NCM 106 Reviewer

Chapter 29-AUTONOMIC NERVOUS Drugs act on ANS & PNS either

SYSTEM STIMULATING or DEPRESSING
responses.
The ANS is:
 A visceral system, which is
responsible for the involuntary Characteristics affecting the SANS &
movements of the body PANS
 Innervates on smooth muscles
and glands
 Controls and regulates the heart,
respiratory system, GIT, bladder,
eyes, and glands

The ANS consists of neurons,

specifically acting on the efferent
pathways of the Nervous System.

2 types of Neurons:
1. Afferent (senses, entry point of
information interpretation)
2. Efferent (enacts, the motor which
transmits info from CNS to effector
organ cells)

2 branches of Efferent Pathways:

1. Sympathetic
 Increases or produce
responses according to signals
from the brain to affect a NOTE:
specific organ
 Is responsible for the “fight-or- WHATEVER IS INCREASING IN
flight response” SYMPATHETIC, IS TO BE
DECREASED IN PARASYMPATHETIC.
2. Parasympathetic Adrenergic Receptor Sites:
 Act on the same organ but
produce opposite responses to 1. Alpha-receptor sites
provide homeostasis  Commonly found in blood
vessels for
vasodilation/vasoconstriction;
 Iris for dilation and constriction;
 Bladder for urinary retention

SJS, Block NG
NCM 106 Reviewer

2. Alpha2 Receptor Sites 4 E’s Sympathetic Nervous System

 Nerve membranes for
1. Exercise
modulation of NE release
2. Excitement
 Beta cells of pancreas for
3. Emergency
insulin release
4. Embarrassment
3. Beta receptors
Three types: These stimulates the SANS in
1. Beta 1 different situations. Through their
 Found in the heart, specifically receptor sites, these E’s cause
on the cardiac tissue for INCREASED HR, HEART
increased cardiac output or CONTRACTIONS, INCREASED
blood pressure BLOOD FLOW, AND INCREASED
2. Beta 2 BLOOD SUGAR.
 Found in the smooth muscle in
Some drugs that mimic the effect
blood vessels
of NE are called:
 Bronchi/Lungs
 Periphery of glycogen 1. Adrenergic drugs
breakdown in muscles and -sympathomimetics
liver -adrenomimetics
 Uterus for relaxed smooth
2. Adrenergic agonists
muscle use
3. Beta 3
 Found in the kidneys,
partnered with the bladder for Drugs that block the effect of NE are:
urine retention and output 1. Adrenergic blockers
Cholinergic Receptor Sites: 2. Sympatholytics
3. Adrenolytics
1. Muscarinic Receptors 4. Adrenergic Antagonists
 Visceral effector organs, such
as sweat glands and vascular
smooth muscle Parasympathetic Nervous System
 Pupil constriction
 GI motility and secretions  Known as the cholinergic
 Urinary bladder contraction system, due to its dependency
on the neurotransmitter
 Slowing of HR
acetylcholine, which
2. Nicotinic Receptors
innervates the muscle
 CNS, adrenal medulla,
autonomic ganglia, Drugs that mimic acetylcholine
neuromuscular junction are:
 Relays muscle contractions,
1. Cholinergic drugs
autonomic responses
2. Parasympathomimetic
 Release of NE and
3. Cholinergic Agonists
epinephrine from adrenal
medulla

SJS, Block NG
NCM 106 Reviewer

Drugs that blocks

acetylcholine:
1. Anticholinergics
2. Parasympatholytics
3. Cholinergic Antagonists

3 D’s of the PANs

 Digestion
 Defecation
 Diuresis (urination)

SJS, Block NG
NCM 106 Reviewer

Chapter 30-Andrenergic Agonists 4. Epinephrine (Adrenalin, Sus-

Phrine)
 Treatment of shock when
Adrenergic agonists are:
increased blood pressure and
 autonomic nervous system drugs heart contractility are essential
that stimulate the adrenergic 5. Metaraminol (Aramine)
receptors of the sympathetic  Treatment of shock if NE or
nervous system (SNS), either Epinephrine cannot be used,
directly (by reacting with receptor prevention of hypotension with
sites) or indirectly (by increasing spinal anesthesia
norepinephrine levels). 6. Norepinephrine (Levophed)
 Also called as a  Treatment of shock
sympathomimetic because its  Used during cardiac arrest to
stimulates the effects of SNS get sympathetic activity

Classified into three: Pharmacokinetics:

1. Alpha/Beta-specific adrenergic  Generally absorbed rapidly
agonists after injection or passage
2. Alpha-specific adrenergic through the mucous
agonists membranes
3. Beta-specific adrenergic  Metabolized in the liver
agonists  Excreted through urine

Alpha/Beta-specific Adrenergic Contraindications & Cautions:

Agonists
 Allergy/Hypersensitivity to any
 Agonists that stimulate both alpha component of the drug
and beta receptors sites.  Pheochromocytoma
 Are called catecholamines  Hypovolemia
 Facilitating the breakdown of  Halogenated Hydrocarbon GA
glucose stores (glycogenolysis) so due to sensitization of
it can be used as energy. myocardium causing serious
 Prototype: Dopamine (Intropin) cardiac effects
Alpha/Beta Adrenergic Agonists w/  Cautioned use for Pts w/
Indications Peripheral Vascular Disease
 Pregnancy
1. Dopamine (Intropin)  Lactation
 Treatment of shock
2. Dobutamine
 Treatment of heart failure Adverse Effects:
3. Ephedrine
 Treatment for hypotensive
episodes

SJS, Block NG
NCM 106 Reviewer

 Cardio: arrhythmias,
hypertension, palpitations,
Alpha-Specific Adrenergic Agonists
angina, and dyspnea
w/ Indications:
 GI: nausea, vomiting, and
constipation 1. Phenylephrine (Neo-
Synephrine)
Drug-to-Drug Interactions:
 Treatment of cold/allergies
 Increases effects of MAOIs and  Shock, glaucoma, allergic
tricyclic antidepressants rhinitis, otitis media medication
 Increased risk of hypertension  Potent vasoconstrictor with
when given w/ medication that little or no effect on the heart or
increases BP bronchi
 Will lose effectiveness when 2. Clonidine (Catapres)
paired with Adrenergic  Treatment of essential
Antagonists hypertension, chronic pain
3. Midodrine (ProAmantine)
 Treatment of orthostatic
Nursing Responsibilities: hypotension

 Accurate dosage
 Dilute before use Contraindications and Cautions:
– tissue irritation
 ➢ Phentolamine  Allergy
 – for extravasation/soln infused  Sever hypertension
leaks out of veins into surrounding  Tachycardia
tissue  Narrow-angle Glaucoma
 Standby: 10 mL NSS + 5-10 mg (exacerbated by arterial
Phentolamine constriction)
 Cardiovascular disease
 Vasomotor Spasm
Alpha-Specific Adrenergic Agonists  Cautioned in Lactation
 Renal or hepatic impairment
 drugs that bind primarily to alpha-
receptors rather than to beta-
receptors.
Adverse Effects
 Prototype: Phenylephrine (Neo-
Synephrine)  CNS: anxiety, restlessness,
depression, fatigue, strange
dreams, and personality changes
 Blurred vision and sensitivity to
light
 Cardio: arrhythmias, ECG
changes, blood pressure
changes, and peripheral vascular
problems

SJS, Block NG
NCM 106 Reviewer

3. Biltolterol (Tornalate)
 Treatment of bronchial Asthma
4. Isoetharine (generic)
Drug-to-Drug Interactions:  Treatment of bronchial asthma
5. Levalbuterol (Xopenex)
 Phenylephrine + MAOIs should be  Treatment of bronchial asthma
avoided due to its effects of sever in patients >4yrs
hypertension, headache, and 6. Metaproterenol (Alupent)
hyperpyrexia  treatment of bronchial asthma
 Phenylephrine + TCAs increase and acute asthma attacks in
sympathomimetic effects children >6yrs
 Clonidine + TCAs decrease 7. Pirbuterol (Maxair Autohaler)
antihypertensive effect  Treatment of bronchial asthma
 Clonidine + Propanolol = and reversible bronchospasm
paradoxical hypertension 8. Salmeterol (Serevent DIskus)
 Treatment of bronchial asthma
and reversible bronchospasm
Nursing Care: 9. Terbutaline (Brethine)
 Taper dosage  Treatment and prevention of
 When giving phenylephrine bronchial asthma and
intravenously, ensure that an reversible bronchospasm
alpha-blocking agent is readily
available to counteract the effects.
Pharmacokinetics:
• Rapidly distributed
Beta-Specific Adrenergic Agonists
• Metabolism – liver
 drugs that bind primarily to beta-
receptors rather than to alpha- • Excretion – urine
receptors • Relatively short half-life
 Manage and treat bronchial spasm,
asthma and other COPD less than 1 hour
 Prototype: Isoproterenol (Isuprel)

