Skip to content

Urinary cholinergic agents: Nursing Pharmacology

Notes

Notes

URINARY CHOLINERGIC AGENTS
DRUG NAME
bethanechol (Urecholine)
CLASS
Urinary cholinergic agent
MECHANISM OF ACTION
Muscarinic antagonist → stimulates contraction of the detrusor muscle
INDICATIONS
Urinary retention
ROUTE(S) OF ADMINISTRATION
PO
SIDE EFFECTS
  • 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
CONTRAINDICATIONS AND CAUTIONS
  • Genitourinary or gastrointestinal obstruction
  • Hypotension, bradycardia, coronary artery disease
  • Asthma, COPD
  • Parkinsonism, seizures
  • Pregnancy and breastfeeding
  • Children < 8 years
  • Hypertension
NURSING CONSIDERATIONS
Assessment and monitoring
Assess
  • 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
Monitor
  • 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
Transcript

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.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  6. "Lehne's Pharmacology for Nursing Care" Elsevier Health Sciences (2014)
  7. "Bethanechol" StatPearls (2021)