All right, now we're on the parasympathetic nervous system. Remember, this is our rest and digest. So stimulation effects. Okay, so what happens here? What does it stimulate?
All right, so unlike an adrenergic, the effects are going to be different. Okay, so the heart rate is going to, cardiovascular speaking, heart rate's going to decrease. We could have increased or lower blood pressure changes. We're going to see pulmonary. bronchoconstriction occur.
Now remember rest and digest. So here is where we're seeing we're in GI, we have increased peristalsis and motility and then we're also going to have an increase in saliva production. Liver we can have plus or minus glycogen or fat breakdown, it can go either way. Typically we're going to see increased urinary output and then pupil constriction. Okay so cholinergic agonist agents, you want to remember the mnemonic sludge.
Okay, so what are the side effects of cholinergic agonists? So remember a cholinergic agonist, so the cholinergic response is a response that's caused by that action of acetylcholine. Remember, that's the neurotransmitter we're dealing with, okay? So sludge, our S is we're going to have salivation, L is lacrimation, U is urinary incontinence.
D is diarrhea, G is GI cramping, and E is emesis. Okay, so you want to definitely remember sludge for the side effects of cholinergic agonist agents. Very important to remember that, okay?
Nursing considerations, assess for therapeutic and side effects. Again, patient education regarding home monitoring of heart rate and blood pressure. and then appropriate dosing and then safety issues.
So it says here swallow and vision, right? So you have to think we're going to have increased salivation and increased lacrimation. So we just want to be careful.
We're having increased lacrimation in the patient's driving. As far as increased salivation, can the patient swallow okay? Maybe they need to be propped sitting up more on a pillow at night when they're sleeping because we are going to have increased salivation. So always think in terms of safety. Examples of drugs we have donepezil.
Action is increases concentrations of acetylcholine in the brain. So remember we would give this for treatment of mild to moderate Alzheimer's disease. This is not a curative form of medication. Remember we're just trying to decrease the progression of Alzheimer's. We can't cure that.
Okay for letter B we have pyridostigmine. So the action is going to decrease acetylcholinesterase. Remember that's an enzyme that actually breaks down acetylcholine.
So ultimately we're looking at and what we're wanting to do is improve acetylcholine. So indications would be important to remember for treatment of myasthenia gravis. Myasthenia gravis is an autoimmune neuromuscular disease and it causes weakness in the skeletal muscles which are responsible for breathing and moving parts of our body.
It also reverses non-depolarizing neuromuscular blocking agents. You'll learn more about that as you move forward, especially when you're getting into fourth. We might give neuromuscular blocking agents to basically help paralyze or block those muscles in the body from being able to move, such as Vecuronium or Rocuronium. Those are examples of non-depolarizing neuromuscular blocking agents.
So if we're going to intubate a patient, right, we needed to breathe for the patient, typically you don't want any muscle movement, okay, especially when that provider is trying to slip a tube into that trachea. So we typically will sedate them and then also paralyze their muscles short term during the intubation process. So I don't want you to get too hard into memorizing non-depolarizing neuromuscular blocking agents.
You'll see that as you move forward. but you definitely want to remember this for the treatment of myasthenia gravis. Cholinergic antagonist agents. So remember these block acetylcholine.
Okay. These are anticholinergics. So side effects that you want to remember, and these are very important to remember all of your side effects here. So we have mad as a hatter.
What does mad as a hatter mean? So the patient can be very confused. It can have CNS effects, lead to sedation, amnesia, or even hallucinations.
but confusion is a big one to remember. Blind as a bat dilates those pupils so it can cause blurred vision. Red as a beet and also add on to there, red as a beet and hot as a hair.
So what does that mean? So the red as a beet, they have, vasodilation actually occurs to dissipate heat and the patient will have facial flushing. So that's why the term red as a beet is being used.
And then hot as a hair, they become hyperthermic. Okay. So remember, red as a beet, hot as a hare.
There's facial flushing and hypothermia that occurs. And then dry as a bone. So we have basically the consequence of decreased sweating, the patient's not really sweating, and then decreased salivation and lacrimation.
So with that we have decreased oral secretions. Okay, important to remember that for dry as a bone. So we can help the patient combat the whole dry as a bone issue as far as the oral secretions go. You can actually, for the dry mouth issues they may have, is you can offer them use of sugarless gum or maybe even a hard candy to have to basically counteract that dry mouth issue.
Nursing considerations, we want to assess for therapeutic and side effects. Monitor heart rate and blood pressure is appropriate. And then atropine additive and other agents. Patient education is use of drugs.
And then we're going to talk about atropine right now. So examples of drugs we have listed here, atropine is there. Actually, it's receptor bound, so it's going to decrease that nerve transmission of acetylcholine.
