Chapter 32 Cholinergic Agonists PrepU
Cholinergic drug action
often called parasympathomimetic drugs because their action mimics the action of parasympathetic nervous system, not limited to a specific site, therefore associated with many undesirable systemic effects
Donepezil (aricept)
once-a-day dosing
The nursing instructor is discussing cholinergic drugs. The nursing students understand what system is acted upon by this family of drugs?
parasympathetic nervous system
Direct-acting cholinergic agonist caution
pregnancy, lactation
Alzheimer's disease
progressive disorder involving neural degeneration in cortex, leads to marked loss of memory and ability to carry on activities of daily living, cause unknown, progressive loss of ACh producing neurons and their target neurons
Myasthenia gravis symptom
progressive weakness and lack of muscle control with periodic acute episodes
Indirect-acting cholinergic agonist
react with the enzyme acetylcholinesterase and prevent it from breaking down the ACh that was released from the nerve, cause increased stimulation of ACh receptor sites
Neostigmine (prostigmine)
strong influence at neuromuscular junction
A middle-aged client is being treated for myasthenia gravis with neostigmine. What change in the client's health status would warrant immediate medical follow-up?
sudden muscle weakness
Alzheimer's disease drug
tacrine (cognex), galantamine (reminyl), rivastigmine (exelon), donepexil (aricept)
Direct-acting cholinergic agonist adverse reaction
nausea, vomiting, cramps, diarrhea, increase salivation, involuntary defecation, bradycardia, heart block, hypotension, urinary urgency, flushing, increased sweating
Acetylcholinesterase inhibitor treat myasthenia gravis
neostigmine (prostigmine), pyridostigmine (regonol, mestinon), ambenonium (mytelase), edrophonium (tensilon enlon)
Direct-acting cholinergic agonist
occupy receptor sites of ACh on the membranes of the effector cells of the postganglionic cholinergic nerves, cause increased stimulation of the cholinergic receptor
What is the recommended administration schedule for the drug donepezil?
once daily at bedtime
What is the duration of action the nurse would expect following administration of bethanechol? A) 30-60 min B) 6-8 hr C) 2-4 hr D) 1-6 hr
D
Myasthenic crisis is an exacerbation of the disease process and its clinical manifestations, requiring:
more anticholinesterase drug.
Indirect-acting cholinergic agonist indication
myasthenia gravis alzheimer's disease
When administering a direct acting cholinergic agonist to the older adult, what assessment should the nurse prioritize? A) Serum potassium level B) Serum blood sugar C) Respiratory function D) BP
D
A client is prescribed donepezil. The nurse would expect to administer this drug at which frequency?
Once a day
A client diagnosed with myasthenia gravis is being discharged home after a crisis. Which should be included in the teaching plan?
Teach the client to adjust the dosage based on needs.
Decreased acetylcholine levels are characteristic of:
Alzheimer's disease
Which agent would be most appropriate to administer to a client with Alzheimer's disease?
Donepezil
Which symptom, if assessed after the administration of donepezil (Aricept), would be cause for alarm?
Reports of nausea, vomiting, and cramping
A patient has just received carbachol (Miostat). Which statement indicates the patient understands the nurse's teaching about this medication?
"I should expect the medication to decrease pressure in my eye."
A client has been placed on the drug bethanechol. The client asks a nurse to explain how the drug bethanechol works. What would be a correct response?
"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine."
A client who has been prescribed bethanechol asks a nurse to explain how the drug works. What would be a correct response?
"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine."
The pharmacology instructor is discussing age-related susceptibility to adverse effects of cholinergic drugs. Which statement could the instructor make to accurately describe the influence of age?
"Physiologic changes resulting from the normal aging process place older adults at higher risk for adverse effects."
The caregiver of client describes the client as having Alzheimer's disease (AD) for 10 years and is currently in the late stage of the disease. The caregiver asks the nurse if the client can go back on the medication donepezil. Which response by the nurse is appropriate?
"The drugs are best used early as they slow the progression of AD."
