2. Cholinergic Drugs
Describe the cholinergic drug effects on major
body systems.
Discuss the nursing process related to the care
of patients receiving cholinergic drugs for select
problems.
3. Cholinergic Drugs
Drugs that stimulate the
parasympathetic nervous system (PSNS)
opposing system to the SNS
Known as: cholinergic agonists or parasympathomimetics
Mimic the effects of the PSNS neurotransmitter:
acetylcholine (Ach)
Two types of Receptors:
determined by: Location & Action once stimulated
Muscarinic receptors – recommended doses with desired effect
Nicotinic receptors – higher doses with undesirable effects
4.
5. Cholinergic Drugs
Mechanism of Action
Direct-acting cholinergic agonists
Bind to cholinergic receptors, activating them
Indirect-acting cholinergic agonists
Inhibit the enzyme acetylcholinesterase - preventing,
which breaks down ACh - moreACh is available at the
receptors
Reversible - Bind to cholinesterase for a period of
minutes to hours
Irreversible - Bind to cholinesterase and form a
permanent covalent bond
The body must make new cholinesterase to break these
bonds
10. Cholinergic Drugs
Indications
Direct-acting drug—bethanechol (Urecholine)
Increases tone and motility of bladder and GI tract
Relaxes sphincters in bladder and GI tract, allowing
them to empty
Used to reverse postsurgical atony of the bladder
and GI tract
Oral dose or SC injection
11. Cholinergic Drugs
Indications
Indirect-acting drugs
Cause skeletal muscle contractions
Used for diagnosis and treatment of myasthenia gravis
Pyridostigmine (Mestinon) – Myasthenia gravis
Used to reverse neuromuscular blocking drugs/anesthesia
Used to reverse anticholinergic poisoning (antidote)
Examples: physostigmine (Antilirium)
15. Cholinergic Drugs
Nursing Implications
Assess for allergies, presence of GI or GU obstructions, asthma, peptic
ulcer disease, or coronary artery disease
Perform baseline assessment of vital signs and systems overview
Medications should be taken as ordered and not abruptly stopped
The doses should be spread evenly apart to optimize the effects of
the medication
Overdosing can cause life-threatening problems. Only physicians
should adjust the dosages
16. Cholinergic Drugs
Nursing Implications
Encourage patients with myasthenia gravis to take
medication 30 minutes before eating to help improve
chewing and swallowing
When cholinergic drugs are prescribed for Alzheimer’s
disease, be honest with caregivers and patients that the
drugs are for management of symptoms, not a cure
Therapeutic effects of anti-Alzheimer’s drugs may not
occur for up to 6 weeks
17. Cholinergic Drugs
Nursing Implications
Monitor for therapeutic effects
Alleviated signs and symptoms of myasthenia gravis
In postoperative patients with decreased GI peristalsis, look
for:
Increased bowel sounds
Passage of flatus
Occurrence of bowel movements
In patients with urinary retention/hypotonic bladder,
urination should occur within 60 minutes of
bethanechol administration
ALSO monitor for adverse effects