6 rights
patient
Time
drug
dose
route
documentation
Good goals
patient focused
time limited
measureable/specific
realistic
important digoxin
check apical pulse for 60 seconds
pregnancy drug categories least to most harmful
A- least likely
D, X = most likely to cause harm to fetus
Ethics
informal, harder to enforce
Legal
formal statement w/ consequences
pain threshold
level of stimuli needed to feel pain
Name 2 NSAIDS
acetaminophen
Tylenol
action of NSAIDS
inhibit prostaglandin synthesis, a chemical needed to transmit pain impulse
SE of NSAIDS
hepatoxicity
max tylenol per day
adults <65 4,000mg
=>65 2,000mg daily
antedote for NSAIDS
mucamist, PO or SQ
NSAIDS are used for
mild-mod pain and fever,
esp in children (b/c aspirin will cause Reye's Syndrome)
which anesthetic = loss of consciousness
General
antidote for narcotics
Narcan
potential SE of opioids, could be fatal
common SE of itching could actually be an anaphylactic response rather than a simple allergic response to histamine release
SE of opioids
sedation, N/V, decreased resp, constipation
list opioids
morphine
codiene
fentanyl (duragesic)= patch
Demerol- dont give- toxic!
general anesthetics action site
CNS
general anesthetic med
propofol
what not to use propofol w/
general anesthetic med:
glaucoma- may wake up blind!
Local anesthetic use
Spinal- for childbirth
local SE
severe HA
Local meds
Lidocaine, benzocaine
local misc
constantly monitor for return of motor function
Neuromuscular blocking drugs
Anectine (succinylcholine)
Norcuran (vecuronium)
Anectine (succinylcholine)
Norcuran (vecuronium) SE's
Neuromuscular blocking drugs:
muscle spasms, increase or decrease BP and heart rate
action of neuromuscular blocking drugs
block NM connection
Anectine (succinylcholine)
Norcuran (vecuronium) USE
neuromuscular blocking drugs: adjunct w/ general anesthesia
sedative/hypnotics
barbituates or benzo's
benzodiazepines
Ativan
Valium
Xanax
Benzodiazepines action
decreases CNS
Benzodiazepine SE's
HA,
drowsiness,
dizziness,
cognititive impairment (esp w/ elderly, may be diagnosed w/ ALZ, but this will go away when they cease the med)
Benzo misc
use caution w/:
glaucoma, may make worse
pregnancy
alcohol
alcohol is synergistic w/ what?
Benzodiazepines:
valium
xanax
ativan
barbituates
seconal
phenobarbital
barbituates action and use
works on brain stem (decreases excitability)
to calm patients, used less than benzos
Barbituates SE
drowsiness dizziness lethargy, Lack of REM cycle
sleep cycle is messed up w/ what?
barbituates (seconal and phenobarbital), mess w/ REM so you don't wake up so refreshed
Muscle relaxant meds
flexeril
baclofin
muscle relaxant action
like an anti anxiety, sedates brain to relax muscles
flexeril and baclofin use
muscle relaxants:
muscle spasms (back injuries)
spacicity (MS and cerebral palsy)
3 chemicals stimulated in CNS
dopamine
norepinephrine
serotonin
what does a sympathomimetic drug work on
norepinephrine
ADHD/narcolepsy meds
Ritalin (methylphenidate)
amphetamines
Ritalin (methylphenidate)
amphetamines ACTION
stimulate cerbral cortex
what to look out for w/ anorexiants and name them
Xenical and Meridia should be used cautiously w/ heart problem patients and glaucoma (will make worse) and w/ MOAI's
Antimigraine drugs
Imitrex
Axert
Relpax
SE of Imitrex, Axert, Relpax
Antimigraine drugs:
Decreased circulation, tingling, will make head congested
Action of Anti Migraine drugs
causes vasoconstriction to reduce swelling, thus is an anti inflammatory
use caution w/ Imitrex, Axert, Relpax and....
Antimigraine drugs caution w/:
heart disease
Analeptic drug
dopram
analeptic action
Dopram stimulates the medulla, which controls resp rate
Dopram use
Analeptic:
COPD, post surgery to stimulate breathing, neonatal apnea
Dopram SE
an analeptic, SE:
tachycardia,
increased HR
diarrhea,
flushing
Sympathetic drugs
Adrenergics & adrenergic blockers
parasympathetic drug classifications
cholinergics and cholinergic blockers (aka anticholinergics)
sympathetic response
fight or flight
parasympathetic response
rest and digest
what are adrenergics and their action?
