Cholinergic Drugs

The nurse is preparing to administer a muscarinic antagonist to a patient. Which mechanism of action should the nurse expect from this drug? a. Binds to cholinergic synapse receptors in the sympathetic nervous system b. Blocks cholinergic synapse receptors in the parasympathetic nervous system c. Binds to cholinergic synapse receptors in the parasympathetic nervous system d. Blocks cholinergic synapse receptors in the ganglia or somatic nervous systemurec

Blocks cholinergic synapse receptors in the parasympathetic nervous system

A patient with an apical pulse of 44 beats/min reports dizziness. Which cholinergic antagonist should the nurse expect the healthcare provider to prescribe? a. Tolterodine b. Atropine c. Tiotropium d. Dicyclomine

b. Atropine

A patient taking bethanechol (Urecholine) asks when to expect to feel the effects of the medication. Which information should the nurse provide the patient? a. 30-60 minutes b. 1-2 days c. 1-6 hours d.5-10 minutes

a. 30-60 minutes

The nurse is preparing to administer bethanechol (Urecholine) to a patient with urinary retention. For which finding should the nurse realize this medication is contraindicated? a. Epilepsy b. Atrial fibrillation c. Xerostomia related to Sjogren's syndrome d.Open-angle glaucoma

a. Epilepsy Bethanechol (Urecholine) is used to treat urinary retention not caused by urinary obstructions, because this can lead to backflow of urine up the ureters and hydronephrosis. This medication is contraindicated in the patient with epilepsy. Xerostomia and open-angle glaucoma are successfully treated with muscarinic agonists. Atrial fibrillation can occur in patients taking muscarinic agonists with preexisting hyperthyroidism.

A patient with pneumonia has increased dyspnea, crackles in the lung bases, and an oxygen saturation level of 89%. Which should the nurse expect to assess after administering ipratropium to this patient? a. Increased oxygen saturation b. Increased nasal congestion c. Decreased pulmonary congestion d.Decreased physical endurance

a. Increased oxygen saturation

A patient is prescribed a direct-acting cholinergic agonist. Which action should the nurse expect to occur from this medication? a. It binds to acetylcholine receptors, enhancing the action potential on the postsynaptic neuron. b. It increases the amount of acetylcholine remaining at the synaptic cleft. c. It binds to the enzyme acetylcholinesterase that prevents acetylcholine from being destroyed. d. It enhances the action potential on the postsynaptic neuron.

a. It binds to acetylcholine receptors, enhancing the action potential on the postsynaptic neuron. A direct-acting cholinergic agonist binds to acetylcholine receptors, enhancing the action potential on the postsynaptic neuron. Indirect cholinergic agonists bind to the enzyme acetylcholinesterase that prevents acetylcholine from being destroyed and increase the amount of acetylcholine remaining at the synaptic cleft, which in turn enhances the action potential on the postsynaptic neuron.

The nurse is reviewing the medication profile for a patient in the hospital. Which medication classification should the nurse identify that dries secretions? a. Muscarinic antagonist b. Nicotinic antagonist c. Muscarinic agonist d.Nicotinic agonist

a. Muscarinic antagonist The signs and symptoms of sympathetic nervous system activation (fight-or-flight response) occurs as a result of acetylcholine suppression. The expected clinical manifestations include drying of secretions.

A patient with urinary retention is prescribed bethanechol (Urecholine). For which side effect should the nurse monitor the patient? a. Orthostatic blood pressure changes b. Urinary incontinence c. Seizures d.Changes in respiratory rate and pattern

a. Orthostatic blood pressure changes Direct-acting cholinergic agonists can cause orthostatic blood pressure changes. Indirect-acting cholinergic agonists can cause respiratory muscle paralysis and seizures. Bethanechol is used to treat urinary retention.

A patient is diagnosed with glaucoma. Which medication should the nurse anticipate being prescribed for this patient? a. Pilocarpine b. Cevimeline c. Neostigmine

a. Pilocarpine

An older patient is receiving atropine. For which side effect should the nurse add interventions to prevent injury in this patient? a. Tachycardia b. Blurred vision c. Constipation d. Dry mouth

b. Blurred vision Atropine can cause blurred vision, increasing the patient's risk for injury. Tachycardia, dry mouth, and constipation affect other body systems, including cardiac and gastrointestinal systems; however, they do not increase this patient's risk for injury.

2. The nurse is preparing to administer a cholinergic antagonist to an older patient with decreased mobility. Which nursing intervention should the nurse include to prevent complications from this drug? a. Enforce fluid restriction b. Increase dietary fiber c. Keep the room warm d.Maintain a well-lit room

b. Increase dietary fiber Cholinergic antagonists can slow peristalsis by decreasing tone and motility of intestinal muscle, which increases the risk of constipation. Dietary fiber should be increased. Fluid restriction is not required because these drugs have drying effects. The room should be kept cooler because cholinergic antagonists inhibit sweat gland secretions. The room should be kept dim because these drugs cause photosensitivity.