F
(T or F) an indication for the use of Duvoid is to diagnose and treat esophageal varices
A nurse is monitoring a patient with Alzheimer's disease for initiation of therapy. In which patient is the administration of donepezil contraindicated?
A patient with asthma
A client has been prescribed topical cholinergic drug therapy for treatment of glaucoma. The nurse would inform the client that which effect might occur when beginning therapy?
Temporary decrease in visual sharpness and headache
In order to promote optimal response to therapy the nurse should discuss what the client and family? (Select all that apply.)
-Purpose of drug therapy -Tolerance will develop to adverse reactions -Adverse reactions that can occur with drug therapy -Which adverse reactions to report to the physician
Cholinergic agents like bethanechol are contraindicated for clients having which medical diagnosis? Select all that apply.
-gastrointestinal (GI) obstruction -sick sinus syndrome -peptic ulcer -asthma
A pt with progressive muscle weakness is undergoing diagnostic testing for myasthenia gravis. Neostigmine 0.022 mg/kg has been prescribed and the pt weighs 144.8 lb. How much Neostigmine should the nurse administer? Provide answer to two decimal places.
1.45 mg
A nurse caring for a client receiving bethanechol for urinary retention should advise the client that voiding usually occurs how long after oral administration?
30 to 90 minutes
A nurse caring for a patient receiving bethanechol (Urecholine) for urinary retention should advise the patient that voiding usually occurs how long after oral administration?
30 to 90 minutes
A pt with myasthenia gravis takes Pyridostigmine on a regular basis. The nurse should anticipate administering this drug by which route? A) Oral B) Intramuscular C) Intravenous D) Subcutaneous
A
Myasthenia graves is treated with indirect-acting cholinergic agents that: A) Lead to accumulation of acetylcholine in the synaptic cleft B) Block the GI effects of the disease, allowing for absorption C) Directly stimulate the remaining acetylcholine receptors D) Can be given only by injection because of problems associated with swallowing
A
What drug would the nurse expect to be administered to a pt requiring treatment for Alzheimer's disease? A) Revastigmine B) Pyridostigmine C) Cevimeline D) Edrophonium
A
Which agent would the nurse administer to counteract a severe reaction occurring with the use of Neostigmine? A) Atropine B) Phentolamine C) Naloxone D) Edrophonium
A
Select all that apply: A nurse is explaining myasthenia gravis to a family. Which of the following points would be included in the explanation? A) It is thought to be an autoimmune disease B) It is associated w/ destruction of acetylcholine receptor sites C) It is best treated with potent antibiotics D) It is a chronic and progressive muscular disease E) It is caused by demyelination of the nerve fibers F) Once diagnosed, it has a 5 year survival rate
A B D
Select all that apply: A nurse would question an order for a cholinergic drug if the pt was also taking which of the following? A) Theophylline B) NSAIDs C) Cephalosporin D) Atropine E) Propranolol F) Memantine
A B D
Select all that apply: What adverse effects might a nurse assess in a pt receiving bethanechol? A) Dehydration B) Diarrhea C) Pallor D) Tachycardia E) Diaphoresis
A B E
Select all that apply: The nurse, transcribing an order for a direct acting cholinergic agent, would consider what conditions to be a contraindication to its use? A) Asthma B) Pregnancy C) Peptic ulcer disease D) Blader obstruction E) Bradycardia
A C D E
SATA. The nurse is caring for an older adult pt who has been prescribed Donepezil to treat Alzheimer's disease. The nurse should question the pt's concurrent use of what medications? A) Theophylline B) Propranolol C) Furosemide D) Acetaminophen E) Ibuprofen
A E
The nurse is caring for a client with asthmatic bronchitis and understands that cholinergic medications are contraindicated because this classification of medication may cause which effect?
Bronchoconstriction
A nurse has administered a drug that will have a therapeutic effect on the client's parasympathetic nervous system. The nurse understands the drug will primarily affect what neurotransmitter?
