Direct-Acting Cholinergic Agonists

Question 1

Medications

Answer 1

• Bethanechol
• Carbachol
• Cevilmeline
• Pilocarpine

Question 2

Action

Answer 2

-Act at cholinergic receptors in the peripheral nervous system to MIMIC the effects of ACh and PNS stimulation (rest and digest)

Question 3

Indications

Answer 3

• Urinary retention
• Induce miosis (pupil constriction)
• Treat dry mouth

Question 4

Contraindications

Answer 4

• Any condition exacerbated by parasympathetic effects: bradycardia, hypotension
• Known allergy
• Peptic ulcer disease
• Intestinal obstruction or recent GI surgery
• Asthma
• Bladder obstruction
• Epilepsy and Parkinsons

Question 5

Caution

Answer 5

Pregnancy and lactation

Question 6

Adverse effects

Answer 6

• Nausea/vomiting, cramps, diarrhea, increased salivation, involuntary defecation
• Bradycardia, heart block, hypotension
• Urinary urgency
• Flushing or increased sweating

Question 7

Drug-Drug Interactions

Answer 7

Acetylcholinesterase Inhibitors

Question 8

Assessment

Answer 8

• History and physical exam
• Check for any of the contraindications
• VS, lung sounds, cardiac status, bowel sounds, and I&O

Question 9

Nursing Diagnoses

Answer 9

• Acute pain r/t GI effects
• Decreased cardiac output r/t cardiovascular effect
• Impaired urinary elimination r/t the effect on the bladder
• Risk for injury r/t blurred vision and changes in visual acuity
• Potential for diarrhea r/t GI stimulatory effect
• Deficient knowledge regarding drug therapy

Question 10

Implementation

Answer 10

• Ensure proper administration of ophthalmic agents
• Administer PO drug on empty stomach
• Monitor pt closely
• Provide safety precautions (for visual acuity)
• Monitor urinary output
• Provide patient teaching

Question 11

Evaluation

Answer 11

• Monitor pt response to drug (improvement in bladder function, increased salivation, miosis)
• Monitor for adverse effects
• Evaluate the effectiveness of the teaching plan
• Monitor the effectiveness of comfort and safety measures/compliance with regimen