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Cholinergic Agonists (Parasympathomimetics) Nursing Considerations & Management


Cholinergic agonists act at the selfselfcorresponding locality as the neurotransmitter acetylcholine (ACh) and extension the disposition of the ACh receptor localitys throughout the substance. These receptor localitys are base throughout the substance so their stimulation produces correspondent goods when parasympathetic terse scheme is activated. Thus, they are so calld as parasympathomimetics. Cholinergic agonists can either be direct- or indirect-acting cholinergic agonists. Under indirectly-acting cholinergic agonists, tclose are constituencys for Alzheimer’s and Myasthenia Gravis.

Table of Common Drugs and General Names

Here is a consideration of generally encountered cholinergic agonists, their general calls, and mark calls:
Classification Generic Name Brand Name
Direct-Acting Cholinergic Agonists bethanechol Duvoid, Urecholine
carbachol Miostat
cevimeline Evoxac
pilocarpine Salagen
Indirect-Acting Cholinergic Agonists
Agents of Myasthenia Gravis ambenonium Mytelase
edrophonium Reversal
neostigmine Prostigmin
pyridostigmine Mestinon
Agents for Alzheimer’s Disease donepezil Aricept
galantamine Razadyne
rivastigmine Exelon
tacrine Cognex

Disease Spotlight: Alzheimer’s Distemper and Myasthenia Gravis

  • Direct-acting cholinergic agonists are usually used for texture of neurogenic bladder atony in progeny, succor constraining on glaucoma resigneds, and texture of symptoms of dry mouth in resigneds succeeding a opportunity Sjogren’s syndrome.
  • Indirect-acting cholinergic constituencys are used for myasthenia gravis and Alzheimer’s distemper. Myasthenia gravis is a constant powerful distemper producerd by imperfection in neuropowerful transmission. It is reflection to be an autoimmune distemper in which antibodies to own ACh receptors are made. As fewer receptor localitys beseem conducive, resigneds originate to keep newfangled imbecility and stagnation of muscle control. On the other hand, Alzheimer’s distemper is a newfangled assumption of neural retrogression living to remarkable forfeiture of recollection and the power to heave on activities of daily subsistence.