Acetylcholine
A nurse is preparing to administer a cholinergic medication. To prepare to administer the medication, the nurses is assessing the client for anticholinergic effects. Cholinergic medications act like which neurotransmitter?
Acetylcholine
What is the substance responsible for transmission of nerve impulses across the parasympathetic nervous system?
Acetylcholine
What are true about the enzyme acetylcholinesterase? (Select all that apply.)
Acetylcholinesterase makes the parasympathetic nervous system function differently. Acetylcholinesterase activity results in the prevention of nerve synapses to continue nerve
A 40-year-old, diagnosed with myasthenia gravis (MG), is scheduled to begin treatment with oral neostigmine. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on what personal behavior?
Adhering strictly to the prescribed administration schedule
The nursing instructor is teaching the students about degenerative diseases that affect both the musculoskeletal and neurologic systems. The student correctly identifies the disease that is a progressive deterioration of emotional, physical, and cognitive abilities as which?
Alzheimer's
The nurse is caring for a client who is receiving an indirect-acting cholinergic medication and knows it is indicated as a treatment for myasthenia gravis as well as which other condition?
Alzheimer's disease
The nursing instructor is teaching the students about degenerative diseases that affect both the musculoskeletal and neurologic systems. The student correctly identifies the disease that is a progressive deterioration of emotional, physical, and cognitive abilities as:
Alzheimer's.
When providing client teaching on taking anticholinesterase drugs, the nurse would include which caution?
Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration.
An 83-year-old male resident of a long-term care facility has a diagnosis of moderate Alzheimer's disease. The client's physician recently prescribed oral rivastigmine, but the client was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should:
Apply the patch to the client's back to reduce the chance that he will remove it.
A patient who is being treated for Alzheimer's disease is receiving donepezil (Aricept), a cholinergic agent, and his pulse drops to 50 after the administration. Which medication should be administered to treat the bradycardia?
Atropine
The health care provider is preparing to administer edrophonium to confirm myasthenia gravis in a 47-year-old male client. What other drug must be available when edrophonium is administered?
Atropine
The nurse is providing information about how to care for clients during a bioterrorism attack. The nurse knows that which drug will be administered in the case of a sarin attack?
Atropine
Which agent would be used to counteract a severe reaction occurring with the use of neostigmine?
Atropine
Which drug is used to reverse an overdose of cholinergic drugs?
Atropine
Which would be most important to have readily available for a client who is receiving an indirect-acting cholinergic agonist and develops a severe reaction?
Atropine
What drug would the nurse question if ordered for a pt who is experiencing a toxic rxn to a nondepolarizing neuromuscular junction blocker? A) Neostigmine B) Edrophonium C) Pyridostigmine D) Galantamine
D
An adult client with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this client's health problem is ultimately attributable to what pathophysiologic process?
Autoimmune destruction of acetylcholine receptors
A pt with Sjogren's syndrome is experiencing dry mouth. Which agent would the nurse expect to be prescribed? A) Carbachol B) Cevimeline C) Edrophonium D) Bethanechol
B
Adverse effects associated w/ the use of cholinergic drugs include: A) Constipation and insomnia B) Diarrhea and urinary urgency C) Tachycardia and HTN D) Dry mouth and tachycardia
B
Alzheimer's disease is marked by a progressive loss of memory and is associate w/: A) Degeneration of dopamine producing cells in the basal ganglia B) Loss of acetylcholine producing neurons and their target neuron in the CNS C) Loss of acetylcholine receptor sites in the PNS D) Increased levels of acetylcholinesterase in the CNS
B
Indirect acting cholinergic agents: A) React with acetylcholine receptor sites on the membranes of effector cells B) React chemically with acetylcholinesterase to increase acetylcholine concentrations C) Are used to increase bladder tone and urinary excretion D) Should be given with food to slow absorption
B
