulation ...
Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Respiratory agents are used to treat: </li></ul><ul><li>Exercise-ind...
Cholinergic Blocking Agents: Therapeutic Uses  <ul><li>Gastrointestinal </li></ul><ul><li>PSNS controls gastric secretions...
Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Gastrointestinal agents are used to treat: </li></ul><ul><li>Peptic ...
Cholinergic Blocking Agents: Therapeutic Uses  <ul><li>Genitourinary </li></ul><ul><li>Relaxed detrusor muscles of the bla...
Cholinergic Blocking Agents:  Side Effects <ul><li>Body System Side/Adverse Effects </li></ul><ul><li>Cardiovascular Incre...
Cholinergic Blocking Agents:  Side Effects <ul><li>Body System Side/Adverse Effects </li></ul><ul><li>Eye Dilated pupils, ...
Cholinergic Blocking Agents:  Side Effects <ul><li>Body System Side/Adverse Effects </li></ul><ul><li>Genitourinary Urinar...
Cholinergic Blocking Agents:  Interactions <ul><li>Antihistamines, phenothiazines,  tricyclic antidepressants, MAOIs </li>...
Cholinergic Blocking Agents: Nursing Implications <ul><li>Keep in mind that these agents will block the action of ACh in t...
Cholinergic Blocking Agents:  Nursing Implications <ul><li>Medications should be taken exactly as prescribed  to have the ...
Cholinergic Blocking Agents: Nursing Implications <ul><li>When giving ophthalmic solutions, apply pressure to the inner ca...
Cholinergic Blocking Agents: Nursing Implications <ul><li>Anticholinergics may lead to higher risk for heat stroke due to ...
Cholinergic Blocking Agents: Nursing Implications <ul><li>Patients should report the following to their physician: urinary...
Cholinergic Agents:  Nursing Implications <ul><li>Monitor for therapeutic effects: </li></ul><ul><li>For patients with Par...
Cholinergic Blocking Agents:  Nursing Implications <ul><li>Monitor for side effects, including: </li></ul><ul><li>Constipa...
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NurseReview.Org - Cholinergic Blockers Updates (pharmacology summaries)

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NurseReview.Org - Cholinergic Blockers Updates (pharmacology summaries)

  1. 1. Drugs Affecting the Autonomic Nervous System Cholinergic Agents and Cholinergic Blocking Agents
  2. 2. Cholinergic Agents <ul><li>Drugs that stimulate the parasympathetic nervous system (PSNS) </li></ul><ul><li>The PSNS is the opposing system to the SNS </li></ul>
  3. 3. Cholinergic Agents <ul><li>Also known as </li></ul><ul><li>cholinergic agonists </li></ul><ul><li>or </li></ul><ul><li>parasympathomimetics </li></ul>
  4. 4. Instructors may wish to use EIC Image #56: The Parasympathetic and Sympathetic Nervous Systems and Their Relationships to One Another
  5. 5. Cholinergic Agents <ul><li>Mimic the effects of the PSNS neurotransmitter </li></ul><ul><li>Acetylcholine (ACh) </li></ul>
  6. 6. Cholinergic Receptors <ul><li>Two types, determined by: </li></ul><ul><li>Location </li></ul><ul><li>Action once stimulated </li></ul><ul><li>Nicotinic receptors and Muscarinic receptors </li></ul>
  7. 7. Nicotinic Receptors <ul><li>Located in the ganglia of both the PSNS and SNS </li></ul><ul><li>Named “nicotinic” because can be stimulated by the alkaloid nicotine </li></ul>
  8. 8. Muscarinic Receptors <ul><li>Located postsynaptically: </li></ul><ul><ul><li>Smooth muscle </li></ul></ul><ul><ul><li>Cardiac muscle </li></ul></ul><ul><ul><li>Glands of parasympathetic fibers </li></ul></ul><ul><ul><li>Effector organs of cholinergic sympathetic fibers </li></ul></ul><ul><li>Named “muscarinic” because can be stimulated by the alkaloid muscarine </li></ul>
  9. 9. Instructors may wish to insert EIC Image #57: The Sympathetic, Parasympathetic, and Somatic Nervous Systems <ul><li>This slide illustrates location of the nicotinic and muscarinic receptors within the PSNS. </li></ul>
  10. 10. Adrenergic Agents: Mechanism of Action <ul><li>Direct-acting (agonist) </li></ul><ul><ul><li>Bind to cholinergic receptors, causing stimulation </li></ul></ul>Lisa L. Hernandez: Is there copy missing at the end? Inhibiting what? HHS: HHS:
  11. 11. Adrenergic Agents: Mechanism of Action <ul><li>Indirect-acting </li></ul><ul><ul><li>Inhibit the enzyme “cholinesterase” </li></ul></ul><ul><ul><li>Result: more ACh is available at the receptors </li></ul></ul>
  12. 12. Indirect-Acting Cholinergic Agents (Cholinesterase Inhibitors) <ul><li>Reversible </li></ul><ul><ul><li>Bind to cholinesterase for a period of minutes to hours </li></ul></ul><ul><li>Irreversible </li></ul><ul><ul><li>Bind to cholinesterase and form a permanent covalent bond </li></ul></ul><ul><ul><li>The body must make new cholinesterase </li></ul></ul>
  13. 13. Drug Effects of Cholinergic Agents <ul><li>Effects seen when the PSNS is stimulated. </li></ul><ul><li>The PSNS is the “rest and digest” system. </li></ul>
  14. 14. Drug Effects of Cholinergic Agents <ul><li>“SLUDGE” </li></ul><ul><li>S alivation </li></ul><ul><li>L acrimation </li></ul><ul><li>U rinary incontinence </li></ul><ul><li>D iarrhea </li></ul><ul><li>G astrointestinal cramps </li></ul><ul><li>E mesis </li></ul>
  15. 15. Drug Effects of Cholinergic Agents <ul><li>Stimulate intestine and bladder </li></ul><ul><ul><li>Increased gastric secretions </li></ul></ul><ul><ul><li>Increased gastrointestinal motility </li></ul></ul><ul><ul><li>Increased urinary frequency </li></ul></ul><ul><li>Stimulate pupil </li></ul><ul><ul><li>Constriction (miosis) </li></ul></ul><ul><ul><li>Reduced intraocular pressure </li></ul></ul><ul><li>Increased salivation and sweating </li></ul>
  16. 16. Drug Effects of Cholinergic Agents <ul><li>Cardiovascular effects </li></ul><ul><ul><li>Decreased heart rate </li></ul></ul><ul><ul><li>Vasodilation </li></ul></ul><ul><li>Respiratory effects </li></ul><ul><ul><li>Bronchial constriction, narrowed airways </li></ul></ul>
  17. 17. Drug Effects of Cholinergic Agents <ul><li>At recommended doses, the cholinergics primarily affect the MUSCARINIC receptors. </li></ul><ul><li>At high doses, cholinergics stimulate the NICOTINIC receptors. </li></ul>
  18. 18. Drug Effects of Cholinergic Agents <ul><li>DESIRED EFFECTS: from muscarinic receptor stimulation </li></ul><ul><li>Many undesirable effects are due to stimulation of the nicotinic receptors </li></ul>
  19. 19. Cholinergic Agents: Therapeutic Uses <ul><li>Direct-Acting Agents </li></ul><ul><li>Reduce intraocular pressure </li></ul><ul><li>Useful for glaucoma and intraocular surgery </li></ul><ul><li>Examples: acetylcholine, carbachol, pilocarpine </li></ul><ul><li>Topical application due to poor oral absorption </li></ul>
  20. 20. Cholinergic Agents: Therapeutic Uses <ul><li>Direct-Acting Agent—bethanechol </li></ul><ul><li>Increases tone and motility of bladder and GI tract </li></ul><ul><li>Relaxes sphincters in bladder and GI tract, allowing them to empty </li></ul><ul><li>Helpful for postsurgical atony of the bladder and GI tract </li></ul><ul><li>Oral dose or SC injection </li></ul>
  21. 21. Cholinergic Agents: Therapeutic Uses <ul><li>Indirect-Acting Agents </li></ul><ul><li>Cause skeletal muscle contractions </li></ul><ul><li>Used for diagnosis and treatment of myasthenia gravis </li></ul><ul><li>Used to reverse neuromuscular blocking agents </li></ul><ul><li>Used to reverse anticholinergic poisoning (antidote) </li></ul><ul><li>Examples: physostigmine, pyridostigmine </li></ul>
  22. 22. Cholinergic Agents: Therapeutic Uses <ul><li>Indirect-Acting Agent—donepezil (Aricept) </li></ul><ul><li>Used in the treatment of mild to moderate Alzheimer’s disease. </li></ul><ul><li>Helps to increase or maintain memory and learning capabilities. </li></ul>
  23. 23. Cholinergic Agents: Side Effects <ul><li>Side effects are a result of overstimulation of the PSNS. </li></ul><ul><li>Cardiovascular: </li></ul><ul><ul><li>Bradycardia, hypotension, conduction abnormalities (AV block and cardiac arrest) </li></ul></ul><ul><li>CNS: </li></ul><ul><ul><li>Headache, dizziness, convulsions </li></ul></ul><ul><li>Gastrointestinal: </li></ul><ul><ul><li>Abdominal cramps, increased secretions, nausea, vomiting </li></ul></ul>