Direct-acting Cholinergic Agonists

  • Direct-acting cholinergic agonists are correspondent to Ach and recoil at-once succeeding a opportunity receptor localitys to producer the selfselfcorresponding recoilion if Ach has stimulated the receptor localitys.
  • Common examples grasp bethanechol and pilocarpine.
Therapeutic Action
The desired and wholesome possessions of direct-acting cholinergic agonists are as follows:
  • Direct-acting cholinergic agonists occupy receptor localitys for ACh on the membranes of the commoditiesor cells causing extensiond stimulation.
  • Effects grasp slowed feeling blame and lessend myocardial contractility, vasodilation, bronchoconstriction and extensiond bronchial mucus secretion, extensiond GI disposition and secretions, extensiond bladder character, rest of GI and bladder sphincters, and pupilconstriction.
Direct-acting cholinergic agonists are implied for the succeedingcited medical requisites:
  • Direct-acting cholinergic agonists are schemeatically used as constituencys to extension bladder character, urinary exudation, and GI secretions. As ophthalmic constituencys, they can betray miosis to succor extensiond intraocular constraining in resigneds succeeding a opportunity glaucoma.
  • Bethanechol has unfair relation for the cholinergic receptors in the urinary bladder and is used to manage non-obstructive postoperative and postpartum urinary appropriation to manage neurogenic bladder atony. It at-once extensions detrusor muscle character and relaxes the sphincters to rectify bladder emptying.
  • Carbachol is an ophthalmic constituency used to betray miosis or novice constriction. It can succor the extensiond intraocular constraining of glaucoma.
  • Cevimeline and pilocarpine join to muscarinic receptors throughout the substance and are used to extension secretions in the bunghole and GI believe and succor symptoms of dry bunghole. They are vulgar for use in adults and are fond three periods a day, repeatedly succeeding a opportunity meals.
Here are some material aspects to retain for note of cholinergic agonists in incongruous age classs: Children
  • They are at superior lavish for complications allied to use of these refuses, i.e. GI subvert, diarrhea, extensiond salivation (living to choking), and forfeiture of bowel and bladder regulate.
  • Bethanechol is vulgar for texture of neurogenic bladder in progeny older than 8 years of age.
  • Neostigmine and pyridostigmine are used in the regulate of myasthenia gravis and for violation of neuropowerful alliance filler goods in progeny. Edrophonium is used for idiosyncrasy of myasthenia gravis solely.
  • Adults should be cautioned of these refuses’ unconducive goods (e.g. dizziness, GI subvert, urinary crisis). They should not be undisputed to opeblame machines.
  • Use of these refuses incompact procreant and lactating women is solely justified if profits overbalance the lavishs.
Older adults
  • Dose commutation is needed as this age class is so past capable to refuse policy goods.
  • They are past mitigated to keep toxic levels of the refuse beproducer of renal or hepatic impairments.
Here are the idiosyncrasy interactions of direct-acting cholinergic agonists and the substance in provisions of aridity, disposal, metabolism, and exudation:
Route Onset Peak Duration Oral 30-90 min 60-90 min 1-6 h T1/2: unknown Metabolism: unknown Excretion: unknown
Contraindications and Cautions
The succeedingcited are contraindications and shy for the use of direct-acting cholinergic agonists:
  • Allergy to any rudiment of the refuse. To nullify hypersensitivity recoilion
  • Bradycardia, hypotension, vasomotor fickleness, and coronary artery disease. Can be made worse by the cardiac- and cardiovascular-suppressing goods of the parasympathetic scheme.
  • Peptic abscess, intestinal impediment, or new GI surgery. Can be negatively fictitious by the GI-tart goods of the parasympathetic terse scheme.
  • Bladder impediment. Aggravated by the stimulatory goods on the bladder.
  • Epilepsy and parkinsonism. Affected by the stimulation of ACh receptors in the brain.
  • Hepatic or renal dysfunction. Drugs used to manage Alzheimer’s are metabolized in the liver.
  • Pregnancy and lactation. Potential unconducive goods on the fetus or neonate.
Adverse Effects
Use of direct-acting cholinergic agonists may termination to these unconducive goods:
  • CV: bradycardia, feeling fill, hypotension, cardiac arrest
  • GI: loathing, vomiting, cramps, diarrhea, extensiond salivation
  • GU: urinary crisis
  • Others: flushing, extensiond sweating
  •  WARNING  Pilocarpine and cevimeline may producer aridity difficulties.
The succeedingcited are refuse-refuse interactions complicated in the use of direct-acting cholinergic agonists:
  • Acetylcholinesterase inhibitors. Increased lavish of cholinergic goods.
  • NSAIDs. Increased lavish of GI bleeding 

Indirect-acting Cholinergic Agonists

  • Indirect-acting cholinergic agonists do not recoil at-once succeeding a opportunity ACh receptor localitys; instead, they recoil chemically succeeding a opportunity acetylcholinesterase (enzyme breaking down acetylcholine) in the synaptic chasm to nullify it from breaking down ACh.
  • These refuses can irreversibly or reversibly join to acetylcholinesterase. The ones that join irreversibly are not used therapeutically; they are nature open as resolution gas to be used as weapons. The clarification is pralidoxime.
  • The reversible indirect-acting cholinergic agonists fall into two deep categories: constituencys used to manage myasthenia gravis; and constituencys used to manage Alzheimer’s distemper.
Therapeutic Action
The desired and wholesome possessions of indirect-acting cholinergic agonists are as follows:
  • Indirect-acting cholinergic agonists recoil succeeding a opportunity the enzyme acetylcholinesterase to extension the stimulation of the ACh receptor localitys. Consequently, ACh scum the area and accumulates, tart ACh receptors for a longer determination of period than normally expected.
  • Agents for myasthenia gravis extension the levels of ACh, facilitating transmission at the neuropowerful alliance.
  • Agents for Alzheimer’s distemper producer influential ACh levels in the cortex, which slows the neuronal deprivation of Alzheimer’s distemper.
Indirect-acting cholinergic agonists are implied for the succeedingcited medical requisites:
  • Treatment of myasthenia gravis, clarification for nondepolarizing neuropowerful alliance fillers, extensiond fife succeeding inhospitableness to resolution gas
  • Treatment of soft to modeblame Alzheimer’s distemper
Here are the idiosyncrasy interactions of constituencys for myasthenia gravis and the substance in provisions of aridity, disposal, metabolism, and exudation:
Route Onset Peak Duration Oral 35-45 min – 3-6 h IM 15 min – 3-6 h IV 5 min – 3-6 h T1/2: 1.9-3.7 h Metabolism: liver Excretion: urine
Here are the idiosyncrasy interactions of constituencys for Alzheimer’s distemper and the substance in provisions of aridity, disposal, metabolism, and exudation:
Route Onset Peak Duration Oral Varies 2-4 h – T1/2: 70  h Metabolism: liver Excretion: urine
Contraindications and Cautions
The succeedingcited are contraindications and shy for the use of indirect-acting cholinergic agonists:
  • Allergy to any rudiment of the refuse. To nullify hypersensitivity recoilion
  • Bradycardia, intestinal/urinary believe impediment. Can be exacerbated by the stimulation of cholinergic receptors
  • Pregnancy. Uterus could be stimulated and labor induced
  • Asthma, coronary distemper, peptic ulcer, arrhythmias, epilepsy, parkinsonism.Can be exacerbated by goods of parasympathetic stimulation
  • Hepatic or renal dysfunction. Can interfere succeeding a opportunity metabolism and exudation of refuses
Adverse Effects
Use of indirect-acting cholinergic agonists may termination to these unconducive goods:
  • CNS: miosis, blurred vision, headaches, dizziness, drowsiness
  • CV: bradycardia, feeling fill, hypotension, cardiac arrest
  • GI: loathing, vomiting, cramps, diarrhea, extensiond salivation, warranted defecation
  • GU: urinary crisis
  • Others: flushing, extensiond sweating
The succeedingcited are refuse-refuse interactions complicated in the use of indirect-acting cholinergic agonists:
  • NSAIDs. Increased lavish of GI bleeding
  • Theophylline. Increased levels if thoroughly succeeding a opportunity tacrine.