Contraindications and Cautions:

Beta-Specific Adrenergic Agonists w/ • Allergy
Indications:
• Pulmonary hypertension
1. Isoproterenol (Isuprel)
 Treatment of shock, cardiac • Halogenated hydrocarbon
arrest anesthesia
 Treatment of heart block in • Eclampsia
transplants
2. Albuterol (Proventil, Ventolin) • Uterine hemorrhage
 Treatment and prevention of
• Intrauterine death
bronchospasm

SJS, Block NG
NCM 106 Reviewer

• Pregnancy CHAPTER 31 ADRENERGIC

BLOCKING ANTAGONISTS
• Lactation
Adrenergic Blocking Agents are:
Drug-Drug Interactions:
 Also known as sympatholytic as
• + other sympathomimetics =
they lyse or block the effects of the
increasing effects
SNS
• +beta-adrenergic blockers =  Their therapeutic and adverse
decreasing effects effects rely on their ability to react
with specific adrenergic receptor
sites w/o activating them
Nursing Responsibilities:  Prevent norepinephrine release
from the nerve terminal or from the
• Receiving Ritodrine – Pt should adrenal medulla from activating
be places in a left lateral position the receptor blocking SNS effects
• Beta adrenergic blocker on  Lower BP
standby in case of extravasation  Slower pulse rate
 Increase renal perfusion with
decreased rennin levels
➧ Most of the beta2-specific
Classified into five:
adrenergic agonists are used to
1. Nonselective Adrenergic
manage and treat asthma,
Antagonists
bronchospasm, and other
2. Nonselective Alpha-
obstructive pulmonary diseases.
adrenergic
➧ Isoproterenol, a nonspecific 3. Nonselective Beta-adrenergic
beta-specific adrenergic agent, is 4. Selective Alpha-adrenergic
used for its sympathomimetic 5. Selective Beta-adrenergic
effects to treat shock, cardiac
standstill, and certain arrhythmias
when used systemically; it is Non-Selective Adrenergic
especially effective in the Antagonists
treatment of heart block in
Are:
transplanted hearts.
 Drugs that primarily block both
➧ Because of its many adverse
alpha- and beta-adrenergic
effects, isoproterenol is reserved
receptors
for use in emergency situations
 Treats cardiac-related conditions
that do not respond to other, safer
therapies.  Prototype: Labetalol
(Normodyne, Trandate)

SJS, Block NG
NCM 106 Reviewer

Antagonists w/ Indications: • Pregnancy

1. Labetalol (Normodyne, • Lactation
Trandate)
 Treatment of hypertension,
hypertension associated with Adverse Effects:
pheochromocytoma, and
clonidine withdrawal • Dizziness
2. Carvedilol (Coreg) • Insomnia
 Treatment of hypertension and
heart failure in adults • Depression
 Can be used alone or as part • Fatigue
of combination therapy
3. Amiodarone (Cordarone) • Vertigo
 Treatment of life-threatening • Anorexia
ventricular arrhythmias
4. Guanadrel (Hylorel) • Cardiac arrhythmias
 Alternative treatment for
• Hypotension
Hypertension that does not
respond to thiazides • CHF
5. Guanethide (Ismelin)
 Hypertension and renal • Pulmonary edema
hypertension (complication • CVA
caused by high blood
pressure)
Drug-Drug Interactions:

Pharmacokinetics: • + enflurane, halothane or

isoflurane anesthetics = excessive
• Well-absorbed and distributed hypotension
systemically
• + diabetic agents = increasing
• Metabolism – liver effect hypoglycemia
• Excretion – urine and feces • Carvedilol + verapamil or
diltiazem = conduction system
disturbance
Contraindications and Cautions:
• Bradycardia
Nursing Care:
• Heart blocks
 Taper dosage
• Shock  Monitor signs of liver failure
• Chronic Heart Failure  Increase fluid intake of Pt

• Diabetes
•Bronchospasm

SJS, Block NG
NCM 106 Reviewer

Nonselective Alpha-Adrenergic
Blocking Agents
Contraindications and Cautions:
Are:
• Allergy
 adrenergic blocking agents that
• Coronary Artery Disease (CAD)
have a specific affinity for alpha-
receptor sites • Myocardial Infarction (MI)
 use is somewhat limited because
of the development of even more • Pregnancy
specific and safer drugs • Lactation
 Prototype: Phentolamine
(Regitine)
Adverse Effects:

Nonselective Alpha-Adrenergic • Hypotension

Antagonist w/ Indication: • Orthostatic hypotension
Phentolamine (Regitine) • Angina
- Used to diagnose • MI
PHEOCHROMOCYTOMA
i) (Tumor of the chromaffin cells • CVA
of the adrenal medulla that
• Tachycardia
periodically releases large
amounts of norepinephrine
and epinephrine into the
system severe hypertension Drug-Drug Interactions:
and tachycardia) • Ephedrine/Epinephrine +
- Alpha 1: Decreases Phentolamine = decreased
sympathetic tone, hypertensive and vasoconstrictive
vasodilation, lowers BP effects
- Alpha 2: Preventing feedback
control of norepinephrine • Phentolamine + alcohol =
release increase in the reflex increased hypotension
tachycardia when BP is
lowered
Nursing Care:
• Inject Phentolamine into the area
Pharmacokinetics: of extravasation of epinephrine
• Rapidly absorbed and dopamine

• Excretion – urine

SJS, Block NG
NCM 106 Reviewer

Alpha1-Specific Adrenergic Adverse Effects

Antagonist
 CNS effects include headache,
Are: dizziness, weakness, fatigue,
drowsiness, and depression
 drugs that have a specific affinity
 Nausea, vomiting, abdominal
for alpha1-receptors
pain, and diarrhea
 causes a decrease in vascular
tone and vasodilation, which leads
to a fall in blood pressure
Drug-to-Drug Interactions
 Prototype: Doxazosin (Cardura)
 If combined with antihypertensive
drugs, increased hypotensiveness
Antagonists w/ Indications: may occur
1. Doxazosin (Cardura)
- Treatment of hypertension
and BPH Nursing Care:
2. Alfuzosin (Uroxatral)  Monitor patient’s BP
- Treatment of benign prostatic  Monitor for adverse effects
hyperplasia (BPH)
3. Prazosin (Minipress)
- Treatment of hypertension
Nonselective Beta-Adrenergic
- Can be used in combination
Blocking Agents
therapy
4. Tamsulosin (Flomax) Are:
- Treatment of BPH
5. Terazosin (Hytrin)  used to treat cardiovascular
- Treatment of hypertension problems (hypertension, angina,
and BPH migraine headaches) and to
prevent reinfarction after MI
Pharmacokinetics  Aims to decrease cardiac
workload, oxygen consumption,
 well absorbed after oral
and arrhythmias
administration
 Prototype: Propranolol (Inderal)
 undergo extensive hepatic
metabolism.
 excreted in the urine
Antagonists w/ Indications:
1. Propranolol (Inderal)
Contraindications and Cautions - Treatment of hypertension,
angina, hypertrophic
 Allergy to any component of the subaortic stenosis, treatment
drug of hypertension, angina,
 Lactation idiopathic check drug guide
 Renal Failure for specific information
 Hepatic Impairment hypertrophic subaortic
 Pregnancy stenosis

SJS, Block NG
NCM 106 Reviewer

2. Carteolol (Cartrol)  Asthma

- Treatment of hypertension in  Cautioned in pts with diabetes &
adults hypoglycemia
- Can be used in combination  Thyrotoxicosis
therapy
3. Nebivolol (Bystolic)
- Treatment of hypertension Adverse Effects
- Can be used in combination
therapy in adults  CNS effects include headache,
4. Nadolol (Corgard) fatigue, dizziness, depression,
- Treatment of hypertension paresthesia, sleep disturbances,
- Management of chronic memory loss, and disorientation
angina in adults (drug of  Cardio: bradycardia, heart block,
choice for hypertensive pt HF, hypotension, and peripheral
with angina) vascular insufficiency. Pulmonary
5. Penbutolol (Levator) effects can range from difficulty
- Treatment of hypertension breathing, coughing, and
6. Pindolol (Visken) bronchospasm to severe
- Treatment of hypertension pulmonary edema and bronchial
7. Sotalol (Betapace) obstruction
- Treatment of life-threatening  GI upset, nausea, vomiting,
ventricular arrhythmias diarrhea, gastric pain
8. Timolol (Blocarde, Timoptic)
- Treatment of hypertension
- Prevention of reinfarction Drug-to-Drug Interactions
after myocardial infarction
- Prophylaxis/relief for  Risk for paradoxical hypertension
migraines (hypertension even with
antihypertensive agents) when
given with clonidine
Pharmacokinetics  Decreased effect when given with
NSAIDs
 well absorbed after oral  Hypertensive episode may result if
administration given with epinephrine
 undergo extensive hepatic  Change in glucose levels when
metabolism. given with Insulin
 excreted in the urine

