Ch 12: Cholinergic Drugs Affecting ANS

A. Treats urinary retention not caused by obstructions Urecholine is used to treat urinary​ retention, which is not a result of urinary obstructions. Cevimeline treats xerostomia. Orthostatic hypotension occurs as a result of bethanechol administration.​ Pyridostigmine, an acetylcholinesterase​ inhibitor, is used to treat myasthenia gravis by increasing the strength of skeletal muscle contraction.

A client asks why bethanechol​ (Urecholine) is prescribed. Which information should the nurse include in​ response?? A. Treats urinary retention not caused by obstructions B. Increases the strength of the skeletal muscle contraction C. Increases the amount of saliva produced in the mouth D. Stabilizes the blood pressure in orthostatic hypotension

D. Physostigmine Physostigmine​ (a cholinesterase​ inhibitor) is given to reverse the symptoms of anticholinergic toxicity. Atropine is used to increase the heart rate. Oxybutynin is used to treat urinary incontinence. Succinylcholine is a neuromuscular blocking agent used during mechanical ventilation in surgery.

A client experiencing​ tachycardia, dilated​ pupils, hallucinations, and confusion is suspected of having anticholinergic toxicity. Which drug should the nurse expect to be prescribed to reverse these​ effects? A. Oxybutynin B. Atropine C. Succinylcholine D. Physostigmine

B. Constipation Atropine can slow peristalsis enough to cause constipation. Atropine is used to decrease bowel motility so it is a treatment for diarrhea. Atropine increases the heart rate and dries out nasal passages.

A client has been taking atropine for the treatment of irritable bowel syndrome for several days. For which adverse effect should the nurse assess this​ client? A. Decreased heart rate B. Constipation C. Diarrhea D. Increased nasal secretions

A. Atropine Atropine increases the heart rate. Tolterodine is used to treat urge incontinence. Benztropine relaxes smooth muscle to decrease muscle rigidity in clients with​ Parkinson's disease. Succinylcholine is a neuromuscular blocker used during mechanical ventilation in surgery.

A client has heart rates ranging between 45 and 55 beats per minute. Which muscarinic antagonist should the nurse expect to be​ prescribed? A. Atropine B. Benztropine C. Tolterodine D. Succinylcholine

A. Acute​ closed-angle glaucoma Atropine is contraindicated in clients with glaucoma because the drug can further increase intraocular pressure. Atropine relaxes smooth muscle in the genitourinary tract and gastrointestinal​ tract, so it is indicated for​ Parkinson's disease and irritable bowel syndrome. It is safe to administer atropine to clients with bradycardia.

A client is prescribed atropine. For which client health problem should the nurse question giving this​ medication? A. Acute​ closed-angle glaucoma B. Bradycardia C. Irritable bowel syndrome D. ​Parkinson's disease

C. Enlarged Prostate Men with enlarged prostates should not take muscarinic antagonists because this can increase the risk for urinary retention. Cataracts are not affected by muscarinic antagonists. Dry mouth and tachycardia are side effects of muscarinic antagonists.

A client is prescribed​ oxybutynin, a muscarinic​ antagonist, for the treatment of urinary retention. For which finding should the nurse withhold the medication and notify the healthcare​ provider? A. Tachycardia B. Cataracts C. Enlarged prostate D. Dry mouth

A. Hepatic function Because cholinergic agonists can impair liver​ function, the​ client's hepatic function should be routinely monitored. The basic metabolic panel measures electrolytes and glucose. Complete blood count measures red blood​ cells, white blood​ cells, and platelets. Renal function studies reflect kidney function. Next Question

A client is taking a cholinergic agonist. Which laboratory value should the nurse closely monitor in this​ client? A. Hepatic function B. Renal function studies C. Basic metabolic panel D. Complete blood count

A. Wear sunglasses for several hours Muscarinic antagonists used to dilate pupils for eye exams can cause photophobia for several hours. Sunglasses would be indicated. The eye drops are instilled prior to the exam and will not be used at home. There are no contraindications against rubbing the eyes. Blurred vision is an expected side effect of the drug.

