McCuistion Ch 16: Cholinergic Agonists and Antagonists

ANS: b. Dizziness c. Hallucinations d. Hyperthermia e. Palpitations Common side effects of anticholinergic drugs, like benztropine, may include dry mouth, constipation, and urinary retention. Dizziness and hallucinations should be reported to the health care provider because these may become dangerous to the client. Because there is a decreased ability to perspire, life-threatening hyperthermia may develop. Palpitations may be due to tachycardia.

27. The older adult client is taking benztropine for symptoms associated with parkinsonism. The nurse will instruct the client to report which clinical manifestation(s) to the health care provider? (Select all that apply.) a. Diarrhea b. Dizziness c. Hallucinations d. Hyperthermia e. Palpitations

ANS: Hold the dose and contact the healthcare provider. Anticholinergic drugs are contraindicated in a client with glaucoma because they increase the intraocular pressure. Therefore, the nurse should hold the drug and contact the prescriber.

A client with narrow-angle glaucoma is prescribed an anticholinergic drug. Which action would be a priority by the nurse? a. Administer the medication as ordered after verifying 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 drug.

ANS: Parkinsonism Anticholinergics, such as biperiden and benztropine, are used to treat early Parkinson. Anticholinesterase, not anticholinergics, are used to treat myasthenia gravis.

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

ANS: -coronary artery disease -gastrointestinal obstruction -supraventricular tachycardia Anticholinergic drugs block the normal parasympathetic responses of the pupils, lungs, heart, blood vessels, gastrointestinal tract, bladder, and salivary glands. Therefore, anticholinergic drugs are contraindicated in clients with any heart disease and diabetes mellitus.

Anticholinergic drugs are contraindicated in clients with which disease processes? (Select all that apply.) a. Coronary artery disease b. Diabetes mellitus c. Gastrointestinal obstruction d. Supraventricular tachycardia

ANS: dilate the pupils Anticholinergics inhibit the acetylcholine receptors and include muscarinic and nicotinic receptors. Anticholinergic eyedrops causes dilated pupils (mydriasis). Cholinergic agonists will constrict pupils. Direct-acting cholinergic agonists will decrease intraocular pressure.

Anticholinergic eyedrops are used for which purpose? a. Constrict the pupils b. Dilate the pupils c. Decrease the intraocular pressure d. Detect astigmatism

Spinal cord

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: A1

Ganglion

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: A2

constrict pupil

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: B - Eye

constrict bronchioles and increase secretions

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: C - Lungs

decrease heart rate

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: D - Heart

dilates

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: E - Blood vessel

increase peristalsis and secretions

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: F - Gastrointestinal tract

contract

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: G - Bladder

increase salivation

Identify cholinergic effects to the different organs affected by the parasympathetic nervous system: H - Salivary gland

Stimulates muscarinic and nicotinic receptors

Mechanism of action for: Acetylcholine

Blocks the action of acetylcholine

Mechanism of action for: Anticholinergic

Blocks the breakdown of acetylcholine. AKA acetycholinesterase inhibitors

Mechanism of action for: Anticholinesterase

Stimulate the parasympathetic system

Mechanism of action for: Cholinergic agonists

Mimics cholinergic actions

Mechanism of action for: Direct-acting parasympathominetic

Stimulates smooth muscle and slows heart rate

Mechanism of action for: Muscarinic receptor

Impacts skeletal muscles

Mechanism of action for: Nicotinic receptor

Causes the breakdown of acetylcholine

Mechanism of action for: Cholinesterase

ANS: Notify the health care provider with current intake and output values. Bethanechol is used to treat urinary retention but will not be effective and should not be used in the case of a mechanical obstruction. If this client was prescribed bethanechol for urinary retention and the urine output is decreasing, the health care provider should be notified to investigate another cause.

The client has been prescribed bethanechol and is experiencing decreased urinary output. Which action would be a priority by the nurse? a. Catheterize the client to drain the bladder and measure output. b. Encourage the client to increase fluid intake to increase urinary output. c. Encourage the client to relax when urinating. d. Notify the health care provider with current intake and output values.

ANS: Obtain an order to administer atropine Bethanechol is a cholinergic agonist. The client is experiencing an adverse response, and the treatment of choice is atropine. The nurse should obtain an order to administer atropine, the antidote for cholinergic overdose. The nurse should document the client's experiences, but it is not the best action by the nurse. Abdominal cramps is due the action on the muscarinic receptors, not due to constipation. Increasing fluid intake will not relieve the side effects of bethanechol.

The client has been taking bethanechol and is experiencing flushing, sweating, nausea, and abdominal cramps. Which action would be best for the nurse to take? a. Document the client's manifestations. b. Give the client a laxative. c. Increase the client's fluid intake. d. Obtain an order to administer atropine.

ANS: "This drug promotes contraction of the bladder." Bethanechol, a direct-acting cholinergic agonists stimulates the muscarinic receptors to contract bladder which increases urination

The client who was prescribed bethanechol asks the nurse how it works. Which response would be most appropriate by the nurse? a. "This drug decreases bladder tone." b. "This drug inhibits bladder contraction." c. "This drug promotes contraction of the bladder." d. "This drug stimulates urine production."

