Older adult clients taking bethanechol (Urecholine) need to be assessed more frequently because of which of the following adverse effects?

Rationale for correct answer:

Pilocarpine is a direct-acting cholinergic agonist that stimulates muscarinic receptors. It is primarily used in the treatment of glaucoma to reduce intraocular pressure by increasing aqueous humor outflow. Nurses administering cholinergic agents like pilocarpine should anticipate both therapeutic effects and systemic adverse effects associated with parasympathetic activation.

Pilocarpine
Pilocarpine is the appropriate choice as it is a cholinergic agent used in ophthalmology to treat glaucoma by activating muscarinic receptors in the eye. This enhances aqueous humor drainage, thereby lowering intraocular pressure.

Glaucoma; reducing intraocular pressure
Glaucoma is managed by lowering intraocular pressure to prevent optic nerve damage. Pilocarpine constricts the pupil (miosis) and opens the trabecular meshwork, facilitating fluid drainage from the anterior chamber.

Bradycardia
Systemic absorption of pilocarpine may stimulate muscarinic receptors in the heart, resulting in slowed heart rate (bradycardia), especially with higher doses or in sensitive individuals. This is a common systemic adverse effect of cholinergic agonists.

Take-home points:

• Pilocarpine is a cholinergic agonist used to treat glaucoma by lowering intraocular pressure via miosis and enhanced aqueous humor outflow.
• Nurses should monitor for systemic cholinergic effects, including bradycardia, excessive salivation, or sweating.
• Understanding the systemic effects of ophthalmic medications is crucial, especially in older adults or those with preexisting cardiac conditions.

Bethanechol (Urecholine) is a direct-acting cholinergic agonist prescribed to stimulate bladder emptying in clients with urinary retention. Older adults are more vulnerable to its parasympathomimetic effects, which can lead to cardiovascular and neurological side effects that require close monitoring.

Rationale for correct answer:

3. Dizziness
Dizziness is a common concern in older adults taking bethanechol due to the risk of orthostatic hypotension and decreased cardiac output. This increases the risk for falls, making frequent assessment essential in this population.

Rationale for incorrect answer:

1. Tachycardia
Bethanechol typically causes bradycardia by stimulating the parasympathetic nervous system. Tachycardia is not a common effect of this drug and would not be the primary concern.

2. Hypertension
Cholinergic agonists tend to lower blood pressure through vasodilation and enhanced parasympathetic tone. Hypertension is not a typical adverse reaction.

4. Urinary retention
Bethanechol is used to treat urinary retention by stimulating the bladder. Retention would indicate a lack of therapeutic effect rather than an adverse one.

Take-home points:

• Bethanechol stimulates the parasympathetic system and can cause dizziness from hypotension, especially in older adults.
• Older clients require close monitoring for orthostatic changes and fall risks while on cholinergic medications.
• This drug is intended to treat urinary retention, not cause it, so effectiveness is measured by successful voiding.