Sympathetic drugs:
catecholamines:
vasoconstrict
vasodilate
increase HR
decrease GI motililty
bladder constriction
dilate bronchi's
mydriasis (dilate pupils)
what are adrenergic blocker's action
Sympathetic drugs:
decrease HR
increase GI
what are adrenergic blockers used for
Sympathetic drugs:
Hypertension
BPH
cholinergics chemical and action
parasympathetic drug:
acetylcholine:
stimulate GI/GU
consticts pupils
increase saliva and sweat
decrease HR
vasodilation
constricts bronchi
helps normal brain function
cholinergic blockers chemical and use
parasympathetic drug:
anticholinergics work on acetylcholine to:
decrease muscle rigidity
decrease tremors
decrease HR (for low dose - increases w/ high dose)
decrease respiratory secretions
dilate bronchi
decreases GI secretions and motility
treats incon
what is a check and balance?
Autonomic nervous system
what does sympathetic nervous system do
stimulates and blocks
vasoconstriction and dilation
increase and decrease body substances to create
fight or flight
parasympathetic
rest/digest
GI motility
regulate gastric secretions & urinary
chemicals in bran that make sympathetic nervous system work properly
catecholamines:
norepinephrine
epinephrine
dopamine
adrenergic meds and uses
albuterol= bronchodilation
ephedrine= topical nasal decongestant (constricts arterioles in nose to decrease swelling so snot can come out)
epinephrine= an opthalmic used for glaucoma
doputamine= heart failure to increase heart rate
adrenergic SE
HA, restlessness, insomnia, increase HR and BP, angina, GI (N/V), anorexia
Adrenergic interventions
check vitals, esp b/c they increase BP and HR,
if pt in heart failure, can use epinephrine, but may cause renal problems, so watch out for this
will know HF is resolveing by BP increaseing b/c HF usually = drop in BP
careful giving adrenergics IV b/c it c
agonists
stimulate
antagonists
block
sympatholytics
another name for adrenergic blocker
inhibit sympathetic nervous system
cholinergics use
parasympathetic drug:
reduce eye pressure (helps glaucoma)
decrease GI motility
helps dry mouth, (Sjogren's syndrome- dramatically dry mouth)
myasthenia gravis (
ALZ
adrenergics use on eyes
sympathetic drug::
reduce intraocular pressure
dilate pupils (mydriasis)
these help to
treat open angle glaucoma
eye exams
adrenergic use on eyes meds
sympathetic drug::
epinephrine
adrenergic agonists
sympathetic drug::
stimulate
antagonists
block
adrenergics - heart
sympathetic drug::
doputamine
adrenergic- bronchodilator
sympathetic drug::
albuterol
adrenergic- topical nasal decongestant
sympathetic drug::ephedrine
adrenergic glaucoma
sympathetic drug::epinephrine
muscarinic cholinergics
parasympathetic drug:
respond to / stimulate effector organs, smooth muscles, cardiac muscles, glands
neurotransmitter responsible for transmission of nerve impulses to effector cells in the parasympathetics system
parasympathetic drug
acetylcholine
nerve receptor stimulated by acetylcholine
parasympathetic drug
cholinergic receptor
cholinergic receptors located in ganglia, where presynaptic and post synaptic nerve fibers meet of both parasympathetic and sympathetic nervous system
parasympathetic drug
nicotinic receptors, can be stimulated by alkaloid nicotine
adverse effects of cholinergic drugs- cardio
parasympathetic drug
bradycardia,
hypotension,
conduction abnormalities
adverse effects of cholinergic drugs (agonists)- CNS
parasympathetic drug
HA
Dizziness
Convulsions
contraction of pupil
parasympathetic drug
miosis
cholinergic receptor located post synaptically in effector organs, such as smooth and cardiac muscles and glands, supplied by parasympathetic fibers
parasympathetic drug
muscarinic receptors
adverse effects of cholinergic drugs (agonists)- GI
parasympathetic drug
abdominal cramps
