Anticholinergic Agents

Question 1

What does Anticholinergic Agents do?

Answer 1

They block or the effect of Acetylcholine which reduces or block the effect of the PNS/Parasympathetic nervous system.

Question 2

What is Cycloplegia?

Answer 2

Paralysis within the eye. Specifically the muscles that determine the shape of the lens, therefore not allowing the eye of focusing on items within close distance.

Question 2

What are Anticholinergic agents also known as?

Answer 2

Parasympatholytic agents (“lytic” means less)

Question 3

What is Belladonna?

Answer 3

A plant. It is also called deadly nightshade.

Question 4

Why would we give Anticholinergic agents?

Answer 4

• To decrease parasympathetic activities and to allow sympathetic system to become more dominant.
• Decrease GI activity and secretions (because we’re decreasing “rest & digest so we can use it to treat ulcers and hyperactive bowels)
• Bronchodilation (May treat COPD or Bronchospasms)
• Relax bladder.
• Decrease secretions before anesthesia.
• Treatment of nausea, vomiting and motion sickness.

Question 5

What plant is the Anticholinergic agents derived from?

Answer 5

Belladonna

Question 6

What receptors of the parasympathetic system is blocked when taking Anticholinergic agents?

Answer 6

Only the muscarinic receptors.

Question 7

How does Anticholinergic agents act?

Answer 7

By competing with acetylcholine for the muscarinic acetylcholine receptor sites.

Question 8

The Anticholinergic agents block the nicotinic receptors

True/False

Answer 8

False

They do not block the nicotinic receptors and have little or no effect at the neuromuscular junction.

Question 9

What are the effects that we may see when we are blocking the Parasympathetic nervous system with Anticholinergic agents?

Answer 9

●Increase in heart rate
●Decrease in GI activity
●Decrease in urinary bladder tone and function
●Pupil dilation (mydriasis)
●Cycloplegia (paralysis of the eye muscles that control pupil contraction)

Question 10

What should we know when children are taking anticholinergic agents?

Answer 10

They are often used in children.
Children are more sensitive to adverse effects so the dosage must be very precise for their weight.

Question 11

What should we know when adults are taking anticholinergic agents?

Answer 11

Safety precautions- no driving
Use with caution in pregnancy- only when benefit outweighs risk
Avoid breastfeeding

Question 12

What should we know when older adults are taking anticholinergic agents?

Answer 12

More likely to have adverse effects due to the body not metabolizing and excreting the drugs as effectively.
Reduce doses
Institute safety precautions

Question 13

What are the drug classes that we need to know for the Anticholinergic agents?

Answer 13

Atropine
Dicyclomine
Glycopyrrolate
Ipratropium
Meclizine
Oxybutynin chloride
Scopolamine
Tiotropium
Tolterodine

Question 14

What are the most important contraindications when it comes to anticholinergic agents?

Answer 14

Any condition that could be exacerbated by blocking of the parasympathetic nervous system: glaucoma (of we dilate further it could restrict aqua. fluid completely) , stenosing peptic ulcer disease (when a peptic ulcer causes the pyloric canal to narrow due to swelling and scarring, would be worsened by GI motility), prostatic
hypertrophy, bladder obstruction (decreases urinary output even further)

Question 15

What cautions should we keep in mind when prescribing anticholinergic agents to our patients?

Answer 15

• Cardiac arrhythmias, tachycardia, myocardial ischemia may worsen due to decreased parasympathetic control over the heartrate.
• Impaired liver or kidney function (metabolism and excretion)
• Pregnancy and lactation
• Hypertension (may worsen)
• Spasticity or brain damage (May be exacerbated)

Question 16

What are the most common and significant adverse effects of the anticholinergic agents?

Answer 16

Cant’t see, Can’t spit, Can’t poop, Can’t pee.

• Blurred vision
• Mydriasis
• Cycloplegia
• Photophobia (eye sensitivity to light)
• Palpitations (abnormal heart rhythms), tachycardia
• Dry mouth, altered taste perception (decreased saliva)
• Urinary hesitancy and retention
• Constipation
• Decreased sweating; predisposition to heat exhaustion.

Question 17

What are the drug drug interactions to keep track of when it comes to anticholinergic agents?

Answer 17

Do not use with any other drug with anticholinergic activity
- Antihistamines
- Antiparkinsonism drugs
- MAOIs - Monoamine oxidase inhibitors
- TCAs - Tricyclic antidepressants
* Phenothiazines
* Herbal therapies - Belladonna, Mandrake moonflower & many mushrooms.

Question 18

What nursing implementations can we expect to make when and after giving a patient anticholinergics?

Answer 18

• Ensure proper administration of the drug ( 30-60 min prior to eating)
• Comfort measures
• Monitor patient response, BP, ECG, Urine output and cardiac output.

Question 19

What implementations should we make when a patient is being given anticholinergics?

Answer 19

○Ensure proper administration of the drug
○Provide comfort measures to help the patient tolerate drug effects
○Monitor patient response closely, including blood pressure, ECG, urine output,
and cardiac output
○Offer support and encouragement to help the patient deal with the drug
regimen
○Provide thorough patient teaching

Question 20

What is Mydriasis?

Answer 20

Dilated Pupils

Question 21

What is Parasympatholytic?

Answer 21

A parasympatholytic agent is a substance or activity that reduces the activity of the parasympathetic nervous system

Question 22

Which drug would we give the patient if they are experiencing and cholinergic crisis or Acetylcholine overdose?

Answer 22

Atropine.