A 59-year-old patient came to see the primary healthcare provider regarding some discomfort that was being experienced as shooting down the left arm. The patient has a history of hypertension, asthma, and glaucoma. Currently the patient is taking the following medications: atenolol for hypertension, albuterol for asthma (as needed), and pilocarpine drops for glaucoma.

The nurse discussed with the patient in the scenario the effects of the medications that they are currently taking. When explaining this the nurse described the common neurotransmitters and how they affect the central nervous system by stating which of the following? (Select all that apply.)

“The major neurotransmitters of the autonomic nervous system are acetylcholine and norepinephrine.”

“You see, the medications you take have an effect on the neurotransmitters of the nervous system since this is what controls your heart rate and blood pressure.”

“The medication that you take for glaucoma stimulates the cholinergic receptors to decrease the intraocular pressure.”

“The cholinergic side of the nervous system is subdivided into alpha, beta, and dopamine receptors.”

“The two main branches of the autonomic nervous system are complementary, since one branch speeds processes up and the other slows things down.”

Answer and Explanation

Correct Answer : A,B,C,E

Understanding how medications influence the autonomic nervous system (ANS) helps both nurses and clients anticipate expected effects and manage adverse reactions. Knowledge of neurotransmitters and receptor activity is fundamental when explaining the pharmacologic actions of medications, especially those affecting heart rate, blood pressure, and intraocular pressure.

Rationale for correct answers:

1. “The major neurotransmitters of the autonomic nervous system are acetylcholine and norepinephrine.”
Acetylcholine is the primary neurotransmitter of the parasympathetic nervous system, and norepinephrine is the primary neurotransmitter of the sympathetic nervous system. These two chemicals regulate many involuntary body functions through the ANS.

2. “You see, the medications you take have an effect on the neurotransmitters of the nervous system since this is what controls your heart rate and blood pressure.”
This statement accurately reflects how autonomic drugs work by mimicking or blocking neurotransmitter actions, thereby influencing cardiovascular parameters like heart rate and BP.

3. “The medication that you take for glaucoma stimulates the cholinergic receptors to decrease the intraocular pressure.”
Cholinergic agonists (e.g., pilocarpine) lower intraocular pressure by increasing aqueous humor outflow through ciliary muscle contraction, which is a parasympathetic (cholinergic) action.

5. “The two main branches of the autonomic nervous system are complementary, since one branch speeds processes up and the other slows things down.”
This reflects the balance between sympathetic ("fight or flight") and parasympathetic ("rest and digest") systems. Their opposing actions help maintain homeostasis depending on the body’s needs.

Rationale for incorrect answer:

4. “The cholinergic side of the nervous system is subdivided into alpha, beta, and dopamine receptors.”
Alpha, beta, and dopamine receptors are classifications under the adrenergic (sympathetic) system, not the cholinergic system. Cholinergic receptors are categorized as nicotinic and muscarinic.

Take-home points:

The autonomic nervous system functions through two main neurotransmitters: acetylcholine and norepinephrine.
Cholinergic and adrenergic medications influence vital functions like heart rate, blood pressure, and intraocular pressure.
Alpha, beta, and dopamine receptors belong to the adrenergic (not cholinergic) system and should not be confused with muscarinic or nicotinic receptors.

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Correct Answer is A

Explanation

Tacrine (Cognex) is a cholinesterase inhibitor used in the treatment of Alzheimer’s disease. It increases acetylcholine levels in the brain to enhance memory and cognition. However, excessive cholinergic stimulation from overdose can lead to signs of cholinergic toxicity, which nurses and caregivers must closely monitor.

Rationale for correct answer:

1. Excessive sweating, salivation, and drooling
These are hallmark signs of cholinergic toxicity. Tacrine increases parasympathetic activity, and an overdose may lead to excessive secretions, bradycardia, muscle weakness, and in severe cases, respiratory compromise.

Rationale for incorrect answer:

2. Extreme constipation
Constipation is more typical of anticholinergic toxicity, not cholinergic excess. Tacrine enhances cholinergic activity, which usually increases GI motility rather than slowing it down.

3. Hypertension and tachycardia
These are signs more often associated with sympathetic nervous system overactivity, not with cholinergic overstimulation caused by drugs like tacrine.

4. Excessively dry eyes and reddened sclera
Dry eyes are an anticholinergic effect. Tacrine, being a cholinergic agent, would more likely cause increased lacrimation (tear production), not dryness.

Take-home points:

Tacrine overdose manifests with signs of cholinergic excess, including sweating, salivation, drooling, and bradycardia.
Cholinergic drugs increase parasympathetic activity; caregivers should know the early signs of overdose to act promptly.
Differentiating between cholinergic and anticholinergic effects is essential for safe medication management in Alzheimer’s care.

A. Pneumonia B. Pulmonary embolism C. Bronchoconstriction D. Bronchodilation

Correct Answer is C

Explanation

Beta-adrenergic blocking agents (beta blockers) are commonly used for hypertension, arrhythmias, and other cardiovascular disorders. However, non-selective beta blockers can block beta-2 receptors in the lungs, which may lead to bronchoconstriction, especially in patients with a history of asthma or COPD.

Rationale for correct answer:

3. Bronchoconstriction
Non-selective beta blockers can block beta-2 receptors in bronchial smooth muscle, leading to bronchoconstriction. This is particularly dangerous in individuals with underlying reactive airway disease.

Rationale for incorrect answer:

1. Pneumonia
Pneumonia may cause shortness of breath, but it is unrelated to beta-blocker therapy and would typically present with fever, cough, and crackles rather than sudden respiratory distress.

2. Pulmonary embolism
A pulmonary embolism is a possible cause of acute shortness of breath, but it is not a common adverse effect of beta blockers and requires other risk factors for thrombosis.

4. Bronchodilation
Bronchodilation is caused by beta-2 agonists, not beta blockers. Beta blockers would have the opposite effect on the airways.

Take-home points:

Non-selective beta blockers may induce bronchoconstriction by blocking beta-2 receptors in the lungs.
Patients with asthma or COPD should be prescribed cardio-selective beta blockers with caution.
Shortness of breath following beta-blocker initiation requires immediate assessment for potential respiratory complications.

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Naxlex Comprehensive Predictor Exams

The client or family of a client taking tacrine (Cognex) should be taught to be observant for which of the following adverse effects that may signal that a possible overdose has occurred?

Correct Answer is A

Explanation

The patient in the scenario who has recently been prescribed a beta-adrenergic blocking agent now presents to the emergency department with shortness of breath. Which adverse effect from the medications is the patient likely exhibiting?

Correct Answer is C

Explanation

The nurse will monitor the patient taking albuterol (Proventil) for which conditions? Select all that apply.

A male patient was discussing with the nurse that he was experiencing problems urinating after taking an antihistamine that has anticholinergic properties and was wondering why this was happening. Which statement by the nurse explains this effect?

Anticholinergics may be ordered for which of the following conditions? Select all that apply.

The nurse is administering atenolol (Tenormin) to a patient. Which concurrent drugs does the nurse expect to most likely cause an interaction? Select all that apply.

The nurse reviewing a patient’s preoperative medications noted that atropine sulfate was listed. In which diagnoses should atropine sulfate be used with caution? Select all that apply

Following administration of phenylephrine (Neo-Synephrine), the nurse would assess for which of the following adverse drug effects?

Propranolol (Inderal) has been ordered for a client with hypertension. Because of adverse effects related to this drug, the nurse would carefully monitor for which adverse effect?