A patient with myasthenia gravis is prescribed pyridostigmine (Regonol). Which assessment finding should indicate that the medication is effective?musc a. Hyperglycemia b. Lack of eye drooping c. Increases heart rate d.Abdominal cramping

b. Lack of eye drooping

A patient is prescribed atropine. Which intervention should the nurse include in the plan of care for this patient? a. Promote independent ambulation b. Monitor heart rate and rhythm c. Place in the prone position d. Increase oral fluid intake

b. Monitor heart rate and rhythm

5. A patient asks why dicyclomine was prescribed. Which information should the nurse provide about its use? a. "It relaxes smooth muscle in the bronchial tree, which opens the airways." b. "It relaxes smooth muscle in the urinary bladder, decreasing incontinence." c. "It decreases gastrointestinal motility related to irritable bowel syndrome." d. "It decreases gastric acid secretions in patients with peptic ulcer disease."

c. "It decreases gastrointestinal motility related to irritable bowel syndrome." Dicyclomine is a gastrointestinal antispasmodic drug used to treat the symptoms of irritable bowel syndrome, including cramping and diarrhea. Bronchodilators are used to open the airways in patients with chronic obstructive pulmonary disease. Muscarinic antagonist drugs treat urge incontinence and overactive bladder. Antisecretory drugs that are muscarinic antagonists decreased gastric acid and secretions.

The nurse teaches about the use of donepezil (Aricept) for Alzheimer's disease. Which statement should indicate the additional teaching about the medication is required? a. "This medication only improves symptoms in the short term." b. "This medication increases acetylcholine in the brain's synapses." c. "This medication will cure Alzheimer's disease." d. "This medication improves memory and cognitive function."

c. "This medication will cure Alzheimer's disease."

The nurse assesses a patient receiving a muscarinic agonist. For which finding should the nurse administer atropine? a. Dry mouth and mucous membranes b. Blurred vision c. Hallucinations and confusion d. Inability to urinate for 8 hours

c. Hallucinations and confusion Hallucinations and confusion are signs of muscarinic toxicity. Atropine is the antidote. Dry mouth and mucous membranes and urinary retention are treated with muscarinic agonists. Blurred vision can occur with the use of pilocarpine eye drops.

The nurse is asked to explain cholinergic drugs. In which area should the nurse explain these drugs act in the somatic nervous system? a. In the neuroeffector junctions b. In the ganglia c. In the neuromuscular junction, resulting in skeletal muscle contraction d.In the acetylcholine (ACh) synapses located in the autonomic ganglia

c. In the neuromuscular junction, resulting in skeletal muscle contraction Cholinergic drugs effect the somatic nervous system by acting at the neuromuscular junction, which results in skeletal muscle contraction. Cholinergic drugs affect the autonomic nervous system at the neuroeffector junctions and at the ganglia. The acetylcholinesterase (AChE) inhibitors are nonselective and affect ACh synapse located at the autonomic ganglia, muscarinic receptors, neuromuscular junctions, and synapse in the CNS.

A patient with Parkinson's disease who is prescribed benztropine asks about the purpose of the drug. Which response should the nurse make? a. "Benztropine will manage the excessive drooling." b. "Benztropine is a medication to manage gastrointestinal symptoms." c. "Benztropine is used to manage sedation and confusion." d. "Benztropine is used to decrease the muscle tremors and rigidity."

d. "Benztropine is used to decrease the muscle tremors and rigidity."

The nurse reviews the use of neuromuscular blockers and actions with a group of new colleagues. Which statement should indicate that teaching was effective? a. "Neuromuscular blockers allow the symptoms of the sympathetic nervous system to predominate." b. "Neuromuscular blockers inhibit transmission at the ganglia in the sympathetic nervous system." c. "Neuromuscular blockers compete with acetylcholine for binding with muscarinic receptors." d."Neuromuscular blockers affect skeletal muscles in the somatic nervous system."

d. "Neuromuscular blockers affect skeletal muscles in the somatic nervous system." Neuromuscular blockers affect skeletal muscles in the somatic nervous system. Ganglionic blockers inhibit transmission at the ganglia in the sympathetic nervous system. Muscarinic antagonists compete with acetylcholine for binding with muscarinic receptors and allow the symptoms of the sympathetic nervous system to predominate.

A patient with a history of chronic obstructive pulmonary disease reports increased dyspnea at times during the day. Which muscarinic antagonist should the nurse suspect to be beneficial for this patient? a. Benztropine b. Tropism c. Tropicamide d. Ipratropium

d. Ipratropium Ipratropium is a muscarinic antagonist that dilates the airways by relaxing bronchial smooth muscle. Tropism is used for an over active bladder. Tropicamide is an ophthalmic solution used to dilate the eyes prior to procedures. Benztropine is used to decrease muscle tremors and rigidity related to Parkinson's disease.

A patient reports problems with urge urinary incontinence. Which muscarinic antagonist should the nurse expect to be prescribed? a. Donepezil b. Ipratropium c. Benztropine d.Oxybutynin

d. Oxybutynin Oxybutynin is used to treat urge incontinence because its action limits smooth muscle spasms in the bladder. Benztropine is used to treat Parkinson's disease and donepezil is used to treat Alzheimer's disease. Ipratropium is a bronchodilator.

A patient is prescribed atropine. For which additional medication should the nurse question giving this medication? a. Melatonin b. Lisinopril c. Guaifenesin d.Quinidine

d. Quinidine Atropine can potentiate the effects of quinidine. Atropine does not interfere with lisinopril or guaifenesin. Melatonin is contraindicated with succinylcholine.