  24. 24. Cholinergic Agents: Side Effects <ul><li>Side effects are a result of overstimulation of the PSNS. </li></ul><ul><li>Respiratory: </li></ul><ul><ul><li>Increased bronchial secretions, bronchospasms </li></ul></ul><ul><li>Other: </li></ul><ul><ul><li>Lacrimation, sweating, salivation, loss of binocular accommodation, miosis </li></ul></ul>
  25. 25. Cholinergic Agents: Interactions <ul><li>Anticholinergics, antihistamines, sympathomimetics </li></ul><ul><li>Antagonize cholinergic agents, resulting in decreased responses </li></ul>
  26. 26. Cholinergic Agents: Nursing Implications <ul><li>Keep in mind that these agents will stimulate the PSNS and mimic the action of ACh. </li></ul><ul><li>Assess for allergies, presence of GI or GU obstructions, asthma, peptic ulcer disease, or coronary artery disease. </li></ul><ul><li>Perform baseline assessment of VS and systems overview. </li></ul>
  27. 27. Cholinergic Agents: Nursing Implications <ul><li>Medications should be taken as ordered and not abruptly stopped. </li></ul><ul><li>The doses should be spread evenly apart to optimize the effects of the medication. </li></ul><ul><li>Overdosing can cause life-threatening problems. Patients should not adjust the dosages unless directed by the physician. </li></ul>
  28. 28. Cholinergic Agents: Nursing Implications <ul><li>Encourage patients with myasthenia gravis to take medication 30 minutes before eating to help improve chewing and swallowing. </li></ul><ul><li>When donepezil is prescribed for Alzheimer’s disease, be honest with caregivers and patients that the drug is for management of symptoms, not for a cure. </li></ul><ul><li>Therapeutic effects of donepezil may not occur for up to 6 weeks. </li></ul>
  29. 29. Cholinergic Agents: Nursing Implications <ul><li>Atropine is the antidote for cholinergics. It should be available in the patient’s room for immediate use if needed. </li></ul><ul><li>Patients should notify their physician if they experience muscle weakness, abdominal cramps, diarrhea, or difficulty breathing. </li></ul>
  30. 30. Cholinergic Agents: Nursing Implications <ul><li>Monitor for side effects, including: </li></ul><ul><li>Increased respiratory Abdominal cramping secretions </li></ul><ul><li>Bronchospasms Dysrhythmias </li></ul><ul><li>Difficulty breathing Hypotension </li></ul><ul><li>Nausea and vomiting Bradycardia </li></ul><ul><li>Diarrhea Increased sweating </li></ul><ul><li>Increase in frequency and urgency of voiding patterns </li></ul>
  31. 31. Cholinergic Agents: Nursing Implications <ul><li>Monitor for therapeutic effects: </li></ul><ul><li>Alleviated signs and symptoms of myasthenia gravis </li></ul><ul><li>In postoperative patients with decreased GI peristalsis, look for: </li></ul><ul><ul><li>Increased bowel sounds </li></ul></ul><ul><ul><li>Passage of flatus </li></ul></ul><ul><ul><li>Occurrence of bowel movements </li></ul></ul><ul><li>In patients with urinary retention/hypotonic bladder, urination should occur within 60 minutes of bethanecol administration </li></ul>
  32. 32. Cholinergic Blocking Agents <ul><li>Drugs that block or inhibit the actions of acetylcholine (ACh) in the parasympathetic nervous system (PSNS) </li></ul>
  33. 33. Cholinergic Blocking Agents: Mechanism of Action <ul><li>Competitive antagonists </li></ul><ul><li>Compete with ACh </li></ul><ul><li>Block ACh at the muscarinic receptors in the PSNS </li></ul><ul><ul><li>As a result, ACh is unable to bind to the receptor site and cause a cholinergic effect. </li></ul></ul>
  34. 34. Cholinergic Blocking Agents: Mechanism of Action <ul><li>Once these drugs bind to receptors, they inhibit nerve transmission at these receptors. </li></ul>
  35. 35. Instructors may wish to use EIC Image #58: Site of Action of Cholinergic Blockers Within the PSNS
