Cholinergic therapy (GU): Nursing pharmacology

Definitions & Key takeaways

Urinary cholinergic agents are medications that activate muscarinic receptors in the bladder to stimulate contractions and aid in bladder emptying. Bethanechol is a commonly used urinary cholinergic agent that is used to treat urinary retention or other bladder-related conditions. It is administered orally or subcutaneously, and the dosage is adjusted based on the patient's response to the medication.

While effective, urinary cholinergic agents like Bethanechol can have side effects that include urinary urgency, bradycardia, hypotension, dyspnea, blurry vision, lacrimation, diaphoresis, hypersalivation, and gastrointestinal disturbances. Nursing considerations when caring for a client taking bethanechol include a focused assessment of urinary symptoms, and monitoring for side effects and therapeutic effects. Client teaching is focused on self-administration and learning to recognize and manage side effects.

Chapters:

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Introduction0:00–0:23

Urinary cholinergic agents are a group of medications that can be used to treat urinary retention, which refers to the inability of a client to empty their bladder completely, or sometimes even at all.
The most commonly used cholinergic agent is bethanechol.Bethanechol can be administered orally, and it works on the bladder as a muscarinic agonist, ultimately stimulating the contraction of the detrusor muscle, which is a wall of smooth muscle that surrounds the bladder.Unfortunately, clients taking a cholinergic agent may experience increased urinary frequency and urgency.

Mechanism of action0:23–0:37

Side effects0:37–1:34

Additional side effects commonly associated with cholinergic agents include headache, dizziness, blurred vision, and lacrimation.
Clients may also develop a skin rash, urticaria, flushing, and diaphoresis. In addition, clients may experience hypersalivation, abdominal cramps, nausea, vomiting, diarrhea, and fecal incontinence.
Some clients may also have bronchoconstriction, which can lead to dyspnea or asthma. The most severe side effects of cholinergic agents include hypotension, bradycardia, as well as reflex tachycardia, and even arrhythmias or cardiac arrest.
Finally, cholinergic toxicity can be managed with the antidote atropine, which blocks muscarinic receptors.As far as contraindications go, cholinergic agents should not be given to clients with genitourinary or gastrointestinal obstruction, as well as those with severe hypotension, bradycardia, or coronary artery disease.

Contraindications and cautions1:34–2:07

Additional contraindications include asthma or COPD, as well as parkinsonism or seizures. Finally, cholinergic agents should be used with caution during pregnancy and breastfeeding, as well as in children younger than 8 years, and in clients with hypertension.

Nursing considerations & client education2:07–3:51

Now, when a client with urinary retention is prescribed a cholinergic agent like bethanechol, first ask them about their urinary symptoms; this includes hesitancy, an intermittent or slow stream of urine, and if they feel their bladder isn’t quite empty after using the bathroom.
Then, assess your client’s vital signs, fluid intake and output, and assess their abdomen for bladder distention. Lastly, review recent laboratory test results, including urinalysis and culture, as well as results of diagnostic tests such as bladder ultrasound and measurement of post-void residual.Next, instruct them to increase their fluid intake and empty their bladder every 3 to 4 hours, even if they don’t feel their bladder is full.
In addition, explain to your client that their medication will help them empty their bladder. Then, let your client know about common side effects that they may experience, including urinary urgency, as well as gastrointestinal disturbances, such as nausea, vomiting, diarrhea, and fecal incontinence.
Instruct your client to take their medication 3 times each day, either 1 hour before or 2 hours after each meal, in order to decrease the risk of nausea and vomiting.
Also, let them know that the medication can cause bradycardia and hypotension, and remind them to make position changes slowly to prevent falls.
Lastly, stress the importance of immediately reporting any signs of cholinergic toxicity, like difficulty breathing, decreased heart rate, and excessive tearing and sweating.Finally, during treatment with a cholinergic agent, monitor your client for side effects, toxicity, and the therapeutic response of decreased urinary retention and decreased bladder distension.
Alright as a quick recap… Bethanechol is a urinary cholinergic agent that works by activating muscarinic receptors in the bladder and stimulating contraction of the detrusor muscle, which ultimately helps with bladder emptying.

Review3:51–4:32

Side effects can include urinary urgency, bradycardia, hypotension, and dyspnea, as well as blurry vision, lacrimation, diaphoresis, hypersalivation, and gastrointestinal disturbances.
Nursing considerations when caring for a client taking bethanechol include a focused assessment of urinary symptoms, monitoring for side effects and therapeutic effects.
Client teaching is focused on self-administration and learning to recognize
Cholinergic therapy (GU): Video, Causes, Symptoms | Osmosis