increased secretions
N/V
adverse effects of cholinergic drugs (agonists)- respiratory
parasympathetic drug:
increase bronchial secretions
bronchiospasms
adverse effects of cholinergic drugs (agonists)- misc
parasympathetic drug:
lacrimation
sweating
salivation
loss of ocular accomodation
miosis
what do cholinergics do
parasympathetic drug:
reduce eye pressure (helps glaucoma)
decrease GI motility
help dry mouth (Sjogren's syndrome)
myesthenia gravis (autoimmune NM disease w/ fluctuating muscle weakness)
ALZ
direct acting cholinergic drugs
parasympathetic drug:
Urecholine (bethanachol)
pylocarpine
indirect acting cholinergic drugs
parasympathetic drug:
Aricept
Mytelase
Urecholine (bethanachol) treats
parasympathetic drug:
acute post operative and post par-tum non obstructive urinary retention
management of urinary retention r/t neurogenic atony of bladder
and tx's adverse effects of other meds, such as bladder dysfunction caused by other meds
heart does not pump enough blood to meet metabolic needs
heart failure
Aricept
Mytelase
misc fact
indirect acting cholinergic:
take about 6 weeks to work
cardiac output is insufficient
heart failure
chronotropic
increase or decrease heart rate
inotropic
increase or decrease the force of heart contraction
PDI
phosphodiesterase inhibitor: Primacore is a PDI, it is a positive inotropic vasodilator
PDI med
primacore
PDI action
a positive + inotropic drug & vasodilator
primacore use
PDI:
in ICU, acute care for short term HF
primacore SE
PDI:
dysrhythmia (irregular HR)
primacore intervention
pdi:
do not use this IV drug w/ dextrose, only infuse w/ NS
no antidote, be careful!!!
Aricept (donezipel) use
:Indirect acting cholinergic: cholinesterase inhibitors:
ALZ, dimentia
cholinergic drug interveintions
give drug same time every day
increase fluids
assess abd for obstruction
apply pressure to lacrimal duct so it doesn't become systemic
sip and suck
ambulate pt's
acetylcholine blockers aka
parasympatholytics
anticholinergics
cholinergic blockers
mydriasis
#NAME?
drug that reduces activity of parasympathetic nervous system
parasympatholytic
cholinergic blocking drug action
block action of acetycholine at receptor site
cholinergic blocking drug uses
decrease resp secretions (good for bronchitis and asthma)
decrease GI secretions (good for acidic stomach)
bladder incontenence
PKD (tx rigidity of muscles and tremors
decrease HR (w/ low dose)
increase HR (w/ high dose)
sinus node dysfunction
cholinergic blocking drug meds
atropine
bentyl
detrol
dysrhythmia
deviation from normal rhythm
arrhythmia
no regular heart rate
action potential
how our cardiac cells are excited
hear rhythm is regulated through ions (CA+, K+, Na+)
electrolytes are ions, they create a contraction that is normal and regular
HF drugs
ACE inhibitors
ARB's (angiotensive receptor blockers)
Beta- blockers
cardiac glycosides (digoxin)
PDI's (primacore)
what class is Procainamide
Class Ia heart med for dysrhythmia
what is class Ia used for
dysrhythmias
what are SE of procainamide
Class Ia:
worse dysrythmias, blood disorders, N, D
Class Ib drug
lidocaine- for heart attack
SE of lidocaine
Class Ib drug:
messes w/ CNS (confusion, twitching)
Fav drug for heart attack
Lidocaine (only available IV) Class Ib
Class III drug
Amiodarone- fav drug for ventricular dysrhythmia
fav drug for ventricular dysrhytmia
Class III drug:
Amiodarone
SE of Amiodarone
Class III drug:fav drug for ventricular dysrhytmia:
75 % of pt's will develope a SE from this med
pulmonary toxicity
takes as many as 3 months for SE to go away!
pulmonary toxicity stages
cough
dyspnea
damaged alveoli (irreversible!)
misc for amiodarone Class III
fav drug for ventricular dysrhytmia: half life is many days, so we don't give daily
also takes as many as 3 months for SE to go away!
