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Urinary cholinergic agents: Nursing Pharmacology



bethanechol (Urecholine)
Urinary cholinergic agent
Muscarinic antagonist → stimulates contraction of the detrusor muscle
Urinary retention
  • Headache, dizziness
  • Blurred vision, lacrimation
  • Skin rash, urticaria, flushing, diaphoresis
  • Increased urinary frequency and urgency
  • Hypersalivation
  • Abdominal cramps, nausea, vomiting, diarrhea
  • Bronchospasm, dyspnea, asthma
  • Hypotension, bradycardia, reflex tachycardia, arrhythmia, cardiac arrest
  • Genitourinary or gastrointestinal obstruction
  • Hypotension, bradycardia, coronary artery disease
  • Asthma, COPD
  • Parkinsonism, seizures
  • Pregnancy and breastfeeding
  • Children < 8 years
  • Hypertension
Assessment and monitoring
  • Urinary symptoms; e.g., hesitancy, intermittent or slow urine stream; incomplete emptying
  • Vital signs
  • Intake and output
  • Presence of bladder distension
  • Laboratory test results
    • Urinalysis, urine culture
  • Diagnostic tests
    • Bladder ultrasound
    • Measurement of post-void residual
  • Side effects, toxicity, therapeutic response: absence of urinary retention and bladder distension

Client education
  • Increase fluid intake
  • Empty bladder every 3–4 hours
  • Purpose of medication: promote bladder emptying
  • Take medication three times each day, one hour before or two hours after each meal to decrease the risk of nausea and vomiting
  • Management of side effects
  • Immediately report signs of toxicity; e.g., like difficulty breathing, decreased heart rate, excessive tearing and sweating

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. 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.

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.

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.


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.

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