  36. 36. Cholinergic Blocking Agents: Chemical Class <ul><li>Natural Synthetic/Semisynthetic </li></ul><ul><li>atropine anisotropine clidinium </li></ul><ul><li>belladonna dicyclomine glycopyrrolate </li></ul><ul><li>hyoscyamine hexocyclium homatropine </li></ul><ul><li>scopolamine ipratropium isopropamide </li></ul><ul><li>oxybutynin propantheline </li></ul><ul><li>tolterodine tridihexethyl </li></ul>
  37. 37. Drug Effects of Cholinergic Blocking Agents <ul><li>Cardiovascular </li></ul><ul><ul><li>Small doses: decrease heart rate </li></ul></ul><ul><ul><li>Large doses: increase heart rate </li></ul></ul><ul><li>CNS </li></ul><ul><ul><li>Small doses: decrease muscle rigidity and tremors </li></ul></ul><ul><ul><li>Large doses: drowsiness, disorientation, hallucinations </li></ul></ul>
  38. 38. Drug Effects of Cholinergic Blocking Agents <ul><li>Eye </li></ul><ul><ul><li>Dilated pupils (mydriasis) </li></ul></ul><ul><ul><li>Decreased accommodation due to paralysis of ciliary muscles (cycloplegia) </li></ul></ul><ul><li>Gastrointestinal </li></ul><ul><ul><li>Relax smooth muscle tone of GI tract </li></ul></ul><ul><ul><li>Decrease intestinal and gastric secretions </li></ul></ul><ul><ul><li>Decrease motility and peristalsis </li></ul></ul>
  39. 39. Drug Effects of Cholinergic Blocking Agents <ul><li>Genitourinary </li></ul><ul><ul><li>Relaxed detrusor muscle </li></ul></ul><ul><ul><li>Increased constriction of internal sphincter </li></ul></ul><ul><ul><li>Result: urinary retention </li></ul></ul><ul><li>Glandular </li></ul><ul><ul><li>Decreased bronchial secretions, salivation, sweating </li></ul></ul><ul><li>Respiratory </li></ul><ul><ul><li>Decreased bronchial secretions </li></ul></ul><ul><ul><li>Dilated bronchial airways </li></ul></ul>
  40. 40. Cholinergic Blocking Agents: Therapeutic Uses <ul><li>CNS </li></ul><ul><li>Decreased muscle rigidity and muscle tremors </li></ul><ul><li>Parkinson’s disease </li></ul><ul><li>Drug-induced extrapyramidal reactions </li></ul>
  41. 41. Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Cardiovascular </li></ul><ul><li>Affect the heart’s conduction system </li></ul><ul><li>Low doses: slow the heart rate </li></ul><ul><li>High doses: block inhibitory vagal effects on the SA and AV node pacemaker cells </li></ul><ul><ul><li>Result: increased heart rate </li></ul></ul>
  42. 42. Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Atropine </li></ul><ul><li>Used primarily for cardiovascular disorders </li></ul><ul><li>Sinus node dysfunction </li></ul><ul><li>Symptomatic second-degree heart block </li></ul><ul><li>Sinus bradycardia with hemodynamic compromise (advanced life support) </li></ul>
  43. 43. Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Respiratory </li></ul><ul><li>Blocking the cholinergic stimulation of the PSNS allows unopposed action of the SNS. </li></ul><ul><li>Results: </li></ul><ul><ul><li>Decreased secretions from nose, mouth, pharynx, bronchi </li></ul></ul><ul><ul><li>Relaxed smooth muscles in bronchi and bronchioles </li></ul></ul><ul><ul><li>Decreased airway resistance </li></ul></ul><ul><ul><li>Bronchodilation </li></ul></ul>
  44. 44. Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Respiratory agents are used to treat: </li></ul><ul><li>Exercise-induced bronchospasms </li></ul><ul><li>Chronic bronchitis </li></ul><ul><li>Asthma </li></ul><ul><li>Chronic obstructive pulmonary disease </li></ul>
  45. 45. Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Gastrointestinal </li></ul><ul><li>PSNS controls gastric secretions and smooth muscles that produce gastric motility. </li></ul><ul><li>Blockade of PSNS results in: </li></ul><ul><ul><li>Decreased secretions </li></ul></ul><ul><ul><li>Relaxation of smooth muscle </li></ul></ul><ul><ul><li>Decreased GI motility and peristalsis </li></ul></ul>
  46. 46. Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Gastrointestinal agents are used to treat: </li></ul><ul><li>Peptic ulcer disease </li></ul><ul><li>Irritable bowel disease </li></ul><ul><li>GI hypersecretory states </li></ul>
