Indirect-Acting Cholinergic Agonists

Question 1

Medications for Myasthenia Gravis

Answer 1

• Neostigmine
• Pyridostigmine (has longer duration of action)
• Edrophonium (diagnostic agent)

Question 2

Medications for Alzheimer’s Disease

Answer 2

• Galantamine
• Rivastigmine
• Donepezil

Question 3

Action

Answer 3

-Blocks ACh at the synaptic cleft, which allows the accumulation of ACh released from the nerve endings and leads to increased and prolonged stimulation of ACh

Question 4

Indications

Answer 4

• Myasthenia gravis

- Alzheimer’s disease

Question 5

Contraindications

Answer 5

• Allergy
• Bradycardia
• Intestinal or urinary blockage
• Pregnancy and lactation

Question 6

Caution

Answer 6

-Any condition that could be exacerbated by cholinergic stimulation

Question 7

Adverse effects

Answer 7

• Bradycardia
• Hypotension
• Increased GI secretions and activity
• Increased bladder tone
• Relaxation of sphincters
• Bronchoconstriction
• Pupil constriction

Question 8

Drug-Drug Interactions

Answer 8

• NSAIDs

- Cholinergic drugs

Question 9

Assessment

Answer 9

• History and physical exam
• Check for any contraindications
• Orientation, reflexes, ability to carry on ADLs
• VS, ECG as appropriate, urinary output, rena;/liver function tests

Question 10

Nursing Diagnoses

Answer 10

• Disturbed thought process r/t CNS effects
• Acute pain r/t GI effects
• Decreased cardiac output r/t BP changes, vasodilation, arrhythmias
• Deficient knowledge regarding drug therapy
• Risk for injury r/t CNS effects
• Diarrhea r/t GI stimulatory effects

Question 11

Implementation

Answer 11

• If given IV, administer slowly
• Maintain atropine on standby
• Discontinue if excessive salivation, diarrhea, emesis, or frequent urination
• Administer PO with meals
• Mark chart if pt is going to surgery
• Monitor for progress
• Arrange supportive care and comfort measures
• Provide pt teaching

Question 12

Evaluation

Answer 12

• Monitor pt response to drug (improvement of condition being treated)
• Monitor for adverse effects
• Evaluate effectiveness of teaching plan
• Monitor the effectiveness of comfort measures/compliance with regimen