class IV drug
Diltiazem aka Cardiazem: a dysrhythmic for atrial flutter
diltiazem (Cardiazem) use
atrial flutter (class IV)
early stage of CAD, will eventually lead to MI
unstable Angina
MI
heart attack
vasospastic angina
spasms in heart muscle, often at rest, and frequently at same time every day
angina pectoris
heart muscle pain due to decreased blood supply
name nitrates and nitrites
isordyl
nitroglycerin
ischemia
poor blood supply
chronic stagle angina
caused by atherosclerosis,
triggered by exertion, stress, intense pain,
usually gone in 15 mins w/ rest
3 types of angina
chronic stable angina
unstable angina (early sign of CAD will lead to MI)
vasospastic angina
action and use of nitrates and nitrites
dilates vessels, used for all 3 anginas
nitrates and nitrites limit
3
nitrates and nitrites SE
HA
increased heart rate
decreased BP
beta blockers are good for
angina
if a nitrate doesn't work in ____ mins, call 911
5 mins
chronic stable angina med
beta blockers (aka adrenergic blocking)
beta blockers (aka adrenergic blocking) meds
Atenolol
Tenormin
Atenolol
Tenormin
SE
decreased heart rate and CO
CCB med
Cardizem
Cardizem use (CCB)
vasospastic
CCB action
blocks calcium, which is the excitation and action potential in heart, thus relaxing heart
SE cardizem CCB
decreased BP
interventions for CCB's
only give when seated (orthostatic hypotension)
check BP 30 mins after administering
primary hypertension
AKA idiopathic, essential hypertention
has unknown cause
90% of hypertension
secondary hypertension
caused by another problem:
drug, liver, kidney
easier to fix b/c you know what is causing it
SE of hypertension meds
ED and decreased libido
ACE inhibitor meds
Capoten (Captopril)
Vasotech
Ace inhibitor use
tx hypertension
heart failure
Capoten (Captopril)
Vasotech
SE
ACE inhibitor meds:
fatigue
mood changes
heart attack
(dry cough?)
Capoten (Captopril)
Vasotech
misc
ACE inhibitor meds:
teach pt re: rebound HTN, may come back worse and lead to MI
doesn't need liver to metabolize so can give to pt's w/ bad liver
Angiotensive II receptor blocker med
Cozaar
Angiotensive II receptor blocker use
tx hypertension
heart failure
Cozaar action
Angiotensive II receptor blocker med:
vasodilator
Angiotensive II receptor blocker SE
Cozaar: increases risk for respiratory infection
HA
Angiotensive II receptor blocker Misc
it is best to give Cozaar w/ meals
Vasodilator med
Apresoline
Apresoline use
Vasodilator med:
tx hypertension
Vasodilator SE
dizziness, dysrhythmia, HA
worst heart med for causing orthostatic hypotension
Apresoline (vasodilator)
other drug options for hypertension
Adrenergics
CCB's
Diuretics
Mics
primary job of hypothalamus
control pituitary gland
what 2 glands make up neuroendocrine system
hypothalamus
pituitary
goal of endocrine system
maintenance of physiology and stability and communication w/ all cells through hormones, keeps us in balance
pituitary hormone drugs (replace/antagonize)
sandostatin (octreotide)
pritessin
desmopressin
Octreotide (Sandostatin) SE
pituitary hormone drugs:
Renal failure
give in caution w/ DM
if pt is on lithium, it will interact and desmopressin will not work
important pituitary notes
meds can cause BS to become irregular in DM patients
teach to report fever, sore throat, joint or muscle pain immediately.
T3
triiodothyronine
T4
thyroxine
4 thyroid meds
T3 triiodothyronine
T4 thyroxine
Calcitonin
TSH (made by pituitary to control thyroid)
science of preparing and dispensing drugs, including dosage form and design
pharmaceutics
rate of drug distribution among various body compartments after a drug has entered the body. Includes the phases of absorption, distribution, metabolism, and excretion of drugs
Pharmacokinetics
rate of drug distribution among various body compartments after a drug has entered the body. Includes the phases of absorption, distribution, metabolism, and excretion of drugs
study of the biochemical and physiologic interactions of drugs at their sites of activity. It examines the physiochemical properties of drugs and their pharmacologic interactions with body receptors
Pharmacodynamics
Legal
dictates the boundaries w/in which professional nurses practice. Standards of care and practice, include the definition of the scope and role of the nurse, and legal guidelines for the minimally safe and adequate nursing practices.
ethical
based on fundamental principles of beneficence, autonomy, justice, veracity, and confidentiality. Adhering to ethical principles and codes of ethics ensures that the nurse is acting on behalf of the patient and with the patient's best interests at heart.
study of genetic variations in drug response and focuses on single-gene variations
pharmacogenetics
level at which basic knowledge is learned and stored. Thinking portion, incorporates a person's previous experiences and perceptions
cognitive domain
most intangible component of the learning process. Conduct that expresses feelings, needs, beliefs, values and opinions
Affective domain
doing" domain. involved in learning a new procedure or skill
psychomotor domain
half life
when med is 1/2 out of body
Remember these adrenergic meds!
