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

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.

Albuterol (Proventil) is a short-acting beta-2 adrenergic agonist commonly used to relieve bronchospasm in conditions like asthma and COPD. While effective in relaxing bronchial smooth muscle, its adrenergic effects can also stimulate beta-1 receptors at higher doses, leading to cardiovascular side effects that nurses must monitor carefully.

Rationale for correct answers:

1. Palpitations – Albuterol can cause cardiac stimulation by activating beta-1 receptors at higher or repeated doses, resulting in palpitations, tachycardia, or other dysrhythmias.

2. Hypertension – Beta-agonists may increase heart rate and contractility, potentially raising blood pressure in some patients, especially in those with underlying cardiovascular conditions.

Rationale for incorrect answers:

3. Hypoglycemia – Albuterol is more commonly associated with hyperglycemia, not hypoglycemia. It stimulates glycogenolysis, potentially increasing blood glucose levels.

4. Bronchospasm – Albuterol is used to relieve, not cause, bronchospasm. However, paradoxical bronchospasm is rare and would be an adverse reaction, not a typical side effect to monitor for routinely.

5. Uterine contractions – Albuterol is sometimes used off-label to inhibit uterine contractions due to its smooth muscle relaxing effects. It does not typically cause uterine contractions.

Take-home points:

• Albuterol may cause palpitations and increased blood pressure due to beta-1 receptor stimulation at higher doses.
• Nurses should monitor cardiovascular effects when administering adrenergic agonists like albuterol.
• Though primarily a bronchodilator, albuterol can have systemic effects, especially if overused.