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Pharmacology II Exam 1 Module 1 & 2
(Parasympathetic, PEACEFUL) Rest and digest: pupils contract, HR lowers,
Bronchoconstriction, Peristalsis/bile increases, contracts bladder.
Parasympathetic: Rest and digest *give Cholinergic/ Anticholinergic*
Direct Acting Cholinergic Drugs
Bethanechol *B-bladder
●Drug Class: cholinergic drug
●MOA: Stimulates cholinergic receptors, contracts bladder
●Therapeutic uses: Urinary retention,-post-op or post-partum, neurogenic bladder
●Side/Adverse effects: Increase salivation, urination, abdominal cramping,
hypotension and sweating, causes bronchoconstriction
●RN considerations: I&O, BP, HR, (Contraindicated for individual with asthma or COPD)
● Antidote: Atropine reverses cholinergic crisis
Cholinesterase Inhibitors Drugs
Donepezil/ Ginkgo Biloba (CAM)
●Moa: Inhibits the breakdown of AChE making more ACh available (rest/digest)
●Therapeutic Use: Alzheimer’s, myasthenia gravis, reverse delirium caused by:
Atropine & diphenhydramine (cholinergic crisis)
●Side/Adverse effects: N/V/D, salivation, tearing, sweating, seizures, bradycardia
●RN consideration: Airway, HR/BP, Neuro, BS, UO, Salivation
Pyridostigmine
● Therapeutic Use: Myasthenia Gravis, Increases muscle strength
● AE/SE: Seizures, bradycardia, cholinergic crisis , restlessness, bronchospasm,
N/V/D, salivation, tearing, sweating, miosis
● RN consideration: Airway, HR/BP, BS, UO,
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Physostigmine
● Drug class: indirect acting cholinesterase inhibitor
● Therapeutic Use: antidote for anticholinergic toxicity/ myasthenia gravis,
Alzheimer’s
● SE/AE: seizures, bradycardia, cholinergic crisis, restlessness, nervousness, urinary
frequency, resp. Paralysis, bronchospasm (admin cautiously with asthma patient)
●Cholinergic Crisis: too much Ach present
● S/S: difficulty breathing, pale, muscle weakness, twitching, bradycardia, excessive
tearing/ sweating, abdominal cramps, blurred vision, constriction of pupils
● Treatment: anticholinergic
Anticholinergic Drugs *inhibits parasympathetic nervous system*
Atropine/Oxybutynin
●Drug Class: Anticholinergic drug
●MOA: blocks action of ACh, induced fight or flight
●Therapeutic use: IBS (GI), bradycardia, eye exams, overactive bladder, asthma,
COPD, Parkinson’s, PUD, treats Cholinergic crisis
●Side effects: bradycardia, dry mouth, blurry vision, constipation, drowsiness, urinary
retention
●Adverse effects: delirium, coma
Give physostigmine to reverse anticholinergic toxicity/delirium
Cholinergic crisis:
● Give fight or flight: anticholinergic
●Symptoms: slow HR, small pupils, muscle twitching, sweating/tearing, muscle
weakness, difficulty breathing, pale, Abd cramps
Paralytics
Succinylcholine/Rocuronium
● DC: paralytics
● Therapeutic Use: skeletal muscle paralysis, surgery, pre and during endotracheal
intubation
● AE/SE: Malignant hyperthermia (give Dantrolene to reverse), cardiopulmonary
arrest
● RN Consideration: resp. Monitoring, hyperkalemia
Pharmacology II Exam 1 Module 1 & 2
(Parasympathetic, PEACEFUL) Rest and digest: pupils contract, HR lowers,
Bronchoconstriction, Peristalsis/bile increases, contracts bladder.
Parasympathetic: Rest and digest *give Cholinergic/ Anticholinergic*
Direct Acting Cholinergic Drugs
Bethanechol *B-bladder
●Drug Class: cholinergic drug
●MOA: Stimulates cholinergic receptors, contracts bladder
●Therapeutic uses: Urinary retention,-post-op or post-partum, neurogenic bladder
●Side/Adverse effects: Increase salivation, urination, abdominal cramping,
hypotension and sweating, causes bronchoconstriction
●RN considerations: I&O, BP, HR, (Contraindicated for individual with asthma or COPD)
● Antidote: Atropine reverses cholinergic crisis
Cholinesterase Inhibitors Drugs
Donepezil/ Ginkgo Biloba (CAM)
●Moa: Inhibits the breakdown of AChE making more ACh available (rest/digest)
●Therapeutic Use: Alzheimer’s, myasthenia gravis, reverse delirium caused by:
Atropine & diphenhydramine (cholinergic crisis)
●Side/Adverse effects: N/V/D, salivation, tearing, sweating, seizures, bradycardia
●RN consideration: Airway, HR/BP, Neuro, BS, UO, Salivation
Pyridostigmine
● Therapeutic Use: Myasthenia Gravis, Increases muscle strength
● AE/SE: Seizures, bradycardia, cholinergic crisis , restlessness, bronchospasm,
N/V/D, salivation, tearing, sweating, miosis
● RN consideration: Airway, HR/BP, BS, UO,
, 2
Physostigmine
● Drug class: indirect acting cholinesterase inhibitor
● Therapeutic Use: antidote for anticholinergic toxicity/ myasthenia gravis,
Alzheimer’s
● SE/AE: seizures, bradycardia, cholinergic crisis, restlessness, nervousness, urinary
frequency, resp. Paralysis, bronchospasm (admin cautiously with asthma patient)
●Cholinergic Crisis: too much Ach present
● S/S: difficulty breathing, pale, muscle weakness, twitching, bradycardia, excessive
tearing/ sweating, abdominal cramps, blurred vision, constriction of pupils
● Treatment: anticholinergic
Anticholinergic Drugs *inhibits parasympathetic nervous system*
Atropine/Oxybutynin
●Drug Class: Anticholinergic drug
●MOA: blocks action of ACh, induced fight or flight
●Therapeutic use: IBS (GI), bradycardia, eye exams, overactive bladder, asthma,
COPD, Parkinson’s, PUD, treats Cholinergic crisis
●Side effects: bradycardia, dry mouth, blurry vision, constipation, drowsiness, urinary
retention
●Adverse effects: delirium, coma
Give physostigmine to reverse anticholinergic toxicity/delirium
Cholinergic crisis:
● Give fight or flight: anticholinergic
●Symptoms: slow HR, small pupils, muscle twitching, sweating/tearing, muscle
weakness, difficulty breathing, pale, Abd cramps
Paralytics
Succinylcholine/Rocuronium
● DC: paralytics
● Therapeutic Use: skeletal muscle paralysis, surgery, pre and during endotracheal
intubation
● AE/SE: Malignant hyperthermia (give Dantrolene to reverse), cardiopulmonary
arrest
● RN Consideration: resp. Monitoring, hyperkalemia