The pregnant woman with myasthenia gravis has been taken off of all indirect-acting cholinergic agents normally to treat her condition. The woman asks the nurse, "What would happen if I took my medicine for myasthenia gravis anyway? What is the nurse's best explanation for why the drug is contraindicated during pregnancy? A) Taking indirect-acting cholinergic agents while pregnant could result in a uterine rupture B) Taking your indirect-acting cholinergic agent could stimulate labor C) Taking your indirect-acting agent could cause birth defects D) Taking your indirect-acting cholinergic agent could cause overstimulation of your heart
B
What effects are associated with the use of cholinergic agonists? A) Increased heart rate B) Increased gastric motility C) Pupil dilation D) Increased contractility of the heart
B
Why are indirect acting cholinergic agonists used for treatment of myasthenia gravis but direct acting agents are ineffective? A) Indirect acting cholinergic agents reduce production of acetylcholinesterase B) Direct acting cholinergic agents allow acetylcholine to accumulate C) Indirect acting cholinergic agents can cross the BBB D) Direct acting cholinergic agents have very short durations of action
B
SATA. What should the nurse include when teaching the family of a pt with Alzheimer's about the possible adverse effects associated with the prescribed Donepezil? A) Constipation B) Muscle cramps C) Insomnia D) Rash E) HTN
B C D
The nurse is assessing a pt who has been taking direct acting cholinergic agonists. What assessment findings should the nurse attribute to this med? A) BP 121/68 B) Heart rate 62 C) Drowsiness D) Three BMs over past 4 days
B; cause bradycardia, hypotension, diarrhea, and urinary urgency
A client is experiencing urinary retention after surgery. The nurse would anticipate administering:
Bethanechol
The health care provider is preparing to write a prescription for a client diagnosed with urinary retention. Which medication does the nurse expect to be prescribed?
Bethanechol
Which drug is NOT used to reverse neuromuscular blockade (skeletal muscle paralysis) caused by nondepolarizing muscle relaxants?
Bethanechol
Which medication will be administered to treat urinary retention?
Bethanechol
Which is an example of a direct-acting cholinergic that acts like the neurotransmitter acetylcholine?
Bethanechol (Urecholine)
A nurse is preparing a presentation for a local group of emergency first responders about biological and chemical weapons. The nurse is describing the effects of exposure to nerve gas. What would the nurse include?
Bronchial constriction
A male pt has been diagnosed with dementia and the nurse is teaching the pt and his wife about his new prescription for Donepezil. What should the nurse teach the pt and his wife? A) Diagnostic imaging in a few months will determine whether Donepezil is beneficial B) Your husband will need a drug holiday in which all his other medications are temporarily withheld, near the beginning of therapy C) This won't cure your husband's dementia, but it can slow the progression significantly D) This drug has benefits for many pts with Alzheimer's, but these are often not evident for 4-6 months
C
A pt is to receive Pilocarpine. The nurse understands that this drug should be most likely used to treat which of the following: A) Myasthenia gravis B) Neurogenic bladder C) Sjogren's disease dry mouth D) Alzheimer's disease
C
A pt receiving Neostigmine uses Naproxen for relief of low back pain. The nurse would caution the pt to report what? A) Increased bruising B) Muscle weakness C) Blood in stool D) Blurred vision
C
Nerve gas is an irreversible acetylcholinesterase inhibitor that can cause muscle paralysis and death. An antidote to such an agent is: A) Atropine B) Propranolol C) Pralidoxime D) Neostigmine
C
The nurse is caring for a pt who has a long-standing diagnosis of myasthenia gravis and who takes Pyridostigmine. What statement by the pt should the nurse prioritize for the follow-up? A) I just don't seem to have much of an appetite these days B) I'm drinking lots, but sometimes I just can't quench my thirst C) I'm feeling so much weaker than I usually do D) I'm worried that I'm getting worse, not better
C
What drug would the nurse expect to be administered as the antidote for the irreversible indirect-acting cholinergic agonists? A) Donepezil B) Pyridostigmine C) Pralidoxime D) Edrophonium
C
What statement best describes the action of direct-acting cholinergic agonists? A) They mimic the action of the sympathetic nervous system B) They undergo a chemical rxn with acetylcholinesterase C) They occupy receptor sites for acetylcholine D) They prevent the breakdown of acetylcholine
C
A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following?
