| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|
| (see Table 8.11. Antineoplastic Drug Classifications - Table 8-11 and Table 8.12. Common Side Effects of Chemotherapeutic Agents - Table 8-12) |
| Cholinergics |
| Bethanechol chloride (Urecholine)—PO 5–30 mg; Subcu 2.5–5.0 mg | Postoperative abdominal atony and distention; bladder atony with retention; postsurgical or postpartum urinary retention; myasthenia gravis | Increases GI and bladder tone; decreases sphincter tone | Belching, abdominal cramps, diarrhea, nausea, vomiting; incontinence; profuse sweating, salivation; respiratory depression |
| NURSING IMPLICATIONS: Check respirations; have urinal or bedpan close at hand and answer calls quickly; atropine SO4 is the antidote for cholinergic drugs |
| Edrophonium (Tensilon)—IV 2 mg; IM 10 mg | Diagnosis of myasthenia gravis; reversal of neuromuscular blockers | Inhibits breakdown of acetylcholine; anticholinesterase | Excess secretions; bronchospasm; bradycardia; abdominal cramps, vomiting, diarrhea; excess salivation; sweating |
| NURSING IMPLICATIONS: Effects last up to 30 min; give IV undiluted with TB syringe |
| Neostigmine (Prostigmin)—PO 15–30 mg q3–4h; Subcu, IM 0.25–1 mg | Myasthenia gravis, postoperative bladder distention, urinary retention, reversal of neuromuscular blockers | Inhibits breakdown of acetylcholine | Excess secretions; bronchospasm; bradycardia; abdominal cramps, nausea, vomiting, diarrhea; excess salivation; sweating |
| NURSING IMPLICATIONS: Take oral form with food or milk; with chewing difficulty, take 30 min before eating |
| Physostigmine salicylate (Eserine)—ophthalmic 0.1 mL of 0.25%–10% solution: not more than 1 drop 4 times daily; IM, IV 0.5–3 mg | Glaucoma; reverse effects of: tricyclic antidepressants, overdose, toxic effects of atropine and diazepam | Increases concentration of acetylcholine | Sweating; marked miosis, lacrimation; nausea, diarrhea |
| NURSING IMPLICATIONS: If brown eyed, may require stronger solution or more frequent dose |
| Pilocarpine HCl—ophthalmic 1–2 gtt 1%–2% solution up to 6 times/day | Chronic open-angle and acute closed-angle glaucoma | Contraction of the sphincter muscle of iris, resulting in miosis | Brow ache, headache, ocular pain, blurring and dimness of vision, allergic conjunctivitis; nausea, vomiting, profuse sweating; bronchoconstriction in clients with bronchial asthma |
| NURSING IMPLICATIONS: Initially the medication may be irritating; teach proper sterile technique for instilling drops—wipe excess solution to prevent systemic symptoms; discard cloudy solutions |
| Pyridostigmine (Mestinon)—PO 60 mg/day × 3 days; IM, IV 2 mg q2–3h; maintenance: 60–150 mg/day | Myasthenia gravis; reversal of neuromuscular blockers | Inhibits breakdown of acetylcholine and prolongs its effects | See Neostigmine |
| NURSING IMPLICATIONS: See Neostigmine |