The patient in the scenario is taking a cholinergic agent. Indicate which medication is being used, what clinical effect the nurse can expect, and for what adverse effect the nurse should monitor.

Choose the most likely option for the information missing from the statements below by selecting from the list of options provided.

The nurse will discuss with the patient the use of

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, which is used for

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and will have the effect of

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.The predictable adverse effect for this medication is.

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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 used primarily to stimulate bladder contraction and restore normal urinary function in non-obstructive urinary retention. It enhances parasympathetic activity, making it useful in clients with bladder atony.

Rationale for correct answer:

2. Urinary retention
Bethanechol stimulates muscarinic receptors in the bladder, promoting detrusor muscle contraction and improving bladder emptying in clients with neurogenic or non-obstructive urinary retention.

Rationale for incorrect answer:

1. Glaucoma
While cholinergic agents are sometimes used for glaucoma, bethanechol is not indicated for this purpose; it primarily targets the urinary and GI systems.

3. Delayed gastric emptying
Although it may mildly stimulate GI motility, it is not the preferred treatment for delayed gastric emptying or gastroparesis.

4. Gastroesophageal reflux disease
Bethanechol is not commonly used for GERD; other agents like proton pump inhibitors or prokinetics (e.g., metoclopramide) are more appropriate.

Take-home points:

• Bethanechol is a cholinergic agonist used to treat non-obstructive urinary retention by promoting bladder contraction.
• It should not be confused with medications used for glaucoma or GI reflux.
• Always assess for contraindications such as asthma or bradycardia before administering cholinergic agents.