Nursing Care:
Contraindications and Cautions
 Taper dosage
 Allergy to any component of the  Monitor patient response to drug
drug
 Heart failure, heart blocks, or
shock
 Bronchospasm
 COPD

SJS, Block NG
NCM 106 Reviewer

Beta-Selective Adrenergic Contraindications and Cautions

Antagonists
 Allergy to any component of drug
Are:  Chronic Heart Failure
 Cardiogenic Shock
 Drugs that do not usually block
beta-receptor site  Heart Block
 Is viable for patients suffering from  Sinus Bradychardia
lung diseases or allergic rhinitis  Cautioned in diabetic pts, thyroid
 Preferred for patients w/ asthma disease, or COPD
 PROTOTYPE: Atenolol
(Tenormin)
Drug-Drug Interaction:
• +clonidine, NSAIDs, rifampin or
Antagonists w/ Indications barbiturates = decrease antiHPN
effect
1. Atenolol (Tenormin)
- Treatment of Myocardial • +epinephrine = hypertension
Infarction, chronic angina, then bradycardia
hypertension
2. Metoprolol (Lopressor) • +lidocaine = increase serum
- Treatment of Hypertension, level and toxicity of lidocaine •
prevention of reinfarction +prazosin = postural hypotension
3. Acebutolol (Sectral) • +verapamil, cimetidine,
- Treatment of hypertension, methimazole = increase effect of
premature ventricular B1 selective blocker.
contractions in adults
4. Betaxolol (Kerlone)
- Treatment for hypertension
Nursing Care:
5. Bisoprolol (Zebeta)
- Treatment for hypertension • Taper the dose
6. Esmolol (Brevibloc)
- Treatment of hypertension • Provide oral form of drug with
- Can be used in combination food
therapy

Pharmacokinetics:
- Bioavailability is increase with
food intake
- Metabolized in liver
- Excreted through urine

SJS, Block NG
NCM 106 Reviewer

Chapter 32 Cholinergic Agonists - Neurogenic bladder atony by

increasing muscle tone and
Are: relaxing the sphincters
 Drugs that increase the activity of - Diagnose and treat reflux
Acetylcholine-receptor sites esophagitis
 often called 2. Carbachol (Miostat)
parasympathomimetic because - Ophthalmic agents used to
their action mimics the action of induce miosis (pupil
the parasympathetic nervous constriction)
system - Relieves increases Intraocular
Pressure (IOP) of glaucoma
3. Pilocarpine (Pilocar, Salagen)
Types: - Ophthalmic agents used to
induce miosis (pupil
1. Direct-Acting Cholinergic constriction)
Agonists - Relieves increases Intraocular
- Occupy receptor sites of Ach Pressure (IOP) of glaucoma
to increase stimulation 4. Cevimeline (Evoxac)
2. Indirect-Acting Cholinergic - Treatment of symptoms of dry
Agonists mouth in Pts with Sjorgen
- Reacts with syndrome
acetylcholinesterase and
prevents breakdown of Ach
Pharmacokinetics
released from nerve
 Well absorbed after oral
administration
Direct-Acting Cholinergic Agonists  Metabolism and excretion
not known
 Reacts directly with receptor sites
to cause the same action as Ach
 Stimulates the muscarine Contraindications and Caution
receptors, such as:
o Increase bladder tone and  Bradycardia
urinary excretion  Hypotension
o Ophthalmic agents  Vasomotor Instability
 Peptic Ulcer
 GI surgery and obstruction
Agonists w/ Indications:  Asthma
 Epilepsy
1. Bethanechol (Duvoid,  Post-op bladder surgery or
Urecholine) obstruction
- Prototype  Caution is advised for Pregnancy
- Non-obstructive postoperative and Lactation
and postpartum urinary
retention

