Drugs%20Affecting%20the%20Autonomic%20Nervous%20System - PowerPoint PPT Presentation

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Cholinergic Drugs Cholinergic Drugs Describe the cholinergic drug effects on major body systems. Discuss the nursing process related to the care of patients receiving ... – PowerPoint PPT presentation

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Title: Drugs%20Affecting%20the%20Autonomic%20Nervous%20System

Drugs Affecting the Autonomic Nervous System
  • Cholinergic Drugs

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
  • Drugs that stimulate theparasympathetic nervous
    system (PSNS)
  • opposing system to the SNS
  • Known as cholinergic agonists or
  • 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

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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

Cholinergic Drugsrest and digest system
  • Salivation
  • Lacrimation
  • Urinary incontinence
  • Diarrhea
  • Gastrointestinal cramps
  • Emesis

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

Cholinergic DrugsDrugs
  • Bethanechol (Urecholine) urinary retention
  • Cevimeline (Evoxac) Xerostomia
  • Memantine (Namenda) Alzheimers dementia
  • Physostigmine (Antilirium) reversal of
    anticholinergic drugs effects
  • Pyridostigmine (Mestinon) Myasthenia gravis

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

Cholinergic DrugsIndications
  • Direct-acting drugbethanechol (Urecholine)
  • Increases tone and motility of bladder and GI
  • 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

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

Cholinergic DrugsIndications
  • Indirect-acting drugscevimeline (Evoxac)
  • Used to treat xerostomia (dry mouth) resulting
    from Sjögrens syndrome

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,
  • Respiratory
  • Increased bronchial secretions, bronchospasm
  • Other
  • Lacrimation, sweating, salivation, loss of
    binocular accommodation, miosis

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

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

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
    Alzheimers disease, be honest with caregivers
    and patients that the drugs are for management of
    symptoms, not a cure
  • Therapeutic effects of anti-Alzheimers drugs may
    not occur for up to 6 weeks

Cholinergic DrugsNursing Implications
  • Monitor for therapeutic effects
  • Alleviated signs and symptoms of myasthenia
  • 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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