A client received a muscarinic antagonist to dilate the pupils for an eye examination. Which teaching should the nurse provide after the​ examination? A. Wear sunglasses for several hours B. Refrain from rubbing the eyes C. Notify healthcare provider of blurred vision D. Continue eye drops at home

B. Binds to acetylcholine​ (ACh) receptors, enhancing the action potential on the postsynaptic neuron D. Causes more acetylcholine​ (ACh) to be released into the synaptic cleft A direct cholinergic agonist causes more ACh to be released into the synaptic cleft and binds to ACh​ receptors, enhancing the action potential on the postsynaptic neuron. Indirect cholinergic agonists bind to AChE​ receptors, preventing ACh from being destroyed. Muscarinic agonists activate cholinergic receptors located at the neuroeffector junctions in the parasympathetic nervous system. Acetylcholinesterase​ (AChE) inhibitors affect ACh synapses located at the autonomic​ ganglia, muscarinic​ receptors, neuromuscular​ junctions, and synapses in the central nervous system.

A client receives a direct cholinergic agonist. In which way should the nurse expect this medication to​ act? (Select all that​ apply.) A. Binds to acetylcholinesterase​ (AChE) receptors, preventing ACh from being destroyed B. Binds to acetylcholine​ (ACh) receptors, enhancing the action potential on the postsynaptic neuron C. Activates cholinergic receptors located at the neuroeffector junctions in the sympathetic nervous system D. Causes more acetylcholine​ (ACh) to be released into the synaptic cleft E. Affects acetylcholine​ (ACh) synapses located at the autonomic​ ganglia, muscarinic​ receptors, neuromuscular​ junctions, and synapses in the central nervous system

B. ​"You should experience fewer episodes of urinary​ incontinence." Oxybutynin is used in the treatment of urinary incontinence. Tiotropium and ipratropium are used to treat asthma and chronic obstructive pulmonary disease and improve breathing. Dicyclomine and hyoscyamine are used to treat irritable bowel syndrome and would cause fewer diarrheal stools. Benztropine is used to treat​ Parkinson's disease by decreasing muscle rigidity and tremors.

A client receiving oxybutynin XL asks how to determine the effectiveness of the medication. Which response should the nurse​ make? A. ​"You should experience improved​ breathing." B. ​"You should experience fewer episodes of urinary​ incontinence." C. ​"You should experience fewer incidences of diarrheal​ stools." D. ​"You should experience decreased muscle rigidity and​ tremors."

C. Binds the enzyme​ acetylcholinesterase, preventing destruction of acetylcholine​ (ACh) An indirect cholinergic agonist binds the enzyme​ acetylcholinesterase, preventing destruction of ACh. Direct cholinergic agonists increase the release of ACh into the synaptic cleft and act by the same mechanism as ACh. Direct cholinergic agonists are inactivated with acetylcholinesterase.

A client with Alzheimer disease is prescribed an indirect cholinergic agonist. In which way should the nurse expect this medication to​ act? A. Acts by the same mechanism as acetylcholine​ (ACh) when released B. Inhibits acetylcholinesterase which destroys acetylcholine C. Binds the enzyme​ acetylcholinesterase, preventing destruction of acetylcholine​ (ACh) D. Increases the release of acetylcholine​ (ACh) from the synaptic cleft

D. Asthma Bethanechol​ (Urecholine) is contraindicated in clients with asthma. Cholinergic agonists are used to treat glaucoma and xerostomia. Urecholine is not contraindicated for a client with myasthenia​ gravis, as it will not increase weakness.

A client with a history of urinary retention is prescribed bethanechol​ (Urecholine). For which health problem should the nurse withhold giving the​ medication? A. Myasthenia gravis B. Glaucoma C. Xerostomia D. Asthma

B. Atropine Atropine is the medication of choice for clients who overdose on cholinergic agonists. Pilocarpine and bethanechol are both muscarinic agonists and should not be prescribed. Galantamine and rivastigmine are acetylcholinesterase inhibitors used in the treatment of​ Alzheimer's disease.

A client with nausea and vomiting accidentally takes extra doses of bethanechol​ (Urecholine). Which medication should the nurse expect to be prescribed as an​ antidote? A. Rivastigmine B. Atropine C. Pilocarpine D. Galantamine

C. Causes an increase in acetylcholine​ (ACh) released into the synaptic cleft Bethanechol​ (Urecholine) is a direct cholinergic agonist. It causes acetylcholine to enter the synaptic cleft and binds to ACh​ receptors, leading to a typical rest and digest response. Indirect cholinergic agonists bind to receptors which enhance action potential of postsynaptic neurons and attach to AChE to prevent ACh destruction. Muscarinic agonists activate cholinergic receptors in the neuroeffector junction of the parasympathetic nervous system.

