Cholinergic+&+Cholinergic+Blocking+Drugs


 * Cholinergics ** and ** Anticholinergics **

...work on the Parasympathetic Nervous System =The Parasympathetic Nervous System (PNS) is a part of the autonomic nervous system and compliments the sympathetic nervous system (SNS). It promotes normal maintenance of the body, utilizes and rids of waste, and increases secretions and mobility of the digestive tract. Basically, it is used for "resting and digesting."=

** Cholinergic Agents ** (Wet as the ocean)

Cholinergic drugs are also known as cholinergic agonists. They mimic the effects of acetylcholine and stimulate the **parasympathetic nervous system**.

Mechanism of Action: **__ Direct-acting cholinergic agonists __** -Bind to cholinergic receptors, activating them. **__ Indirect-acting cholinergic agonists __** -Inhibit the enzyme cholinesterase which breaks down acetylcholine (these causes an increase in acetylcholine at the receptors).

** Why Use Direct-Acting Cholinergic Drugs? **  * __ Glaucoma __ : Reduces intraocular pressure

Which includes the drugs: **Acetylcholine**, **carbachol**, **pilocarpine** (poor oral absorption used topically).

__ Atony and Neurogenic Bladder __ : Increases tone and motility of bladder and GI tract. Which includes the drug: **Bethanechol (Urecholine)** (PO or SUB Q. Urination should occur within 60 minutes of administration).

** Why Use Indirect-Acting Cholinergic Drugs? **   * __ Myasthenia gravis __ :  Help with skeletal muscle contraction and inhibits the breakdown of acetylcholine.

Which include the drugs: **Pyridostigmine and Physostigmine.** Physostigmine is used as an antidote for anticholinergic poisoning (atropine) and common pesticide poisoning.

* __ Alzheimer's Disease __ : Prevents cognitive deterioration and increases concentrations of acetylcholine in the brain. Which includes the drug: **Donepezil (Aricept).** (Not a cure and may take up to 6 weeks to work).

** Contraindications (WHEN NOT TO USE): ** GI or GU tract obstruction Bradycardia Hyperthyroidism Epilepsy Hypotension COPD Parkinsons Disease

Side Effects:

<span style="color: blue; display: none; font-family: 'Arial','sans-serif'; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">Side Effects: <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">Bradycardia, hypotension, conduction abnormalities <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 10pt; text-indent: 0.5in;">Headache, dizziness, convulsions <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">Abdominal cramps, increased secretions, nausea, vomiting

Increased bronchial secretions, bronchospasms <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">

<span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">Other: Lacrimation, sweating, salivation, loss of binocular accommodation, miosis (pupil constriction)

** What drugs should you avoid when taking cholinergics? ** <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">-Anticholinergics <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">-Antihistamines <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">-Sympathomimetics <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">*Caution with other cholinergic agents-has additive effects

** What are signs and symptoms of toxicity? ** **// "SLUDGE" //** **// S //** alivation **// L //** acrimation **// U //** rinary incontinence **// D //** iarrhea **// G //** astrointestinal cramps **// E //** mesis

**__ Nursing Implications __** <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">-Medications should not be stopped abruptly and taken as ordered. <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">-Assess for presence of GI or GU obstructions, asthma, peptic ulcer disease, or coronary artery disease. <span style="color: #000000; font-family: Calibri; font-size: 18pt; line-height: 115%; margin: 0in 0in 0pt 0.5in;">-Patients with **myasthenia gravis should take their medication 30 minutes before eating to help improve chewing and swallowing.** ** -Monitor for therapeutic effects **

= Anticholinergic Agents = <span style="color: #8036db; display: block; font-size: 240%; line-height: 0px; overflow: hidden; text-align: center;"> = "Dry as the Desert" = =<span style="color: #40b890; font-family: Arial,Helvetica,sans-serif; font-size: 160%;">How do they work? = = Anticholinergic drugs block or inhibit the actions of acetylcholine (ACh) in the PNS = *Also called cholinergic blockers, parasympatholytics, or antimuscarinics

*Blocks and/or competes with ACh receptors *Inhibits nerve transmission at ACh receptors -->When ACh is blocked, the PNS is inhibited and the SNS is able to take over
 * <span style="color: #44ae8b; font-family: Arial,Helvetica,sans-serif; font-size: 20pt;">Mechanism(s) of Action **

