Chapter 19 Study guide

Bethanechol chloride

- cholinergic: parasympathomimetic -Primarily used to increase urination in the -treatment of urinary retention and neurogenic bladder -promotes contraction of the bladder -increases GI secretions and peristalsis -pupillary constriction -bronchoconstriction -should be taken on an empty stomach -use cautiously with patients with low BP and HR

The nurse is taking care of five patients in the emergency department. Which patient(S) would be candidates to receive atropine? (Select all that apply) A. 25 year old having surgery for appendicitis B. 42 year old with a heart rate of 38 beats/min and dizziness C. 50 year old with diarrhea D. 61 year old with urinary retention E. 68 year old wit gastric ulcers

A. 25 year old having surgery for appendicitis B. 42 year old with heart rate of 38 beats/min and dizziness

The pediatric patient has urinary retention. Which cholinergic drug does the nurse anticipate will be prescribed to increase urination? A. Bethanechol B. Edrophonium chloride C. Metoclopramide D. Neostigmine bromide

A. Bethanechol (Urecholine)

Anticholinergic drugs are contraindication in patients with which other disease processes? (select all that apply) A. coronary artery disease B. Diabetes mellitus C. GI obstruction D. Supra-ventricular tachycardia

A. Coronary artery disease C. GI obstruction D. supra-ventricular tachycardia

How does the body respond to large doses of cholinergic drugs? (select all that apply) A. Decreased blood pressure B. Decreased salivation C. Increase bronchial secretions D. Mydriasis E. Urinary retention

A. Decreased blood pressure C. increase bronchial secretions

A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication? A. asthma B. hypetension C. diabetes mellitus D. chronic allergies

A. asthma

What teaching points will the nurse include for a 30 year old patient whois taking hyoscyamine for IBS? (select all that apply) A. ensure adequate fluid intake B. Don't drive until you are aware of how this medication will affect your vision C. Sucking on hard candy may help with dry mouth D. Increased sweating is a common side effect E. Report a rapid heart rate to your health care provider

A. ensure adequate fluid intake B. don't drive until you are aware of how this medication will affect your vision C. sucking on hard candy may help with dry mouth E. report a rapid heart rate to your health care provider

Stimulates muscarinic receptors

Acetylcholine

Blocks the breakdown of acetylcholine

Anti-cholinesterase

Blocks the action of acetylcholine

Anticholinergic

Which type of medication is Bethanechol? A. Anticholinergic B. Cholinergic agonist C. Cholinesterase agonist D.Sympatholytics

B. Cholinergic agonist

The patient is scheduled for a comprehensive eye examination. Anticholinergic eyedrops are used for which purpose? A. Constrict the pupils B. Dilate the pupils C. Decrease the intraocular pressure D. Detect astigmatism

B. Dilate the pupils

The older adult patient is taking benztropine (cogent)for symptoms associated with Parkinsonism. The nurse will instruct the patient to report which clinical manifestation to the health care provider? (select all that apply) A. diarrhea B. dizziness C. hallucinations D. hyperthermia E. Palpitations

B. Dizziness C. hallucinations D. hyperthermia E. palpitations

A patient is prescribed scopolamine (transform scop). It is most important for the nurse to assess the patient for a history of which condition? A.diabetes mellitus B. Glaucoma C. Allergy to penicillin D. Gastric ulcer

B. Glaucoma

A nurse has just administered atropine to a patient. It is most important for the nurse to assess the patient for the development of which effect? A. Nausea B. tachycardia C. rales D. hypotension

B. tachycardia

How does bethanechol work in the body? A. Inhibits muscarinic receptors B. Inhibits nicotinic receptors C. Stimulates muscarinic receptors D. Stimulates nicotinic receptors

C. Stimulates muscarinic receptors

The patient is admitted for evaluation for peptic ulcers. She is taking propantheline three times a day. The nurse is teaching this patient about nutrition while taking the medication. The priority nutrition teaching point is that the patient should eat foods that are high in which component? A. calcium B. fat C. fiber D. protein

C. fiber

The 80-year old patient has glaucoma and is prescribed an anticholinergic drug. What is the nurse's priority action? A. Administer the medication as ordered after verfiying the patient's identity B. Give only one-half of the prescribed dose C. Hold the dose and contact the health care provider D. Wait until after the patient has taken glaucoma medication and then give the medication

C. hold the dose and contact the health care provider

A patient received atropine as a preoperative medication 30 minutes ago. The nurse evaluates the medication as effective if the patient states? A. I feel like I need to throw up B. I need to urinate C. My mouth feels dry D. I have a headache

C. my mouth feels dry

Which medication treats myasthenia gravis by increasing muscle strength? A. Bethanechol B. Edrophonium Chloride C. Neostigmine bromide (prostigmin) D. pilocarpine

C. neostigmine bromide

The patient has been prescribed bethanechol and asks the nurse how it works. What is the nurse's best response? A. Drug decreases bladder tone B. This drug inhibits bladder contraction C. This drug promotes contraction of the bladder D. This stimulates urine production

C. this drug promotes contraction of the bladder

A patient has received atropine, it is most important for the nurses to assess the patient for? A. anxiety B. constipation C. urinary retention D. impaired oral mucous membrane