Dobutamine (heart failure= +inotropic)
Corlopram (ER hypertension= lowers BP)
dopamine (shock, cardiopulmonary arrest)
norepinephrine (hypotensive state & shock = vasoconstrics)
p 294
adrenergic SE
HA, restlessness, insomnia
increase HR, increase BP, Chest pain
these could be SE or indications (may want to raise HR if it is in 40's)
GI=N/V/anorexia
Dobutamine, Corlopram, dopamine, norepinephrine
epinephrine warning for HF
can be used for HF, but will cause renal damage
how do we know HF is resolving?
BP will raise
nucleic acid
biochemical compound made up of 2 molecules- RNA and DNA
DNA
deoxyribonucleic acid
genome
entire DNA structure in an organism
alpha1 blocker meds
Cardura
alfuzosin
are adrenergic blockers
alpha1 blocker use
dilates arteries and veins
used for hypertension and BPH
Cardura
alfuzosin
alpha1 blocker action
blocks catecholamines
(Cardura, alfuzosin)
alpha1 blocker SE
decreased BP (more than desired)
increase HR
dizzyness
notify dentist/surgeon before removing tooth or surgery
(Cardura, alfuzosin)
alpha1 blocker cautions
(Cardura, alfuzosin)
use in caution w/:
liver and kidney disease
CAD
PUD
sepsis
avoid excessive exercise
notify dentist/surgeon before removing tooth or surgery
Beta-blocker meds
adrenergic blockers
Inderal
Atenolol
Toprol
Beta-blocker action
(Inderal, Atenolol, Toprol)
blocks catecholamines
Beta-blocker use
(Inderal, Atenolol, Toprol)
angina
MI
hypertension
HF
migraines
Beta-blocker SE
(Inderal, Atenolol, Toprol)
decreased BP and HR
may mask signs of hypoglycemia!!!!
if apical pulse is <60 hold med till talk to DR
if weight loss is =>2lbs in 24 hours, call Doc
Beta-blocker interventions
(Inderal, Atenolol, Toprol)
may mask signs of hypoglycemia!!!!
if apical pulse is <60 hold med till talk to DR
if weight loss is =>2lbs in 24 hours, call Doc
top 5 reasons for cholinergics
decrease eye pressure (helps glaucoma)
decrease GI motility
helps dry mouth (Sjogren's syndrome)
myesthania gravis (neuromuscular disorder)
ALZ
most common and dangerous SE of cholinergics
decreased HR
antidote for cholinergics
Atropine
ANS drugs
adrenergics: (albuterol, ephidrine, epinephrine, doputamine)
adrenergic blockers: (a1: Cardura & alfuzosin)
(bb:inderal, atenolol, toprol)
cholinergics: (direct acting- urecholine & pilocarpine)
(indirect acting: Aricept & Myetalase)
cholinergic blockers:
cardiac glycoside med
digoxin/digitalis (Lanoxin)
cardiac glycoside med use
HF & Afib
slows HR
(digoxin/Lanoxin)
cardiac glycoside med action
positive inotropic
(digoxin/Lanoxin)
cardiac glycoside med SE
dysrhythmia (esp low HR)
colored vision (see a green/yellow/purple- means toxic, med is going to brain)
anorexia
SE mean pt is toxic level, hold med, monitor lab values
20% will develop toxicity
(digoxin/Lanoxin)
cardiac glycoside med interventions
check apical pulse for 60 secs and hold med if <60bpm
monitor lab values (normal digoxin lab value 0.5-2ng/ml)
cardiac glycoside med Misc
lots of these patients are on other meds, like Lasix (low K+)
Low K+ increases toxicity risk of digoxin
(pt should be on aldactone or other K+ sparring diuretic)
Normal digoxin lab value and dose
0.5-2ng/ml= normal lab value
0.125-0.5 mg/daily dose
cardiac glycoside med antidote
antidote for digoxin/Lanoxin:
digibind
thyroid replacement drugs
Levothyroxine (synthroid)
Levothyroxine (synthroid) use
hypothyroidism
Levothyroxine (synthroid) SE
dysrhythmia (check apical and radial pulse)
teach pt to observe for palpitations (bounding)
Levothyroxine (synthroid) interventions
teach pt to take at same time every day (AM= increases HR)
teach pt to observe for palpitations (bounding)
