Question

Set #2

1. What are the actions of cholinergics and anticholinergics?

2. You are preparing to administer atropine to your patient. What classification is this drug? Explain the uses of this medication?

a. For each use, what evaluation would tell you that the patient has a therapeutic effect?

b. When obtaining a history, what conditions or other drugs are you concerned the patient has that could interact or be contraindicated with this drug?

c. How does this drug impact vital signs?

d. What are the side effects of this drug you would be monitoring for? The adverse reactions?

e. What are the nursing interventions for this drug classification?

f. What teaching should be included when administering this drug classification?

Answer 1

1. Cholinergics :-

#. Another name for Cholinergic Drugs:

Parasympathomimetic drugs or Muscarinic Agonists

Bind to muscarinic receptors activating receptors in all effectors organs of the parasympathetic nervous system

#. Cholinergic Drug Actions:

*Decrease intraoccular pressure by constricting pupil and contracting ciliary bodies of the eyes

*Heart brake: lower heart rate, decrease output, lowers BP

*Dilates blood vessels Skin, Viscera, Mucus Membranes (GI)

*Increase tone and motility of GI smooth muscles

*Increase peristalsis

*Contraction of the detruser muscle bladder increase bladder pressure and relaxes trigone and bladder sphincter = urination.

Anticholinergics :-

Action :

- block the binding of Ach to the receptor

- antagonize the action of acetylcholine at the postganglionic cholinergic sites in the heart, salivary glands, and smooth muscle of GU/Gi tract - therefore none specific

- selectively ANTIMUSCARINIC

- at usual doses they exert NO effect on nicotinic cholinergic receptors

2. Atropine :-

Therapeutic class :-

antiarrhythmics

Pharmacological class :-

anticholinergics antimuscarinics

Indications

• IM: Given preoperatively to decrease oral and respiratory secretions.• IV: Treatment of sinus bradycardia and heart block.• PO: Adjunctive therapy in the management of peptic ulcer and irritable bowel syndrome.• IV: Reversal of adverse muscarinic effects of anticholinesterase agents (neostigmine, physostigmine, or pyridostigmine).• IM, IV: Treatment of anticholinesterase (organophosphate pesticide) poisoning.• Inhaln: Treatment of exercise-induced bronchospasm.

Action

• Inhibits the action of acetylcholine at postganglionic sites located in: » Smooth muscle, » Secretory glands , » CNS (antimuscarinic activity).

A) 1. For pre op care - oral and respiratory secretions we assess that the secretions are decreased or not to prevent aspiration.

2. Sinus bradycardia - we assess whether the heart rate is normal or not between 60-100bpm.

3. Reversal of many muscarinic effects by assessing the sign and symptoms .

4. For bronchospasm - after use we assess whether the patient is relieved from breathing difficulty or not

5. Assess the effect as an antidote for poisoning

B) Other drugs that could interact with this drugs are :-

- Digitalis , cholinergics , physostigmine causes adverse effects .

- Benzodiazapine , antihistamines ,and antidepressants enhances the effects of atropine .