Cholinergic Blocking Drugs: Actions

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Presentation transcript:

Introduction to Clinical Pharmacology Chapter 27 Cholinergic Blocking Drugs

Cholinergic Blocking Drugs: Actions Cholinergic blocking drugs inhibit the activity of acetylcholine at the parasympathetic nerve synapse Some of these drugs inhibit nerve impulses at both muscarinic and nicotinic receptors; affect many organs and structures of the body, including the eyes, respiratory and gastrointestinal (GI) tracts, heart, bladder

Cholinergic Blocking Drugs: Uses Primary uses of cholinergic blocking drugs: Pylorospasm and peptic ulcer Ureteral or biliary colic, bladder overactivity Vagal nerve–induced bradycardia Parkinsonism Preoperative reduction of oral secretions

Cholinergic Blocking Drugs: Adverse Reactions #1 Gastrointestinal reactions: dry mouth; nausea; vomiting; dysphagia which is difficulty in swallowing; heartburn; constipation Central nervous system reactions: headache; flushing; nervousness; drowsiness; weakness; insomnia; nasal congestion; fever; mental confusion Visual reactions (eyes): blurred vision; mydriasis; photophobia; cycloplegia; increased ocular tension During summer months possible heat prostration include fever; tachycardia; flushing; warm, dry skin; and mental confusion, these symptoms need to be reported to provider

Cholinergic Blocking Drugs: Adverse Reactions #2 Genitourinary reactions: urinary hesitancy and retention; dysuria Cardiovascular reactions: palpitations; bradycardia; tachycardia Other: urticaria; decreased sweat production; anaphylactic shock; rash Should withhold a cholinergic blocking drug from an older adult client who is excited (not depressed), agitated, mentally confused, drowsy

Cholinergic Blocking Drugs: Contraindications Contraindicated in patients: With hypersensitivity to drugs or with glaucoma Anticholinergics are contraindicated in patients: With myasthenia gravis; tachyarrhythmias; myocardial infarction; heart failure (unless bradycardia present)

Cholinergic Blocking Drugs: Precautions Use drugs with caution in patients with: GI infections; benign prostatic hypertrophy; urinary retention; hyperthyroidism; hepatic or renal disease; hypertension Use atropine with caution in patients with asthma

Cholinergic Blocking Drugs: Interactions Interactant drug Effect of interaction Antibiotics/antifungals Decreased effectiveness of anti-infective drug Meperidine, flurazepam, phenothiazines Increased effect of cholinergic blocker Tricyclic antidepressants Haloperidol (Haldol) Decreased effectiveness of antipsychotic drug Digoxin Increased serum levels of digoxin

Nursing Process: Assessment #1 Preadministration assessment: Obtain health history and history of signs and symptoms Obtain blood pressure, pulse, and respiratory rate Additional assessment: check stool of the patient who has peptic ulcer for color, signs of occult blood; determine visual acuity in the patient with glaucoma; look for signs of dehydration, weigh the client if prolonged diarrhea

Nursing Process: Assessment #2 Ongoing assessment: Check vital signs; observe for adverse drug reactions; evaluate the symptoms and complaints related to the patient’s diagnosis Report any increase in severity of symptoms to primary health care provider immediately

Nursing Process: Planning Expected outcomes for patient Optimal response to therapy Support of patient needs related to the management of adverse reactions Understanding of and compliance with the prescribed therapeutic regimen

Nursing Process: Implementation #1 Promoting an optimal response to therapy: Patient receiving a preoperative drug: Instruct the patient to void before the drug is given Inform the patient that his or her mouth will become extremely dry, that this is normal, and that fluid is not to be taken Instruct the patient to remain in bed after administration of drug

Nursing Process: Implementation #2 Monitoring and managing patient needs: Impaired comfort: xerostomia Encourage patient to take a few sips of water before and while taking an oral drug and to sip water at intervals during meals Check oral cavity daily for soreness or ulcerations

Nursing Process: Implementation #3 Monitoring and managing patient needs (cont.) Constipation: Urge patient to increase fluid intake up to 2000 mL daily; eat a diet high in fiber; obtain adequate exercise and encourage ambulation Primary health care provider may prescribe a stool softener, if necessary, to prevent constipation

Nursing Process: Implementation #4 Monitoring and managing patient needs (cont.) Risk for injury: Drugs may cause drowsiness, dizziness, blurred vision; monitor the patient for any disturbance in vision Keep pathway clear of items such as throw rugs, furniture and floors dry Elderly patient should be observed at frequent intervals for excitement; agitation; mental confusion; drowsiness; urinary retention

Nursing Process: Implementation #5 Monitoring and managing patient needs (cont.) Disturbed sensory perception: visual Room should be kept dimly lit and curtains or blinds closed to eliminate bright sunlight in the room Assess for any blurred vision Assist patient to find other forms of diversional therapy, such as interaction with others or listening to the radio

Nursing Process: Implementation #6 Monitoring and managing patient needs (cont.) Ineffective tissue perfusion: Monitor for change in pulse rate or rhythm Failure of drug to increase the heart rate must be reported to the primary health care provider immediately

Nursing Process: Implementation #7 Educating the patient and family: Inform the patient about common adverse reactions associated with these drugs Caution must be observed while driving or performing other tasks requiring alertness and clear vision List the adverse reactions that can be included in the teaching plan, along with the measures that may lessen their intensity or allow the patient to perform tasks at times when these adverse reactions are least likely to occur

Nursing Process: Implementation #8 Educating the patient receiving a preoperative drug: Give patient an explanation of preoperative drug Inform the patient and family members that drowsiness, extreme dryness of mouth and nose will occur about 20 to 30 minutes after drug is given

Nursing Process: Implementation #9 Educating the patient with a peptic ulcer: Give patients with peptic ulcer full explanation of treatment regimen Discuss importance of diet in peptic ulcer treatment and give full explanation of special diet

Nursing Process: Evaluation Therapeutic effect is achieved when symptoms are relieved Adverse reactions are identified, reported, and managed successfully through appropriate nursing interventions Oral mucous membranes remain moist Patient complies with prescribed drug regimen

Nursing Process: Evaluation No evidence of injury is seen Patient and family demonstrate an understanding of the drug regimen Patient verbalizes importance of complying with the prescribed therapeutic regimen