C. urinary retention

Types of drugs that stimulate the parasympathetic system

Cholinergic

Causes the breakdown of acetylcholine

Cholinesterase

The nurse would question an order for atropine for which patient? A. a 35 year old with peptic ulcer B. 50 year old with parkinsonism C. 55 year old with cirrhosis D. 60 year old with glaucoma

D. 60 year old with glaucoma

The patient has ingested an organophosphate poison in a suicide attempt. What medication does the nurse anticipate the health care provider will order to treat this patient? A. Bethanechol (Urecholine) B. Edrophonium chloride (tensilon) C. Metoclopramide ( reglan) D. Pralidoxime CI (protopam)

D. Pralidoxime CI

The patient has been taking bethanechol and is experiencing flushing, sweating, nausea, and abdominal cramps. What is the nurse's best action? A. Document the patient's manifestations B. Give the patient a laxative C. Increase the patient's fluid intake D. Prepare to administer atropine

D. Prepare to administer atropine

The patient has been prescribed bethanechol and is experiencing decreased urinary output. What is the nurse's priority action? A. Catheterize the patient to drain the bladder and measure output B. Encourage the patient to increase urinary output C. Encourage the patient to relax when urinating D. Notify health care provider with current intake and output values

D. notify health care provider with current intake and output values

A specific group of anticholinergics may be prescribed in the early treatment of which neuromuscular disorder? A. multiple sclerosis B. muscular dystrophy C. Myasthenia gravis D. Parkinsonism

D. parkinsonism

Atropine is most useful in the treatment of which cardiovascular condition? A. ventricular fibrillation B. First degree heart block C. Premature atrial contraction D. sinus bradycardia

D. sinus bradycardia

Stimulates smooth muscle and slows heart reate

Muscarinic receptor

Impacts skeletal muscle

Nicotinic receptor

Mimics the cholinergic actions

Parasympathomimetic

Direct-acting cholinergic agonists

act on receptors to activate a tissue response primarily selective to muscarinic receptors Bethanechol chloride Metoclopramide HCL

Nonselective clolinergic agonists

affects muscarinic and nicotinic receptors

Selective cholinergic agonists

affects only muscarinic receptors

Atropine

anticholinergic: parasympatholytics act on muscarinic receptors pre-operative medication to decrease salivary secretions and to increase HR when bradycardia is present antidote for bethanechol overdose dilate pupils for eye exam

Tolterodine tartrate ( detrol)

antimuscarinic: anticholinergic blocks muscarinic receptors in the urinary bladder to decrease urinary frequency, urgency, incontinence Contraindications: urinary and gastic retention, narrow-angle glaucoma; lactation Cautions: narrow-angle glaucoma; urinary bladder outflow obstruction

Benztropine

antiparkinson: anticholinergic agent blocks muscarinic receptors; reduce excess involuntary movement Contraindications: closed-angle glaucoma; psychosis, myasthenia gravis Caution: children younger than 3; tachycardia, cardiac disease, neuropathy

Bethanechol chloride contraindications

asthma COPD bradycardia hypotension peptic ulcer Parkinsonism hyperthyroidism

Bethanechol chloride antidote

atropine

Pilocarpine

direct-acting cholinergic agonist constricts the pupils promotes drainage of aqueous humor treat glaucoma

Metoclopramide HCL (Reglan)

direct-acting cholinergic agonists prescribed to treat GERD accelerates gastric emptying time

Benztropine side effects

dry mouth blurred vision depression tachycardia palpitations urinary retention photophobia

Atropine side effects

dry mouth dry skin mydriasis blurred vision photophobia urinary retention constipation tachycardia hypotension coma steven-johnson syndrome ventricular fibrillation

Tolterodine Tartrate (detrol) side effects

dry mouth, eyes, skin urinary retention weight gain dysuria constipation hypertension bronchitis vertigo dizziness

Indirect-acting cholinergic agonists

inhibit the action of enzyme cholinesterase permitting acetylcholine to persist and attach to the receptor do not act on receptors

Bethanechol chloride side effects

miosis blurred vision frequent urination salivation orthostatic hypotension bradycardia heart block cardiac arrest acute asthma attack

Anticholinergics

parasympatholytics drugs that inhibit the actions of acetylcholine by occupying the acetylcholine receptors decrease GI motility decrease in salivation dilation of pupils increase pulse rate decrease bladder contraction can acts as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion

Irreversible cholinesterase inhibitors

potent agents because of long lasting effects produce pupillary constriction

Reversible cholinesterase inhibitors

produce pupillary constriction in glaucoma increase muscle strength in patients with myasthenia graves Ex: physostigmine Caution: bradycardia, asthma peptic ulcers, hyperthyroidism contraindications; urinary or intestinal obstruction

Antiparkinson-anticholinergic drugs

selected decrease involuntary movement, tremors, muscle rigidity affect the CNS Ex: benztropine

Effects of cholinergic agonists

stimulate bladder and Gastrointestinal tone, constrict the pupils (miosis) increase neuromuscular transmission decrease HR and BP Increase salivation, GI, bronchial glandular secretions

Cholinergic agonists

stimulate the parasympathetic nervous system mimic acetylcholine