Levothyroxine (synthroid) contraindication
this thyroid replacement drug is contraindicated if pt has adrenal insufficiency or MI
Antithyroid med
PTU (propylthiouracil)
PTU (propylthiouracil) use
tx Graves disease (hyperthyroidism)
PTU (propylthiouracil) action
blocks secretion of thyroid hormones
PTU (propylthiouracil) SE
antithyroid med:
hepatoxicity (palpate R upper quad)
ask pt and check chart for Hx of alcoholism or hepatitis
Bone Marrow Toxicity (RBC loss= tired and pale, platelet loss = bruised and bleeding, WBC loss = infections)
PTU (propylthiouracil) misc and interventions
antithyroid med
takes 2 weeks to see improvement
take w/ meals to prevent GI upset
Category D pregnancy drug
largest endocrine gland
pancreas (also an exocrine gland)
type 1 diabetes
originally juvenile
body does not produce insulin
rapid acting insulin
Humalog
regular insulin
Humulin R,
Novolin R
Long acting insulin
Lantus
Biguanide med
Metformin
PO antidiabetic med
Biguanide action
Metformin increases receptor sensitivity to insulin (invites insulin into cells) and decreases glucose production in liver and absorption in intestines (so glucose goes out in poo)
Biguanide use
Metformin is a first line drug and the most commonly used oral drug to tx type 2 DM
difference between sulfonylureas and metformin
Unlike sulfonylureas, metformin does not stimulate insulin secretion and therefore is not associated w/ hypoglycemia and weight gain
Biguanide SE
Metformin SE's
GI upset, N, heatburn, D
Biguanide Misc
please use w/ caution w/ renal and liver disease, and HF
sulfonylurea meds
glipizide and glyburide
sulfonylurea use
glipizide and glyburide are used w/ Metformin to control BS
sulfonylurea intervention
give glipizide and glyburide 30 mins before meal
Glinide med and use
Repaglinide BS med, not used much b/c its old. Give w/ each meal
Thiazolidinediones meds
also called 'glitazones'
Actose
Benadoin
Avendia
Thiazolidinediones (glitaones) SE
increase risk for HF, (esp avandia)
will take several weeks for full effect
(Actose, Benadoin, Avendia)
Alpha-glucosidase inhibitor meds
Precose and glyset
to control BS
Alpha-glucosidase inhibitor contraindication
Precose and glyset (to control BS):
are contraindicated in IBD and other malabsorption syndrome
Amylin mimetic meds
Symlin (SQ before meals to tx BS)
Amylin mimetic action
amylin is hormone secreted by beta cells, drug will make body believe amylin has been secreted
Amylin mimetic use
Symlin is used if insulin isn't working in DM patients
Incretin mimietc meds
Byetta (exanatide)
Januvia
Incretin mimietc use
tx type 2 DM if everything else has failed (including insulin)
Byetta (exanatide)
Januvia
Incretin mimietc misc
discovered from Gila Monster
Byetta (exanatide)
Januvia
Hypoglycemia meds
glucose-elevating drug forms
buccal
semisolid gel
table sugar
inject glucagon
caution w/ injecting glucagon
carefeul BS will rise, but they will most likely vomit, turn them on their side so they dont aspirate
parasympathetic nervous system does
controls gastric secretions
the following considered a use of adrenergic drugs
asthma
cardiac failure
glaucoma
when giving doputamine IV you may have what SE
tissue necrosis
Cardura is considered a
adrenergic blocker
one serious complication of beta blockers is that it will
mask hypoglycermia
which chemical is responsible for nerve transmission in the parasympathetic nervous system
acetylcholine
which is a common use for cholinergic drugs
bladder atony
antidote for urecholine is
Atropine
do to SE of aricept, what is an intervention
increase fluids
when taking cholinergic blocking meds fluid intake should be
6-8 glasses H2O a day