Cholinergic crisis
A client has atony of the smooth muscle of the gastrointestinal tract. Which type of medication will be administered to increase smooth muscle strength?
Cholinergic drugs
A 32-year-old breast-feeding mother has been diagnosed with closed-angle glaucoma and is receiving cholinergic therapy. She does not have a history of asthma, cardiovascular disease, or biliary disorder. What is the most important factor that the nurse would consider during ongoing assessment of the therapy?
Cholinergic stimulation in her infant
It is important for a nurse to understand which body systems are affected by cholinergic drug adverse reactions, as this will determine how the nurse should assess the client. Which body systems are affected by cholinergic drug adverse reactions? (Select all that apply.)
Circulatory Respiratory Gastrointestinal Central nervous
A nurse is assessing a female client prior to giving her a cholinergic drug for myasthenia gravis. Which symptoms would cause the nurse to withhold the medication and call the provider? (Select all that apply.)
Clenching of the jaw Excessive salivation Severe abdominal cramping
A client with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. When the nurse finds the client anxious, diaphoretic, and visibly flushed, what action should the nurse take to best assure the client's safety?
Contact the health care provider as the client may be experiencing a cholinergic crisis.
The nurse has administered a 10 yr old pts scheduled dose of bethanechol. What follow-up assessment should the nurse prioritize? A) GI assessment B) Assessment for dry mouth C) Cognitive assessment D) Assessment of urine output
D
The nurse has administered a cholinergic agent to a pt. What assessment would best identify the intended therapeutic effects? A) Lung auscultation B) Activity tolerance and ambulation C) Weight and abdominal girth D) Urinary output
D
The nurse is caring for a pt with myasthenia gravis. What medication is the nurse most likely to administer? A) Galantamine B) Tacrine C) Rivastigmine D) Neostigmine
D
The nurse would expect to administer Donepezil to a pt with Alzheimer's disease who: A) Cannot remember daily members' names B) Is mildly inhibited and can sill follow medical dosing regimens C) Is ablate carry on normal activities of daily living D) Has memory problems and would benefit from once-a-day dosing
D
When reviewing cholinergic agonists, the nurse learns that there are direct acting and indirect acting cholinergic agonists. What is the agent acts directly or indirectly on? A) Nerve impulse transmission B) Acetylcholine potency C) Acetylcholine production D) Acetylcholine receptor sites
D
Which indirect-acting cholinergic agonist has the shortest duration of action? A) Neostigmine B) Namzaric C) Pyridostigmine D) Edrophonium
D
The client is to receive an IV cholinergic medication. When the nurse administers the drug what reaction will the nurse anticipate?
Decrease in heart rate
The nursing instructor is teaching students about Alzheimer's disease. The instructor informs the students that clients with this illness experience problems with memory and thinking. The reason that this happens is which?
Degeneration of cholinergic pathways
A female client had surgery 24 hours ago to repair a hernia. The nurse finds that the client has not had a bowel movement since the day before the surgery. She is experiencing abdominal distention, and during auscultation the nurse notes an absence of bowel sounds. Further examination and testing reveal a paralytic ileus. The provider orders bethanechol. The nurse is aware that bethanechol is included in which drug classification?
Direct-acting cholinergic drug
A female client is taking cholinergic medication to control bladder retention. She presents to the emergency department with confusion, shortness of breath, and an apical pulse of 42 beats per minute and irregular. What action would the nurse expect the health care provider to take?
Discontinue the cholinergic medication secondary to the diagnosis of bradycardia.
A 65-year-old male client takes cholinergic medication. He presents to the emergency department with symptoms associated with GI distress. He is diagnosed with a small bowel obstruction. What action would the nurse expect the health care provider to take?
Discontinue the cholinergic medication to prevent injury to the areas proximal to the obstruction
Which medication would the nurse expect to administer orally once a day to a client with AD?
Donepezil
A 70-year-old female patient has just been diagnosed with Alzheimer's disease. What cholinergic drug is used for the treatment of Alzheimer's disease?
