Cholinergic Drugs
Which of the following are a direct-acting muscarinic?
Nicotine
Pilocarpine (Pilocar)
Atropine
Neostigmine (Prostigmin)
What is the use of Pilocarpine (Pilocar)? (Select all that apply)
Increase muscle strength
Xerostomia
Adjunct to smoking cessation programs
Emergency treatment of bradyarrhythmia
Open-angle glaucoma
What are the contraindications/precautions of Pilocarpine (Pilocar)? (Select all that apply)
Angina
New MI
Allergy in opthalmic use
Nephrolithiasis
Narrow-angle glaucoma
What are the adverse reactions of Pilocarpine (Pilocar)? (Select all that apply)
Loss of visual acuity and accommodation
Peripheral constriction
Insomnia, nightmare
Sinus bradycardia
Cholinergic crisis
What is important to consider with Pilocarpine (Pilocar)?
Avoid last dose before bedtime
Safety issues with vision changes
Lack of thermal regulation
Obtain thorough history to identify cardiac pts
What is an important nursing consideration when a patient is specifically on Pilocarpine (Pilocar)?
Oral hygiene
Encourage participation in smoking cessation programs
Must NOT use eye drops when checking pupil response during a neuro assessment
Assess for extensive dental work
Why do Pilocarpine eye drops make detached retina's worse?
It causes mydriasis
It pulls it out more due to pressure
It causes eyes to become itchy
It decreases in accomodation
What is the antidote for cholinergic crisis?
Pilocarpine
Atropine
Neostigmine
Nicotine
What is it called when a patient has overstimulation due to excess acetylcholine and suffer from respiratory muscle paralysis and excess respiratory secretions (strangled and drowning at same time)?
First pass effect
Cholinergic crisis
Rebound HTN
First dose effect
Which of the following are a direct-acting nicotinic?
Pilocarpine
Nicotine
Atropine
Neostigmine
What are contraindications/precautions when taking nicotine? (Select all that apply)
Angina
Avoid smoking
Renal or hepatic disorders
Avoid use in new MI
May exacerbate hyperthyroidism
What are adverse reactions of nicotine? (Select all that apply)
Insomnia
Nightmare
Dyspepsia
Confusion
Local irritation, rash
Which drugs could induce a drug interaction of nicotine? (Select all that apply)
Lithium carbonate
Haloperidol
Anesthetics
Adenosine
Steroids
What are important nursing considerations for nicotine? (Select all that apply)
Obtain thorough history to identify cardiac pts
Assess for extensive dental work
Photophobia may develop
Encourage participation in smoking cessation programs
Avoid last dose before bedtime
Why is it important to avoid taking the last dose of nicotine before bed?
It may cause constipation
To avoid insomnia and nightmares
It may cause blurred vision
It may cause tachycardia
Which drug treats urinary retention?
Nicotine
Bethanechol (Urecholine)
Metoclopramide HCl (Reglan)
Neostigmine (Prostigmin)
Which drug treats GERD?
Pilocarpine (Pilocar)
Metoclopramide HCl (Regaln)
Bethanechol (Urecholine)
Nicotine
Which of the following are direct-acting cholinergic agonists? (Select all that apply)
Neostigmine (Prostigmin)
Pilocarpine (Pilocar)
Nicotine
Bethanechol (Urecholine)
Metoclopramide HCl (Reglan)
What is an example of an indirect-acting cholinergic?
Nicotine
Neostigmine (Prostigmin)
Atropine
Pilocarpine (Pilocar)
Which of the following are contraindications for muscarinic agonists? (Select all that apply)
Intestinal or urinary tract obstruction
Severe bradycardia
Parasthesias
Active asthma
Hot flashes
What are the uses for Neostigmine (Prostigmin)? (Select all that apply)
Myasthenia gravis
Prevent or treat preop urinary retention, paralytic ileus
Antidote for non-depolarizing neuromuscular blocking agents
GERD
Xerostomia
Why is Neostigmine (Prostigmin) used after surgery regarding muscles?
It helps with cramping
It helps the paralysis
It's used to treat seizures
It helps with tingling
Why should you use caution when giving Neostigmine (Prostigmin) to a cardiac pt?
Decreases contractility
Increases myocardial O2 demand
Increases arrythmias
Decreases conduction
What are some contraindications for Neostigmine (Prostigmin)? (Select all that apply)
GI or urinary obstruction
Avoid in MI
Increases hypotension and bradycardia
Avoid in peritonitis
Retinal or acute iritis
What's an important adverse reaction of Neostigmine (Prostigmin)? (Select all that apply)
Cholinergic crisis
Decreased sweating
Sinus bradycardia
Tachycardia
Coughing
What drug class does Neostigmine (Prostigmin) also fall under?
Alzheimer's
Parkinson
Motion Sickness
Antihypertensive
Which of these are Alzheimer's meds? (Select all that apply)
Cyclinizine (Marzine)
Rivastigmine (Exelon)
Benztropine (Cogentin)
Donepezil (Aricept)
Dimenhydrinate (Dramamine)
Which of the following is a muscarinic antagonist?
Neostigmine (Prostigmin)
Atropine
Pilocarpine (Pilocar)
Bethanechol (Urecholine)
What are the uses of Atropine? (Select all that apply)
Emergency treatment of bradyarrhythmia
Preop med to reduce salivation
Antidote for organophosphate insecticide toxicity or neuromuscular blockade
Increase HR for bradycardia
Dilate pupils for ocular diagnostic exams
Which of the following are cautions of Atropine? (Select all that apply)
COPD
N/V/D
Renal or hepatic disorders
Heart failure
Angina
What can happen during cholinergic overdose? (Select all that apply)
Increased temp
Confusion, delirium
Decreased secretions
Flushed face
Pupils dilate
What happens when you increase the dosage of Atropine?
Bradycardia
Tingling
Tachycardia
Cramping
Which of the following can be drug interactions of Atropine? (Select all that apply)
Lithium carbonate
Magnesium
Phenothiazine antipsychotics
Haloperidol
Adenosine
Why is there a risk for injury when on Atropine?
Sensory dysfuction
Blurred vision and drowsiness
Altered clotting factors
Neuropathy
Which of the following should the nurse consider when a patient is on Atropine?
Risk for urinary retention and constipation
Oral hygiene
Lack of thermal regulation
Photophobia may occur
Avoid last dose before bedtime
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