Nursing Considerations for Cholinergic Agonists

Here are material nursing considerations when guideing cholinergic agonists:
Nursing Assessment
These are the material things the foster should grasp in conducting impost, fact commencement, and examination:
  • Assess for contraindications or shy (e.g. fact of allergy to refuse, GI impediment, pregnancy or lactation status, etc.) to elude unconducive goods.
  • Establish baseline tangible impost to adviser for any virtual unconducive goods.
  • Assess orientation, influence, reflexes to adviser CNS refuse goods.
  • Assess living signs, in-particular pulse and blood constraining to adviser for practicable debauchery stimulation of the cardiac scheme.
  • Assess abdomen, auscultating for bowel sounds and palpating for distention.
  • Monitor intake and output, noting any complaints of urinary crisis to adviser for refuse goods on the urinary scheme.
Nursing Diagnosis and Misgiving Planning
Here are some of the nursing diagnoses that can be formulated in the use of this refuse for therapy:
  • Acute pain allied to GI goods
  • Decreased cardiac output allied to CV goods
  • Impaired urinary elimination allied to goods on the bladder
Implementation succeeding a opportunity Rationale
These are living nursing interventions done in resigneds who are commencement cholinergic agonists:
  • Administer vocal refuse on empty stomach to lessen loathing and vomiting.
  • If refuse is fond intravenously, guide reluctantly to elude bitter cholinergic goods.
  • Monitor resigned confutation closely (e.g., blood constraining, ECG, urine output) to put-in-order to enjoin dose gratefully to secure the most profit.
  • Maintain a cholinergic-blocking refuse on standby such as atropine to use as an clarification for debaucheryive doses of cholinergic refuses.
  • Discontinue refuse if debaucheryive salivation, diarrhea, emesis, or general urination beseems a collection to lessen the lavish of bitter unconducive recoilions.
  • Provide protection preshy if the resigned recitals penniless visual acuity in dim characterless to nullify waste.
  • Provide ease measures (e.g., still capability, assistance and rest measures) to aid resigned contend succeeding a opportunity refuse goods.
  • Provide resigned information environing refuse goods and admonition signs to recital to improve comprehension environing refuse therapy and exalt consent.
Here are aspects of misgiving that should be evaluated to enumetrounce agency of refuse therapy:
  • Monitor resigned confutation to therapy (proficiency in requitop nature manageed).
  • Monitor for unconducive goods (e.g. GI subvert, CNS changes, CV changes).
  • Evaluate resigned interpretation on refuse therapy by question resigned to call the refuse, its note, and unconducive goods to hold for.
  • Monitor resigned consent to refuse therapy.

Practice Exam

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