A client with urinary retention is prescribed bethanechol​ (Urecholine), a direct cholinergic agonist. Which statement should the nurse use to explain this​ medication's mechanism of​ action? A. Binds to acetylcholine​ (ACh) receptors, enhancing action potential of postsynaptic neurons. B. Activates cholinergic receptors located at the neuroeffector junction in the sympathetic nervous system. C. Causes an increase in acetylcholine​ (ACh) released into the synaptic cleft D. Attaches to the enzyme acetylcholinesterase​ (AChE), which prevents acetylcholine destruction.

A C E A. Monitor intake and output ratio C. Monitor for blurred vision E. Monitor for orthostatic hypotension

A nurse administers Bathanechol (Urecholine) to a patient. What are her specific roles in caring for the patient after drug administration? SATA A. Monitor intake and output ratio B. Monitor for muscle weakness C. Monitor for blurred vision D. Monitor ptosis E. Monitor for orthostatic hypotension

B C E B. Monitor muscle strength and neuromuscular status. C. Monitor ptosis, diplopia and chewing. E. Monitor muscle weakness

A nurse administers physostigmine (Antilirium) to a patient. What are her specific roles in caring for the patient after drug administration? SATA A. Monitor intake and output B. Monitor muscle strength and neuromuscular status. C. Monitor ptosis, diplopia and chewing. D. Monitor for blurred vision. E. Monitor muscle weakness

C. A decrease in muscle weakness, ptosis and diplopia. Pyridostigmine is used primarily for myasthenia gravis, a neurological disorder characterized by muscle weakness and ptosis. A decrease in these symptoms is an expected therapeutic outcome for this drug.

A nurse is preparing a plan of care for a patient with myasthenia gravis. Which outcome statement would be appropriate for a patient receiving a cholinergic agonist such as pyridostygmine (Mestinon) for this condition? The patient will exhibit: A. An increase in pulse rate, blood pressure, and respiratory rate. B. Enhanced urinary elimination. C. A decrease in muscle weakness, ptosis and diplopia. D. Prolonged muscle contractions and proprioception.

A. Peptic ulcer disease B. Bradycardia D. Irritable bowel syndrome Anticholinergics are used in the treatment of PUD, bradycardia, and IBS because they suppress the effects of ACh and stimulate the sympathetic nervous system. Anticholinergics may cause decreased sexual function because the parasympathetic impulses are blocked. Urine retention is a potential adverse effect of anticholinergics.

Anticholinergics may be ordered for which conditions? SATA A. Peptic ulcer disease B. Bradycardia C. Decrease sexual function D. Irritable bowel syndrome E. Urine retention

C. Dizziness The nurse should monitor older patients for episodes of dizziness caused by CNS stimulation from the parasympathetic NS. bethanechol does not cause tachycardia or hypertension, and it is used to treat nonobstructive urinary retention.

Older adult patients taking bethanechol (Urecholine) need to be assessed more frequently because of which adverse effect? A. Tachycardia B. Hypertension C. Dizziness D. Urinary retention

B. An indirect cholinergic agonist inhibits acetylcholinesterase​ (AChE); a direct agonist activates the receptor. The difference between indirect and direct cholinergic agonists is that direct cholinergic agonists bind directly with the site whereas indirect agonists inhibit​ AChE, preventing ACh from binding to the receptor sites. Direct cholinergic agonists do not inhibit the binding​ process, and they do not produce acetylcholinesterase. Direct cholinergic agonists enhance the action potential of the postsynaptic neurons and they increase the amount of ACh remaining at the synaptic cleft.

The nurse is preparing a presentation about indirect and direct cholinergic agonists. Which information should the nurse include about the differences between these two groups of​ medications? A. An indirect cholinergic agonist enhances the action potential of the postsynaptic​ neuron; a direct agonist increases the amount of acetylcholine​ (ACh) remaining at the synaptic cleft. B. An indirect cholinergic agonist inhibits acetylcholinesterase​ (AChE); a direct agonist activates the receptor. C. An indirect cholinergic agonist causes acetylcholine​ (ACh) to be​ released; a direct agonist produces more acetylcholinesterase​ (AChE). D. An indirect cholinergic agonist binds to the acetylcholine​ (ACh) receptor; a direct agonist inhibits the binding process.

B. Inhibits transmission at the neuromuscular junctions of skeletal muscle D. Inhibits transmission at the ganglia of the somatic nervous system

The nurse is preparing to administer a nicotinic antagonist to a client. Which outcome should the nurse​ expect? (Select all that​ apply.) A. Opens parasympathetic nervous system channels B. Inhibits transmission at the neuromuscular junctions of skeletal muscle C. Elicits the​ fight-or-flight response in the parasympathetic nervous system D. Inhibits transmission at the ganglia of the somatic nervous system E. Opens sympathetic nervous system channels

D. Absence of bowel sounds Muscarinic antagonists such as dicyclomine slow intestinal motility. Muscarinic antagonists are used to treat muscle tremors and urinary​ incontinence, and to open airways in clients with chronic obstructive pulmonary​ disease, but they do not cause copious amounts of sputum.