  47. 47. Cholinergic Blocking Agents: Therapeutic Uses <ul><li>Genitourinary </li></ul><ul><li>Relaxed detrusor muscles of the bladder </li></ul><ul><li>Increased constriction of the internal sphincter </li></ul><ul><li>Reflex neurogenic bladder </li></ul><ul><li>Incontinence </li></ul>
  48. 48. Cholinergic Blocking Agents: Side Effects <ul><li>Body System Side/Adverse Effects </li></ul><ul><li>Cardiovascular Increased heart rate, dysrhythmias </li></ul><ul><li>CNS CNS excitation, restlessness, irritability, disorientation, hallucinations, delirium </li></ul>
  49. 49. Cholinergic Blocking Agents: Side Effects <ul><li>Body System Side/Adverse Effects </li></ul><ul><li>Eye Dilated pupils, decreased visual accommodation, increased intraocular pressure </li></ul><ul><li>Gastrointestinal Decreased salivation, decreased gastric secretions, decreased motility </li></ul>
  50. 50. Cholinergic Blocking Agents: Side Effects <ul><li>Body System Side/Adverse Effects </li></ul><ul><li>Genitourinary Urinary retention </li></ul><ul><li>Glandular Decreased sweating </li></ul><ul><li>Respiratory Decreased bronchial secretions </li></ul>
  51. 51. Cholinergic Blocking Agents: Interactions <ul><li>Antihistamines, phenothiazines, tricyclic antidepressants, MAOIs </li></ul><ul><li>When given with cholinergic blocking agents, cause ADDITIVE cholinergic effects, resulting in increased effects </li></ul>
  52. 52. Cholinergic Blocking Agents: Nursing Implications <ul><li>Keep in mind that these agents will block the action of ACh in the PSNS. </li></ul><ul><li>Assess for allergies, presence of BPH, glaucoma, tachycardia, MI, CHF, hiatal hernia, and GI or GU obstruction. </li></ul><ul><li>Perform baseline assessment of VS and systems overview. </li></ul>
  53. 53. Cholinergic Blocking Agents: Nursing Implications <ul><li>Medications should be taken exactly as prescribed to have the maximum therapeutic effect. </li></ul><ul><li>Overdosing can cause life-threatening problems. </li></ul><ul><li>Blurred vision may cause problems with driving or operating machinery. </li></ul><ul><li>Patients may experience sensitivity to light and may want to wear dark glasses or sunglasses. </li></ul>
  54. 54. Cholinergic Blocking Agents: Nursing Implications <ul><li>When giving ophthalmic solutions, apply pressure to the inner canthus to prevent systemic absorption. </li></ul><ul><li>Dry mouth may occur; can be handled by chewing gum, frequent mouth care, and hard candy. </li></ul><ul><li>Check with physician before taking any other medication, including OTC medications. </li></ul><ul><li>ANTIDOTE for atropine is physostigmine salicylate (Antilirium). </li></ul>
  55. 55. Cholinergic Blocking Agents: Nursing Implications <ul><li>Anticholinergics may lead to higher risk for heat stroke due to effects on heat-regulating mechanisms. </li></ul><ul><li>Teach patients to limit physical exertion, and avoid high temperatures and strenuous exercise. </li></ul><ul><li>Emphasize the importance of adequate fluid and salt intake. </li></ul>
  56. 56. Cholinergic Blocking Agents: Nursing Implications <ul><li>Patients should report the following to their physician: urinary hesitancy and/or retention, constipation, palpitations, tremors, confusion, sedation or amnesia, excessive dry mouth (especially if they have chronic lung infections or disease), or fever </li></ul>
  57. 57. Cholinergic Agents: Nursing Implications <ul><li>Monitor for therapeutic effects: </li></ul><ul><li>For patients with Parkinson’s disease: fewer tremors and decreased salivation and drooling </li></ul><ul><li>For patients with peptic ulcer disease: decreased abdominal pain </li></ul>
  58. 58. Cholinergic Blocking Agents: Nursing Implications <ul><li>Monitor for side effects, including: </li></ul><ul><li>Constipation Tachycardia </li></ul><ul><li>Tremors Confusion </li></ul><ul><li>Hallucinations Sedation </li></ul><ul><li>Urinary retention Hot, dry skin </li></ul><ul><li>Fever </li></ul><ul><li>CNS depression (occurs with large doses of atropine) </li></ul>

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