Anticholinergics

Question 1

What plant are Anticholinergics derived from?

Answer 1

Belladonna

Question 2

What does cycloplegia mean?

Answer 2

Paralysis of the eye
(muscles that are responsible for operating the lens of the eye)

Question 3

What is mydriasis?

Answer 3

Dilated pupil

Question 4

Anticholinergics
Mechanism of Action

Answer 4

• Blocks the effects of acetylcholine by competing with ACh at the MUSCARINIC ACh receptor sites
• This, in turn, blocks the effects of the parasympathetic nervous system and allows the sympathetic nervous system to become more dominant.
• Also blocks ACh at cholinergic receptors in the sympathetic nervous system

AKA: “parasympatholytic agents”

They do not block ACh at the nicotinic receptor sites…. little or no effect at the neuromuscular junction

Question 5

Anticholinergics
Indications

Answer 5

• Decrease GI activity and secretions
• Bronchodilation (decrease bronchospasms)
• Relaxes bladder tone - prevents overactive bladder
• Decrease secretions before anesthesia
• Treatment of nausea, vomiting, and motion sickness
• Restore cardiac rate and blood pressure
• Treat pylorospasm and hyperactive bowels (IBS)
• Atropine: Antidote to cholinergic crisis

Question 6

What are the effects of BLOCKING the parasympathetic nervous system?

THINK: What are the effects of the Sympathetic nervous system???

Answer 6

• ⬆️ Heart Rate
• ⬆️ Blood Pressure
• Dry Mouth
• ⬇️ respiratory secretions
• ⬇️ in GI activity (peristalsis)
• ⬇️ in urinary bladder tone and function –> urinary retention
• Pupil dilation (mydriasis)
• Cycloplegia
• Glucose release

Question 7

Considerations for using Anticholinergics
In Children

Answer 7

• Often used in children
• Very precise doses according to weights
• More sensitive to adverse effects

Question 8

Considerations for using Anticholinergics
In Adults

Answer 8

• Avoid driving until effects are known
• Avoid breastfeeding because of effects on infant
• Caution in pregnancy - weigh benefits vs risk

Question 9

Considerations for using Anticholinergics
In Older Adults

Answer 9

• More likely to have adverse effects
• Reduced doses
• Safety precautions (fall risk)

Question 10

Anticholinergic
Drug Names

Answer 10

• Atropine (antidote to cholinergic crisis)
• Dicyclomine (GI issues)
• Glycopyrrolate (treats ulcers, reduces secretions)
  🤢🤮
• Meclizine (motion sickness)
• Scopolamine (postoperative n&v, motion sickness)
  🫁
• Ipratropium (lower respiratory, opens airways)
• Tiotropium (lower respiratory, COPD)
  🫣
• Tolterodine (overactive bladder)
• Oxybutynin Chloride (overactive bladder)

Question 11

Anticholinergics
Contraindications

Answer 11

Absolute:
* Allergy
* Any condition that could be exacerbated by blocking the PNS: glaucoma, stenosing peptic ulcer disease, prostatic hypertrophy, bladder obstruction ➡️ worsens these conditions

Cautions:
* Cardiac arrythmias, tachycardia, myocardial ischemia
* Imparied liver or kidney function
* Pregnancy and lactation
* Hypertension
* Spasticity or brain damage

Question 12

Anticholinergics
Adverse Effects

Answer 12

👁️ Blurred vision related to: cyclopegia or mydriasis
👁️ Photophobia (light sensitivity)
💓 Heart palpitations, tachycardia
👅 Dry mouth, altered taste perception
💛 Urinary hesitancy and retention
💩 Constipation
💦 Decreased sweating
🥵 Predisposition to heat exhaustion

Question 13

Anticholinergics
Drug Interactions

Answer 13

🚫 Any other drug with anticholinergic activity: Antihistamines, Antiparkinsonism drugs, MAOIs, TCAs
🚫 Phenothiazines
🚫 Herbal therapies: belladonna, mandrake, moonflower, mushrooms

Question 14

Anticholinergics
Assessment

Answer 14

History:
* Contraindications, cautions
* pregnancy, lactation

Physical:
* Neurological status (level of orientation, affect, reflexes, papillary response)
* Vital Signs
* Cardiopulmonary status (listen to lung sounds)
* ECG (check for arrhythmias)
* Abdominal (bowel sounds, patterns, bladder distension, urinary output)

Labs:
* Renal function tests

Question 15

Anticholinergics
Nursing Diagnoses

Answer 15

• Impaired Comfort (r/t GI, CNS, CU, and CV effects)
• Altered cardiac output (r/t CV effects)
• Constipation (r/t GI effects)
• Urinary retention (r/t bladder relaxation)
• Injury Risk (r/t CNS effects)
• Thermal Injury Risk (r/t inability to sweat)
• Nonadherence
• Knowledge Deficiency

Question 16

Anticholinergics
Implementation/Patient Teaching

Answer 16

• Provide comfort measures to help with adv. effects
• Monitor closely including BP, ECG, urine output, cardiac output
• Take drug 30-60 minutes before eating
• Void before administration
• Sugarless lozenges for dry mouth