The nurse is preparing to administer dicyclomine to a client with irritable bowel syndrome. For which assessment finding should the nurse withhold the medication and contact the healthcare​ provider? A. Urinary incontinence B. Copious amount of sputum C. Muscle tremors D. Absence of bowel sounds

A. Asthma Muscarinic agonists should not be given to a client with asthma because this medication contracts bronchial smooth​ muscle, causing the airways to​ narrow, leading to further airway obstruction. Muscarinic agonists are used to treat​ glaucoma, xerostomia, and urinary retention and would not be contraindicated for these conditions.

The nurse notes that a client is prescribed a muscarinic agonist. For which health problem should the nurse withhold the​ medication? A. Asthma B. Urinary retention C. Xerostomia D. Glaucoma

D. Parasympathetic Muscarinic antagonists block the parasympathetic system and stimulate the sympathetic system. Nicotinic antagonists block both the autonomic and somatic nervous systems.

The nurse prepares a muscarinic antagonist for a client. Which system should the nurse expect to be inhibited by this​ medication? A. Somatic nervous B. Autonomic nervous C. Sympathetic D. Parasympathetic

C. Increased heart rate D. Blurred vision E. Urinary retention Muscarinic antagonists like atropine have side effects of blurred​ vision, urinary​ retention, and increased heart rate. Other side effects include pupillary dilation and decreased bronchial secretions.

The nurse prepares discharge teaching for a client taking atropine. Which information about side effects should the nurse​ provide? (Select all that​ apply.) A. Pupillary constriction B. Increased bronchial secretions C. Increased heart rate D. Blurred vision E. Urinary retention

A. Excessive sweating, salivation, drooling Over dosage of parasympathomimetic such as neostigmine may produce excessive sweating, drooling, dyspnea, or excessive fatigue. These symptoms should be promptly reported. Diarrhea, not constipation, is an adverse effect associated with cholinergic and cholinesterase-inhibitors. Hypertension, tachycardia, dry eyes or reddened sclera are not associated with these drugs.

The patient or caregiver of a patient taking neostigmine (Prostigmin) should be taught to be observant for which adverse effect that may signal a possible overdose has occurred? A. Excessive sweating, salivation, drooling B. Extreme constipation C. Hypertension and tachycardia D. Excessively dry eyes and reddened sclera

B. Constipation Anticholinergic medications such as benztropine slow intestinal motility; therefore, constipation is a potential side effect. patients should be taught methods to manage constipation such as increasing fluids and fiber in the diet

The patient takes benztropine (Cogentin) should be provided education on methods to manage which common adverse effect? A. Heartburn B. Constipation C. Hypothermia D. Increased gastric motility

Muscarinic receptor agonists

What are direct acting cholinergic drugs?

Bethanechol (Urecholine)

What is the prototype drug for a cholinergic agent (parasympathomimetic)?

physostigmine (Antilirium)

What is the prototype drug for a cholinesterase inhibitor?

A. Direct-acting cholinergic agonist

What kind of drug is bethanechol (Urecholine)? A. Direct-acting cholinergic agonist B. Indirect-acting cholinergic agonist C. Direct-acting cholinergic antagonist D. Cholinesterase Inhibitor

B. Indirect-acting cholinergic agonist D. Cholinesterase inhibitor

What kind of drug is pyridostigmine (Mestinon)? SATA A. Direct-acting cholinergic agonist B. Indirect-acting cholinergic agonist C. Direct-acting cholinergic antagonist D. Cholinesterase Inhibitor

A C D E G These are all responses to stimulation of the parasympathetic nervous system.

When a muscarinic receptor is activated, what are some of the expected responses? SATA A. Bladder contracts B. Salivation is inhibited C. Bronchioles constrict D. Heart rate slows E. Pupils constrict F. Digestion is inhibited G. Erection is stimulated

B. A 65-year old man with benign prostatic hyperplasia Atropine causes urinary retention to worsen, and is, therefore, contraindicated, in patients with benign prostatic hyperplasia.

Which factor in the patient's history would cause the nurse to question a medication order for atropine? A. A 32-year old man with a history of drug abuse B. A 65-year old man with benign prostatic hyperplasia C. An 8-year old boy with chronic tonsillitis D. A 22-year old woman on the second day of her menstrual cycle