Donepezil (Aricept)
The nurse is caring for a client in the emergency department who has a history of myasthenia gravis. The client has symptoms that could be interpreted as either myasthenic crisis or cholinergic crisis. The nurse is aware that the physician will order what medication to help determine the type of crisis the client is experiencing?
Edrophonium
The nurse is preparing a teaching plan for a patient who is taking rivastigmine. What precaution should the nurse teach the patient and family to minimize the risk of GI adverse effects?
Having small, frequent meals
After teaching a group of students about direct acting cholinergic agonists, the instructor determines that additional teaching is necessary when the students identify what as an adverse effect?
Hypertension
A nurse is caring for a client who is taking rivastigmine. The client's nursing care plan will prioritize which nursing diagnosis?
Imbalanced Nutrition: Less Than Body Requirements related to decreased desire to eat secondary to nausea and vomiting from drug therapy
The pharmacology instructor is discussing the drug therapy for Alzheimer's disease with a group of nursing students and states that indirect-acting cholinergic drugs do what to improve symptoms?
Improve cholinergic neurotransmission to the brain
The nurse administered donepezil (Aricept) to a patient. What is the therapeutic response the nurse expects to assess?
Improved memory
A patient with dementia of Alzheimer's disease is administered donepezil HCL. What are the actions associated with cholinesterase inhibitors?
Increase in the level of acetylcholine in CNS
A patient is administered edrophonium (Tensilon) to confirm the diagnosis of myasthenia gravis. What effect will the edrophonium (Tensilon) have 30 minutes after the medication administration, which will confirm the diagnosis?
Increased muscle strength
A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs. Which interaction should the nurse monitor for in this patient?
Increased risk of GI bleeding
Which physiologic effect would be related to the use of cholinergic agents?
Increased salivation
A nurse administers bethanechol (Urecholine). What assessment finding is attributable to the effect of this medication?
Increased urinary output
The client is receiving Bethanechol for bladder atony. What assessment findings indicate the effect of this medication?
Increased urinary output
A patient with myasthenia gravis is administered neostigmine (Prostigmin). How does this cholinergic drug produce its effect?
It stimulates the parasympathetic nervous system.
Jack Thomas is a 45-year-old automobile mechanic with a history of throat cancer. Jack has just undergone radical neck resection. As a result of the surgery, Jack suffers from xerostomia, a dry mouth condition. He is prescribed pilocarpine therapy. What advice should you give Jack regarding the drug therapy?
Jack should be cautioned about blurred vision and its hazards.
A nurse is caring for a patient with urinary retention who is undergoing cholinergic drug therapy. What ongoing assessment should the nurse perform while caring for the patient? (Select all that apply.)
Measure and record the fluid intake and output. Palpate the bladder to determine its size. Monitor voiding after drug administration.
A nurse administers carbachol eye drops to a client. What would indicate that the drug is effective?
Miosis
Indirect-acting cholinergic agonist drug-drug interaction
NSAIDs
A patient with advanced-stage Alzheimer's disease is seen by a physician who prescribes a newer drug that is not a cholinesterase inhibitor. This drug is a N-methyl-D-asparate (NMDA) receptor antagonist. This drug is better known as:
Namenda
After teaching a group of students about indirect acting cholinergic agonists used to treat myasthenia gravis, the instructor determines that the teaching was effective when the students identify which agent?
Neostigmine
A patient with dementia of Alzheimer's disease is prescribed rivastigmine by the primary health care provider. Which is the correct method of administering rivastigmine to the patient?
Orally
What is important for the nurse to realize about the difference between systemic and otic cholinergic medications?
Otic medications are less likely to cause complications.
The nursing instructor is discussing cholinergic drugs with his clinical group. What system would the instructor tell the students is stimulated by cholinergic drugs?
Parasympathetic nervous system
A patient with Alzheimer's disease is being treated with Exelon. The nurse knows that this drug is also used to treat which disorder?