<span style="font-family: Symbol,helvetica,sans-serif;">* Increases HR (in large doses) ||<  ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Increased HR, dysrhythmias || <span style="font-family: Symbol,helvetica,sans-serif;">* Dilates bronchial airways ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Exercise-induced bronchospasms <span style="font-family: Symbol,helvetica,sans-serif;">* Asthma <span style="font-family: Symbol,helvetica,sans-serif;">* Chronic bronchitis <span style="font-family: Symbol,helvetica,sans-serif;">* COPD ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Decreased bronchial secretions || <span style="font-family: Symbol,helvetica,sans-serif;">* Increases drowsiness, disorientation, and hallucinations (in large doses) ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Muscle rigidity <span style="font-family: Symbol,helvetica,sans-serif;">* Tremors <span style="font-family: Symbol,helvetica,sans-serif;">* Drug-induced EPS (and tardive dyskinesia) ||< *Excitation, restlessness, irritability, disorientation, hallucinations, and delirium || <span style="font-family: Symbol,helvetica,sans-serif;">* Decreases intestinal and gastric secretions <span style="font-family: Symbol,helvetica,sans-serif;">* Decreases motility and peristalsis ||<  ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Decreased salivation, GI motility, and gastric secretions || <span style="font-family: Symbol,helvetica,sans-serif;">* Increases constriction of internal sphincter <span style="font-family: Symbol,helvetica,sans-serif;">* Urinary retention ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Overactive bladder <span style="font-family: Symbol,helvetica,sans-serif;">* Urinary incontinence <span style="font-family: Symbol,helvetica,sans-serif;">* Reflex neurogenic bladder ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Urinary retention || <span style="font-family: Symbol,helvetica,sans-serif;">* Decreases accomodation ||<  ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Same as Drug Effects ||
 * <span style="color: #3dab83; font-family: Arial,Helvetica,sans-serif; font-size: 200%;">Drug effects (Therapeutic effects), Indications (Why take these drugs?), and Side Effects **
 * <  || ** Drug Effects ** ddddddddddddddddddddd || ** Indications ** ddddddddddddddd || ** Side Effects ** ddddddddddddddddd ||
 * ** Cardiovascular ** ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Lowers HR (in small doses)
 * ** Respiratory ** ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Decreases bronchial secretions
 * ** CNS ** ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Decreases muscle rigidity and tremors (in small doses)
 * ** GI ** ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Relaxes smooth muscle of GI tract
 * ** GU ** ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Relaxes detrussor muscle
 * ** Glandular ** ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Decreases bronchial secretions, salivation, and sweating ||<  ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Decreased sweating ||
 * ** Eye ** ||< <span style="font-family: Symbol,helvetica,sans-serif;">* Dilates pupils and increases ocular pressure

*Drug Allergy *Narrow-angle glaucoma *Acute asthma *Myasthenia gravis *Respiratory distress *Acute cardiovascular instability *GI/GU obstructions
 * <span style="color: #42ab82; font-family: Arial,Helvetica,sans-serif; font-size: 20pt;">Contraindications (Do not use if you have...) **

**Anticholinergic drugs can be "natural", like Scopolamine and Atropine, or synthetic like Benztropine, Dicyclomine, Oxybutynin, Tolteradine, and Glycopyrrolate.**
 * <span style="color: #45b391; font-family: Arial,Helvetica,sans-serif; font-size: 20pt;">Drugs **

//** Atropine **// *primarily used for CV disorders and sinus node dysfunction *symptomatic 2nd degree heart block *decreases secretions from nose, mouth, pharynx and bronchi *relaxes smooth muscle in bronchi and bronchioles, leading to bronchodilation and a decreased airway resistance //*Reversal drug for CHOLINERGIC overdose// // * // Antidote for Atropine overdose is Physostigmine

*Antiparkonsonian drug *Decreases muscle rigidity
 * // Benztropine (Cogentin) //**

*Treats: peptic ulcer disease, irritable bowel disease, and GI hypersecretory states
 * // Dicyclomine (Bentyl) //**

*Used preoperatively to decrease secretions (respiratory, GI, and salivation) during surgery
 * // Glycopyrrolate (Robinul) and Atropine //**

*Transdermal patch placed behind the ear *Prevention of motion sickness *Corrects imbalance of ACh and norepinephrine in the brain
 * // Scopolamine //**

*Treats incontinence and overactive bladder *Relaxes detrussor muscle and increases constriction of the internal sphincter *Treats reflex neurogenic bladder (Oxybutynin only)
 * // Tolteradine (Detrol) and Oxybutynin (Ditropan) //**

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*Antihistamines, phenothiazines, MAOI's and TCA's
 * <span style="color: #44be95; font-family: Arial,Helvetica,sans-serif; font-size: 20pt;">Drug Interactions (Do not use with...) **

* Assess for: BPH, glaucoma, MI, tachycardia, allergies, hiatal hernia and GI/GU obstruction(s) *Sensitivity to light and dry mouth may occur *High risk of heat stroke in geriatric patients, so limit higher temperatures, physical exertion, and/or exercise, and stress fluid and salt intake
 * <span style="color: #3ebe9a; font-family: Arial,Helvetica,sans-serif; font-size: 20pt;">Nursing Impications **

Report the following conditions to your physician: Urinary hesitancy and/or constipation, palpitations, tremors, confusion, sedation or amnesia, excessive dry mouth and fever

** GAME TIME!! ** ** Match the indication with the drug used to treat it! **

** 1.) **** Alzheimer's Disease ** ** 2.) **** Cardiac and Respiratory Disorders ** ** 3.) **** Atony and Neurogenic Bladder ** ** 4.) **** Prevent motion sickness ** ** 5.) **** Myasthenia gravis ** ** 6.) **** Peptic ulcer & IBD ** ** 7.) **** Glaucoma ** ** 8.) **** Parkinson's Disease ** ** 9.) **** Decrease secretions preoperatively ** ** 10.) **** Treat reflex neurogenic bladder (spinal cord injury) ** ** 11.) **** Incontinence-overactive bladder **

** a.) **** Glycopyrrolate (Robinul), Atropine ** ** b.) **** Donepezil (Aricept) ** ** c.) **** Acetylcholine, carbachol, pilocarpine ** ** d.) **** Benztropine (Cogentin) ** ** e.) **** Dicyclomine (Bentyl) ** ** f.) **** Oxybutynin (Ditropan) ** ** g.) **** Scopolamine ** ** h.) **** Bethanechol (Urecholine) ** ** i.) **** Atropine ** ** j.) **** Pyridostigmine, Physostigmine ** ** k.) **** Tolterodine (Detrol), Oxybutynin (Ditropan) **

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Reference : <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt; line-height: normal;">Anne, L., Rainforth, S., Harrington, S., & S., J. (2010). Pharmacology and the Nursing Process. St. Louis: Mosby.