So what we would give this for is for a patient who has symptomatic bradycardia, right? So, you know, a lot of people run around with different heart rates. We've learned what normal is, right? But you could have someone who walks around normally with a heart rate of 50-55. Maybe they're an athlete, right?
that heart rate doesn't bother them. They have normal bodily functions, normal bodily processes. However, when you say someone is symptomatic bradycardia, that'd be the patient where 50, 55 is not normal for them, right?
And maybe they're lightheaded, dizzy, short of breath, maybe complaining of chest pain. So that would be someone who is symptomatic bradycardia. So we can give atropine to help increase that heart rate.
Pupil dilation, if we wanted pupil dilation to occur. occur, we can also give atropine. Acetylcholine actually causes people constriction. So we could give atropine in order to cause people dilation.
And then we also give atropine to decrease secretions preoperatively. A lot of times in the ER, if we're going to do a conscious sedation on a little kiddo. So let's say maybe a kid came in with a big laceration on their face, right? A kid, if you tell them to sit still, right, you're sewing stitches, right?
They're not going to do that, but they're probably going to fight. scream, be very scared, crying, right? So if we do a conscious sedation, we give them some medication to make them sleepy so they're a little more cooperative.
We can give them atropine to decrease their secretions, right? So that way we don't want them drooling and then potentially have an airway issue when we have them sedated to sew up that laceration on their face. And then we'll do it for other type of operative procedures as well, but that's just an example of how we use it in the ER. BENTOL or dicyclamine is the prototype name, generic name you'll need to know.
So actions to decrease GI motility. It's an antispasmodic. So we'll give it for patients who have GI motility disturbances such as irritable bowel syndrome. So that's something important to remember about that. Benstropine, we use this as a synthetic anticholinergic and an antihistamine agent.
We can also give it for as adjuvant treatment for patients with Parkinson's disease and it just helps reduce the rigidity and tumors, tumors sorry tremors they may have. Toltradine, that's a mucineric receptor blocker so we can give that for patients with urinary bladder issues. So it would basically use it as a urinary tract antispasmodic.
And then indication would be urinary frequency, urgency, those patients with urgent continence syndrome. And then scopamine, this also looks familiar to you as well, right? Antimucineric agent, it helps mediate parasympathetic effects. So it corrects imbalance basically between epinephrine and norepinephrine.
And we can give it as well for those higher centers of the brain that... particularly controls the vomiting center. So we would give this for someone to prevent motion sickness. So that's the biggest thing to take back I want you to understand from that.
So scopamine we would be giving that to help treat patients with or prevent motion sickness. Okay, so this last grid here, you can modify this how you want to. This is just a quick grid to help kind of break down the different drugs that we've talked about, which nervous system is being affected by them, and the effects.
So if you look here to the left, we have sympathetic nervous system, right? So in that first box, it says adrenergic agonist, and it also has anticholinergic effects. So the medications listed in that first box there, those one, two, three, four meds, right?
Or five meds, I should say. These are adrenergic agonies. So they're going to have an adrenergic response, right?
They're stimulating. So that's that fight or flight response. But they also have anticholinergic effects. Are they anticholinergic drugs? No, they're not.
But the effects that they elicit are that of anticholinergic effects. So I've basically broken this down in a grid for you guys. You can see the medications. Hopefully it helps you kind of classify them a little bit better, understand their effects.
So you want to remember there, these medications that we're talking about now, it mimics norepinephrine and epinephrine. Okay. So I'm talking in reference to these right now. Okay.
So mimics norepinephrine and epinephrine. And those are the medications listed for you that we've already gone over. The next box down says adrenergic antagonists or cholinergic effects.
So if this is an adrenergic antagonist, remember, it's going to interrupt the sympathetic nervous system stimulation. So it kind of gives like the rest and digest portion of that, but it also has cholinergic effects. So these block norepinephrine and epinephrine, okay? If it's an adrenergic antagonist, they're going to block norepinephrine and epinephrine.
And then the medications are listed there for you. So on the right side, we have parasympathetic nervous system, and you have listed on your grid cholinergic agonist, anti-adrenergic effects. So yes, these are cholinergic agonists.
So therefore they have a cholinergic response, but they also have that anti-adrenergic rest and digest effects. Okay. These aren't adrenergic agonists. These are just the effects that they also elicit.
They also have anti-adrenergic effects. Okay. So these mimic...
acetylcholine right so this is a cholinergic agonist that mimics acetylcholine and those are the two medications listed under there for you and then underneath that cholinergic antagonists these have adrenergic effects right so cholinergic antagonists these are anti-cholinergics right so it has an anti-cholinergic response but it also has an adrenergic effect so it does have that stimulating fight-or-flight response effect to it And these medications, remember, block acetylcholine. And then those medications are listed there for you. So if you have another format you want to put these in that helps you kind of understand them a little bit better, please do.
This was just to help be beneficial to you so you can kind of classify them, see them grouped this way, and maybe just have a little more insight and understanding to them. But please reach out as needed. Thank you.