Parkinson's disease
A client is treated in the critical care unit for overdose of indirect cholinergic drugs. What is the treatment of choice in this situation? (Select all that apply.)
Pralidoxime A cholinesterase reactivator
The nurse is developing a care plan for a client who will receive donepezil in the home setting. How can the nurse best facilitate safe and effective administration of the medication?
Teach the client's caregiver to administer the medication in a timely and safe manner.
A patient has been newly diagnosed with myasthenia gravis. What nursing intervention is appropriate?
Recommend that one or more members of the patient's family learn CPR.
A military nurse is part of a team reviewing the appropriate response to chemical weapons attacks, including sarin, tabun, and soman. When reviewing the physiology of a response to such drugs, the nurse should identify what goal of treatment?
Restore anticholinesterase function
The nurse is developing a teaching plan for an outpatient receiving cholinergic drugs. What should be the role of the nurse when developing a teaching plan?
Review the purpose of the drug therapy with the patient and family.
A group of students are reviewing the drugs that are available for treating Alzheimer's disease. The students demonstrate understanding of the information when they identify which drug as appropriate for treatment?
Rivastigmine
A client taking rivastigmine reports to the clinic nurse that she has been having gastrointestinal problems since she started the medication. The nurse will advise the client to do which?
Take the medication with food
The client has been prescribed a cholinergic agonist. Which statement is true concerning the administration of cholinergic agonists?
The parasympathetic nervous system is stimulated by these medications.
What statement is true concerning the administration of cholinergic agonists?
The parasympathetic nervous system is stimulated by these medications.
The nurse administered neostigmine to a client with myasthenia gravis. The nurse is doubling the dose that the client was taking at home. Three hours later, the nurse is assessing the client and notes the following symptoms: nausea with vomiting, diarrhea, and sweating. What does the nurse interpret these symptoms to be?
This is cholinergic crisis, and the physician needs to be notified immediately.
When assessing a client for possible adverse effects of direct-acting cholinergic agents, what might the nurse find?
Urinary urgency
The nursing student correctly identifies that the transmitter in the cholinergic neuropathways that appears insufficient in patients with Alzheimer's disease is:
acetylcholine
When describing the parasympathetic nervous system to a group of students, which substance would the nursing instructor discuss as being responsible for transmission of nerve impulses across this system?
acetylcholine
Direct-acting cholinergic agonist drug-drug interaction
acetylcholinesterase
Direct-acting cholinergic agonist action
act as cholinergic receptor in peripheral nervous system to mimic the effects of ACh and parasympathetic stimulation
Indirect-acting cholinergic agonist contraindications
allergy, bradycardia, intestinal urinary tract obstruction, lactation
Indirect-acting cholinergic agonist caution
any condition that could be exacerbated by cholinergic stimulation, asthma, coronary disease, peptic ulcer, arrhythmias, epilepsy, parkinsonism
Direct-acting cholinergic agonist contraindication
any condition that would be exacerbated by parasympathetic effects (brachycardia, hypotension), peptic ulcer disease, intestinal obstruction or recent GI surgery, asthma, bladder obstruction, epilepsy, parkinsonism
Nursing consideration (direct-acting cholinergic agonist, indirect-acting cholinergic agonist)
assessment (history, physical exam), nursing diagnosis, implementation, evaluation
A 78-year-old client is admitted to the Emergency Department (ED) and is diagnosed with bradycardia. The client tells the nurse that the client is taking donepezil (Aricept), a cholinergic agent, for Alzheimer's disease. The nurse knows that the drug of choice for bradycardia is:
atropine
A client being treated for myasthenia gravis is receiving neostigmine. When the client's pulse drops to 50 after the administration, which medication should be administered to treat the bradycardia?
atropine
A client experiences an overdose of a cholinergic drug. Which medication would the nurse anticipate that the client will receive as a reversal agent?
atropine
A client is reporting diarrhea, rigidity and spasm after receiving pyridostigmine. Which medication is appropriate to suggest to the prescriber?
atropine
Which would be most important to have readily available for a client who is receiving an indirect-acting cholinergic agonist and develops a severe reaction?
atropine
Myasthenia gravis is a(n):
autoimmune disorder.