SJS, Block NG
NCM 106 Reviewer

Adverse Effects Medications for Myasthenia Gravis

w/ Indications
 N&V
 Abdominal cramps 1. Pyridostigmine (Regonol,
 Diarrhea Mestinon)
 Increased salivation - Prototype
 Involuntary defecation - Management of myasthenia
gravis
- Antidote to neuromuscular
junction blockers
Drug-Drug Interactions
- Allows for survival increase
 +acetylcholinesterase inhibitor = when exposed to nerve gas
increase cholinergic effects 2. Neostigmine (Prostigmin)
- Diagnosis of Myasthenia
Gravis
Nursing Care 3. Edrophonium (Tensilon, Enlon)
- Diagnosis of Myasthenia
 Administer medication to Pt with Gravis
empty stomach to decrease 4. Ambenonium (Mytelase)
Nausea and Vomiting - Treatment for Myasthenia
Gravis in adults

Indirect-Acting Cholinergic Agonists

Alzheimer’s Disease
 React chemically with
acetylcholinesterase to prevent  Progressive disorder involving
breakdown of Ach → neural degeneration in the cortex
accumulation of Ach → longer → memory loss and inability to
period of time for Ach to stimulate carry on ADLs
receptors  Progressive loss of Ach-producing
 Work at all PSNS, CNS, and at the neurons and their target neurons
neuromuscular junction  Drugs – allows for slow
Have two categories: progression of the disease
1. Medications for Myasthenia
Gravis Agents for Alzheimer’s Disease w/
2. Agents for Alzheimer’s Indications:
Disease 1. Doneprezil (Aricept)
- Prototype
- Management of Alzheimer
Myasthenia Gravis: dementia
- Severe dementia treatment
 Progressive weakness and lack of
2. Galantamine (Razadyne)
muscle control with periodic acute
- Management of mild to
episodes
moderate Alzheimer dementia
 Chronic autoimmune muscular
- Delays progression of disease
disease caused by a defect in the
3. Rivastigmine (Exelon)
neuromuscular transmission

SJS, Block NG
NCM 106 Reviewer

- Management of mild to Chapter 33-Anticholinergic Agents

moderate Alzheimer dementia
- Treatment of dementia related Are:
to Parkinson disease  Drugs that block the effects of
4. Tacrine (Cognex) Ach
- Management of mild to  AKA parasympatholytics
moderate Alzheimer dementia  Widely used to decrease GI
activity and secretions in the
treatment of ulcers and to
Pharmacokinetics decrease other
parasympathetic activities to
 Well absorbed and distributed
allow the sympathetic system
 For MG do not cross blood-brain
to become more dominant
barrier
 PROTOTYPE: Atropine
o Unknown metabolism and
excretion
 For Alzheimer’s dse
o Hepatic metabolism Anticholinergic Agents w/ Indications
o Excretion – urine 1. Atropine (generic)
- Decreases secretions,
bradycardia, relaxes bladder
Contraindications and Cautions - Antidote for cholinergic drugs
- Allows for pupil dilation
 Allergy 2. Scopolamine (Transderm Scop)
 Bradycardia - Decreases nausea and
 Intestinal or urinary tract vomiting associated with
obstruction motion sickness
 Pregnancy 3. Ipratropium (Atrovent)
 Lactation - Maintenance treatment of
 Asthma bronchospasm
 Coronary disease 4. Dicyclomine (Antipas, Dibent)
 Peptic ulcer - Treatment of hyperactive
 Arrhythmias bowel in adults
 Epilepsy 5. Glycopyrrolate (Robinul)
 Parkinsonism - Decrease secretion before
anesthesia or intubation
6. Propantheline (Pro-Banthine)
Drug-Drug Interaction - Used in adjunct therapy of
ulcers
 +NSAIDs = GI bleeding
 +cholinergic drugs = decrease
anticholinesterase effect Pharmacokinetics
 Theophylline + Tacrine = increase
theophylline level ◦ Well absorbed and widely
distributed
◦ Excretion – urine

SJS, Block NG
NCM 106 Reviewer

Contraindications and Caution

 Toxic megacolon
 Prostatic hypertrophy
 Bladder obstruction
 Cardiac arrhythmias
 Tachycardia
 Myocardial ischemia
 Impaired kidney or liver
function
 Myasthenia gravis
 Caution is advised in
Lactation, Hypertension,
Spasticity, and brain damage

Adverse effects
 Dry mouth
 Altered taste perception
 Nausea
 Heartburn
 Constipation
 Bloated feeling
 Tachycardia
 Palpitations
 Urinary hesitancy and retention
 Decreased sweating
 Suppression of lactation

Drug-Drug Interactions
 +antihistamines,antiparkinsonism
, MAOi, TCA = increase
anticholinergic effects
 +phenothiazines = decrease
effect of phenothiazines

Nursing Care
 Allow for adequate hydration and
temperature control

SJS, Block NG