Cholinergic Drugs

DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM

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.

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

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 - more ACh 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

Cholinergic Drugs rest and digest system

SLUDGE
 Salivation  Lacrimation  Urinary incontinence  Diarrhea  Gastrointestinal cramps  Emesis

Cholinergic Drugs Drug Effects

 Stimulate intestine and bladder

Increased gastric secretions Increased gastrointestinal motility Increased urinary frequency  Stimulate pupils Constriction (miosis) Reduced intraocular pressure  Increased salivation and sweating
 Cardiovascular effects

Decreased heart rate Vasodilation  Respiratory effects Bronchial constriction, narrowed airways

Cholinergic Drugs Drugs

 Bethanechol (Urecholine) urinary retention  Cevimeline (Evoxac) Xerostomia  Memantine (Namenda) Alzheimer s dementia  Physostigmine (Antilirium) reversal of anticholinergic drugs effects  Pyridostigmine (Mestinon) Myasthenia gravis

Cholinergic Drugs Indications

Direct-acting drugs
 Reduce intraocular pressure  Topical useful for glaucoma and intraocular surgery
pilocarpine

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

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)

Cholinergic Drugs Indications

Indirect-acting drugs cevimeline (Evoxac)

 Used to treat xerostomia (dry mouth)

resulting from Sjgren s syndrome

Cholinergic Drugs Adverse Effects

Adverse effects are a result of overstimulation of the PSNS
 Cardiovascular Bradycardia, hypotension, conduction abnormalities (AV block and cardiac arrest)  CNS Headache, dizziness, convulsions  Gastrointestinal Abdominal cramps, increased secretions, nausea, vomiting  Respiratory Increased bronchial secretions, bronchospasm  Other Lacrimation, sweating, salivation, loss of binocular accommodation, miosis

Cholinergic Drugs Interactions

 Anticholinergics, antihistamines, sympathomimetics
Antagonize cholinergic drugs, resulting in decreased responses

 Other cholinergic drugs

Additive effects

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

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

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