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Drugs Affecting the Autonomic Nervous System

Cholinergic Drugs. Drugs Affecting the Autonomic Nervous System. Cholinergic Drugs. Describe the cholinergic drug effects on major body systems. Discuss the nursing process related to the care of patients receiving cholinergic drugs for select problems. Cholinergic Drugs.

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Drugs Affecting the Autonomic Nervous System

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  1. Cholinergic Drugs Drugs Affecting the Autonomic Nervous System

  2. Cholinergic Drugs • Describe the cholinergic drug effects on major body systems. • Discuss the nursing process related to the care of patients receiving cholinergic drugs for select problems.

  3. Cholinergic Drugs • Drugs that stimulate theparasympathetic nervous system (PSNS) • opposing system to the SNS • Known as: cholinergic agonists or parasympathomimetics • Mimic the effects of the PSNS neurotransmitter: acetylcholine (Ach) • Two types of Receptors: • determined by: Location & Action once stimulated • Muscarinic receptors – recommended doses with desired effect • Nicotinic receptors – higher doses with undesirable effects

  4. Cholinergic DrugsMechanism of Action • Direct-acting cholinergic agonists • Bind to cholinergic receptors, activating them • Indirect-acting cholinergic agonists • Inhibit the enzyme acetylcholinesterase - prventing, which breaks down ACh - more ACh is available at the receptors • Reversible - Bind to cholinesterase for a period of minutes to hours • Irreversible - Bind to cholinesterase and form a permanent covalent bond • The body must make new cholinesterase to break these bonds

  5. Cholinergic Drugs“rest and digest” system “SLUDGE” • Salivation • Lacrimation • Urinary incontinence • Diarrhea • Gastrointestinal cramps • Emesis

  6. Cholinergic DrugsDrug Effects • Stimulate intestine and bladder • Increased gastric secretions • Increased gastrointestinal motility • Increased urinary frequency • Stimulate pupils • Constriction (miosis) • Reduced intraocular pressure • Increased salivation and sweating • Cardiovascular effects • Decreased heart rate • Vasodilation • Respiratory effects • Bronchial constriction, narrowed airways

  7. Cholinergic DrugsDrugs • Bethanechol (Urecholine) – urinary retention • Cevimeline (Evoxac) – Xerostomia • Memantine (Namenda) – Alzheimer’s dementia • Physostigmine (Antilirium) – reversal of anticholinergic drugs effects • Pyridostigmine (Mestinon) – Myasthenia gravis

  8. Cholinergic DrugsIndications Direct-acting drugs • Reduce intraocular pressure • Topical useful for glaucoma and intraocular surgery • pilocarpine

  9. Cholinergic DrugsIndications Direct-acting drug—bethanechol (Urecholine) • Increases tone and motility of bladder and GI tract • Relaxes sphincters in bladder and GI tract, allowing them to empty • Used to reverse postsurgical atony of the bladder and GI tract • Oral dose or SC injection

  10. Cholinergic DrugsIndications Indirect-acting drugs • Cause skeletal muscle contractions • Used for diagnosis and treatment of myasthenia gravis • Pyridostigmine (Mestinon) – Myasthenia gravis • Used to reverse neuromuscular blocking drugs/anesthesia • Used to reverse anticholinergic poisoning (antidote) • Examples: physostigmine (Antilirium)

  11. Cholinergic DrugsIndications Indirect-acting drugs—cevimeline (Evoxac) • Used to treat xerostomia (dry mouth) resulting from Sjögren’s syndrome

  12. Cholinergic DrugsAdverse Effects Adverse effects are a result of overstimulation of the PSNS • Cardiovascular • Bradycardia, hypotension, conduction abnormalities (AV block and cardiac arrest) • CNS • Headache, dizziness, convulsions • Gastrointestinal • Abdominal cramps, increased secretions, nausea, vomiting • Respiratory • Increased bronchial secretions, bronchospasm • Other • Lacrimation, sweating, salivation, loss of binocular accommodation, miosis

  13. Cholinergic DrugsInteractions • Anticholinergics, antihistamines, sympathomimetics • Antagonize cholinergic drugs, resulting in decreased responses • Other cholinergic drugs • Additive effects

  14. Cholinergic DrugsNursing Implications • Assess for allergies, presence of GI or GU obstructions, asthma, peptic ulcer disease, or coronary artery disease • Perform baseline assessment of vital signs and systems overview • Medications should be taken as ordered and not abruptly stopped • The doses should be spread evenly apart to optimize the effects of the medication • Overdosing can cause life-threatening problems. Only physicians should adjust the dosages

  15. Cholinergic DrugsNursing Implications • Encourage patients with myasthenia gravis to take medication 30 minutes before eating to help improve chewing and swallowing • When cholinergic drugs are prescribed for Alzheimer’s disease, be honest with caregivers and patients that the drugs are for management of symptoms, not a cure • Therapeutic effects of anti-Alzheimer’s drugs may not occur for up to 6 weeks

  16. Cholinergic DrugsNursing Implications Monitor for therapeutic effects • Alleviated signs and symptoms of myasthenia gravis • In postoperative patients with decreased GI peristalsis, look for: • Increased bowel sounds • Passage of flatus • Occurrence of bowel movements • In patients with urinary retention/hypotonic bladder, urination should occur within 60 minutes of bethanechol administration • ALSO monitor for adverse effects

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