ANS: fiber Because of the decrease in gastrointestinal motility that can be associated with propantheline, the client should be encouraged to eat foods that are high in fiber and drink adequate amounts of liquid to prevent constipation.

The client with new diagnosis of peptic ulcers was prescribed propantheline. Which substance would the nurse teach that is a priority point for nutrition? a. Calcium b. Fat c. Fiber d. Protein

ANS: -A client having surgery for appendicitis -A client with a heart rate of 38 beats/minute and dizziness Atropine would be beneficial as a preoperative drug to help control oral secretions. It is also used for clients who are symptomatic with a heart rate less than 50 beats per minute and is symptomatic of decreased cardiac output. Bethanechol is for urinary retention. Benztropine is for paralytic ileus. Propantheline bromide is used for gastric ulcers.

The nurse is taking care of five clients in the emergency department. Which client(s) would be candidate(s) to receive atropine? (Select all that apply.) a. A client having surgery for appendicitis b. A client with a heart rate of 38 beats/minute and dizziness c. A client with paralytic ileus d. A client with urinary retention e. A client with gastric ulcers

ANS: a client with narrow-angle glaucoma Atropine-like drugs should not be administered to clients with narrow-angle glaucoma because they will increase the intraocular pressure.

The nurse would question an order for atropine for which client? a. A client with a peptic ulcer b. A client with parkinsonism c. A client with cirrhosis d. A client with narrow-angle glaucoma

ANS: Bethanechol Bethanechol, a direct-acting cholinergic agonist, is used to treat urinary retention. Metoclopramide, a direct-acting cholinergic agonist, is used to treat gastrointestinal (GI) symptoms. Neostigmine bromide is used to treat myasthenia gravis.

The pediatric client 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

ANS: Neostigmine bromide Neostigmine bromide is used to treat myasthenia gravis (MG). Bethanechol is used to treat urinary retention. Pilocarpine is used to treat glaucoma.

Which drug treats myasthenia gravis by increasing muscle strength? a. Bethanechol b. Edrophonium chloride c. Neostigmine bromide d. Pilocarpine

ANS: Pralidoxime chloride Pralidoxime chloride is an anticholinergic that inhibits the actions of acetylcholine. It is given for cholinesterase inhibitor toxicity and oragnophosphate pesticide toxicity. Bethanechol is a direct-acting cholinergic agonist and is used to treat urinary retention. Metoclopramide, a direct-acting cholinergic agonist, is used to treat gastrointestinal (GI) symptoms.

Which drug would the nurse anticipate administering to a client who ingested an organophosphate poison? a. Bethanechol b. Edrophonium chloride c. Metoclopramide d. Pralidoxime chloride

ANS: -Decreased blood pressure -Increased bronchial secretions Cholinergic drugs are parasympathomimetics in that they mimic the parasympathetic responses. One response is the dilation of blood vessels, which decreases blood pressure. Other responses include pupillary constriction (miosis), bronchoconstriction and increased bronchial secretions, decreased heart rate, increased gastrointestinal peristalsis and secretions, bladder contraction, and increased salivation.

Which outcome to the body would occur from receiving large doses of cholinergic drugs? (Select all that apply.) a. Decreased blood pressure b. Decreased salivation c. Increased bronchial secretions d. Mydriasise. Urinary retention

ANS: Stimulates muscarinic receptors Bethanechol, a direct-acting cholinergic agonist, works on the muscarinic receptor. Nicotinic receptors work on skeletal muscles. Anticholinergics inhibits muscarinic and nicotinic receptor.

Which statement describes the mechanism of action for bethanechol? a. Inhibits muscarinic receptors b. Inhibits nicotinic receptors c. Stimulates muscarinic receptors d. Stimulates nicotinic receptors

ANS: -Ensure adequate fluid intake. -Do not drive until you are aware of how this drug will affect your vision. -Sucking on hard candy may help with dry mouth. -Report a rapid heart rate to your health care provider. Hyoscyamine is an anticholinergic drug that will have similar side effects to the prototype drug atropine. Adequate fluid intake will help prevent constipation. Vision may be blurry, and the client should be advised not to drive until the effects of the drug on the vision are known. Sucking on hard candy or sugar-free ice pops, as well as increased fluid intake, may help with dry mouth. The client should be educated as to baseline heart rate and advised to report tachycardia (rates above 100 beats/minute) to the health care provider. Increased sweating is not a common side effect.

Which teaching point(s) will the nurse include for a client taking hyoscyamine for irritable bowel syndrome? (Select all that apply.) a. Ensure adequate fluid intake. b. Do not drive until you are aware of how this drug 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.

ANS: Cholinergic agonist Bethanechol is a direct-acting cholinergic agonist. Agonists promote tissue response.

Which type of medication is bethanechol? a. Anticholinergic b. Cholinergic agonist c. Cholinesterase inhibitor d. Sympatholytic