Rivastigmine (exelon)
available in solution for swallowing ease
Ambenonium (mytelase)
available only in oral form, cannot be used if patient can't swallow tablets
Direct-acting cholinergic agonist type (indication)
bethanechol (duvoid, urecholine), carbachol (miostat), pilocarpine (pilocar)
Indirect-acting cholinergic agonist action
blocks acetylcholinesterase at synaptic cleft, allows accumulation of ACh released from nerve ending leads to increased and prolonged stimulation of ACh
Indirect-acting cholinergic agonist adverse reaction
bradycardia, hypotension, increased GI secretions and activity, increased bladder tone, relaxation of GI and genitourinary sphincters, bronchoconstriction, pupil constriction
Pyridostigmine (regonol mestinon)
has a longer duration of action than neostigmine
A new patient has come to the clinic. The patient tells the nurse that the patient takes Aricept. It would be important for the nurse to assess the patient's medical and medication history because many bodily functions are affected by the:
cholinergic medications' ability to stimulate the parasympathetic nervous system.
A client has been receiving bethanechol for 1 week. One hour after the dose is administered, the client develops sweating, flushing, abdominal cramps, and nausea. What is the rationale for the development of these symptoms?
cholinergic overdose
Myasthenia gravis
chonic muscular disease caused by defect in neuromuscular transmission, autoimmune disease patients make antibodies to ACh receptors causing gradual destruction of them
Edrophonium (tensilon enlon)
diagnostic agent for myasthenia gravis
Indirect-acting cholinergic agonist (how)
do not react directly with ACh receptor sites, react chemicaly with acetylcholinesterase in the synaptic cleft to prevent it from breaking down ACh, ACh released form presynaptic nerve accumulates stimulating the ACH receptors, bind reversibly to acetylcholinesterase so effects will pass with time
A client is diagnosed with Alzheimer's disease. The nurse should anticipate administering which medication?
donepezil
A cholinergic crisis is characterized by which event?
excessive stimulation of the parasympathetic nervous system
Tacrine (cognex)
first drug to tread alzheimer's dementia
An older adult client has been diagnosed with early-stage Alzheimer's disease and has begun treatment with donepezil. When providing health education to the client and the client's spouse, the nurse should identify what goal of treatment?
improvement of cognition and function
The client in the final stage of Alzheimer's disease tends to suffer from weight loss and eating problems. This is primarily due to:
inability to swallow.
Direct-acting cholinergic agonist indication
increase the tone of the detrusor muscle of the bladder and relax the bladder sphincter
The nurse administers a drug that will increase micturition. What should the nurse assess for a therapeutic effect?
increased voiding
Carbachol (miostat) pilocarpine (pilocar)
induce miosis pupil constriction, relieve intraocular pressure of glaucoma, perform certain surgical procedures
Nerve gas
irreversible acetylcholinesterase inhibitor
Nerve gas action
leads to toxic accumulation of ACh at cholinergic receptor sites, can cause parasympathetic crisis and muscle paralysis
NSAIDs
the nurse is providing patient education to a patient taking an indirect-acting cholinergic agonist. What drug-drug interaction would the nurse include in the patient education?
Bethanechol (duvoid, urecholine)
urinary retention, neurogenic bladder atony, diagnose and treat reflux esophagitis
Galantamine (reminyl)
used to stop progression of alzheimer's dementia
Indirect-acting cholinergic agonist pharmacokinetic
well absorbed distributed throughout body, metabolized in the liver and excreted in urine
Direct-acting cholinergic agonist pharmacokinetic
well absorbed, have relatively short half life 1-6 hrs, metabolized and excretion of these drugs is not known
Exelon
which of the drugs used to treat Alzheimer's disease is available in solution for swallowing ease?
A nurse should alert a client to which adverse effects of pyridostigmine (Mestinon)? (Select all that apply.)
• Nausea • Skin flushing
