final

• Cholinergic agonists


  Bethanechol (Urochline) and Neostigmine
• Bethanechol (Urocholine)


  Is direct acting
• Bethanechol (Urocholine) action


  Mimics ACh to produce parasympathetic nervous system responses
• Bethanechol (Urocholine) Use


  - Paralytic ileus

  - Post-op urinary retention

  - Abdominal distention

  - Glaucoma

  - Anticholinergic overdose
• Bethanechol (Urocholine) Side Effects


  - Urinary incontinence

  - Flushing, Diaphoresis

  - Blurred vision

  - Muscular tremors

  - Hypotension

  - Bradycardia

  - Bronchoconstriction (with overdose)

  - Cholinergic Crisis
• Bethanechol (Urocholine) Nursing Implications


  - Assess VS and cardiac function

  - Assess urine output

  - Assess therapeutic response

  - Treat overdose with Atropine

  - Contraindicated with asthma
• Neostigmine


  is indirect acting
• Neostigmine Action


  unknown
• Neostigmine Use


  Myasthenia Gravis
• Neostigmine Side Effects


  muscle weakness
• Chronic Antagonist


  Atropine
• Atropine Action


  Blocks musarinic receptor sites preventing binding of Ach
• Atropine Use


  - Surgical pre-op

  - Sinus node dysfunction

  - Bradycardia

  - Heart blocks

  - Asthma, COPD

  - Parkinson's Disease
• Atropine Side Effects


  - Dry mouth

  - Drowsiness

  - Constipation

  - Urinary retention

  - Tachycardia

  - Hot, dry, flushed skin

  - Confusion

  - Increased intraocular pressure

  - Blurred vision

  - Bradycardia
• Atropine nursing implications


  - Assess VS and cardiac function

  - Assess urine output

  - Assess therapeutic response

  - Comfort measures for side effects, Ice chips, good oral hygiene, fluids for constipation

  - Caution with decrease renal function

  - Contraindicated with myasthenia gravis

  - Contraindicated with glaucoma
• Atropine


  - SLUDGE

  Salvation

  Lacrimation

  Urination

  Defecation

  GI cramping

  Emesis
• Adrenergic Agonists


  - epinephrine

  - Phenylephrine (Non-synephrine)

  - Dobutamine (Dobutrex)

  - Dopamine (Intropin)

  - Prazosin (minipress)

  - Propranolol (Inderal)
• Epinephrine


  adrenergic agonist
• Epinephrine action


  - Stimulates SNS receptors

  - Alpha 1: Vasoconstriction, mydriasis

  - Beta 1: Pos. chromotropic effects, pos. Inotropic effects, pos. Dromotropic effects

  - Beta 2: Bronchodilatation
• Epinephrine use


  - Anaphylactic reactions

  - cardiac arrhythmias

  - hypotensive shock
• Epinephrine side effects


  - Hypertension

  - tachycardia

  - cardiac arrhythmias

  - urinary retention

  - cerebral hemorrhage

  - angina

  - CNS excitability Hyperglycemia

  - extravasation
• epinephrine nursing implications


  - Assess VS and cardiac function

  - Assess urine output

  - Assess therapeutic response

  - Consult MD prior to taking OTC cold medications

  - Watch blood glucose levels in diabetics

  - Ensure safety 2 degree to CNS excitability

  - Monitor EKG for arrhythmias

  - Assess IV for extravasation
• you use epinephrine in an


  Emergency
• Phenylephrine (Non-synephrine)


  Alpha Adrenergic Agonist
• Phenylephrine (Non-synephrine) action


  - stimulates alpha receptors

  - vasoconstriction, mydriasis
• Phenylephrine (Non-synephrine) use


  - Glaucoma

  - Nasal congestion

  - hypotension
• Dobutamine (Dobutrex)


  Beta 1 Adrenergic Agonist
• Dobutamine (Dobutrex) action


  - Stimulate Beta 1 receptors in the heart

  - Pos. Chromotropic effects

  - pos Inotropic effects

  - Pos dromotropic effects
• Dobutamine (Dobutrex) use


  - Hypotension

  - Shock 2 degree to MI
• Dopamine (Intropin) action


  - Dopamine receptor activity is dose related

  - low dose action, vasodilation of renal and mesenteric arteries

  - high dose action, stimulates Beta 1 receptors (inotropic effects)
• Dopamine (Intropin) use


  ARF and CHF
• Prazosin (minipress)


  Alpha aderenergic blockers
• Prazosin (minipress) action


  blocks alpha receptors preventing binding of catecholamines
• Prazosin (minipress) use


  - HTN

  - frost bite, raynaud's diease

  - phenochronocytoma

  - glaucoma

  - extravasation

  - post partem and post abortion bleeding
• Prazosin (minipress) side effects


  - Orthostatic hypotension; dizziness

  - Nausea /vomiting/Diarrhea; edema

  - stimulates uterine contractions

  - reflex tachycardia
• Prazosin (minipress) nursing implications


  - Assess VS and cardiac function

  - Assess urine output

  - Assess therapeutic response

  - Assess S/S CHF

  - Consult MD before taking OTC meds

  - Watch blood sugar in diabetics

  - Safety secondary to orthostatic hypotension

  - Alpha blockers contraindicated in pregnancy

  - Beta Blockers contraindicated in Asthma

  - Hold beta blockers if pulse is < 60

  - Instruct pts not to stop beta blockers abruptly
• Propranolol (Inderal)


  Beta Aderenergic Blockers
• Propranolol (Inderal) action


  Blocks beta receptors preventing binding of catecholamines
• Propranolol (Inderal) use


  - Post MI

  - Angina

  - HTN

  - Arrhythmia's
• Propranolol (Inderal) side effects


  - Orthostatic hypotension

  - dizziness

  - Nausea /vomiting/Diarrhea

  - edema

  - stimulates uterine contractions

  - reflex tachycardia