Anticholinergic Agents

Question 1

What does Anticholinergic Agents do?

Answer 1

They block the effect of Acetylcholine

Lyse or block the effect of the PNS; Parasympathetic agents.

Question 2

Why would we give Anticholinergic agents?

Answer 2

To decrease parasympathetic activities and to allow sympathetic system to dominate.
Decrease GI activity and secretions.
Bronchodilation.
Relax bladder.
Decrease secretions before anesthesia.
Treatment of nausea, vomiting and motion sickness.

Question 3

What plant is the Anticholinergic agents derived from?

Answer 3

Belladonna

Question 4

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

Answer 4

Only the muscarinic effectors.

Question 5

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

Answer 5

The cholinergic receptors of the sympathetic nervous system.

Question 6

How does Anticholinergic agents act?

Answer 6

By competing with acetylcholine for the muscarinic acetylcholine receptor sites.

Question 7

The Anticholinergic agents block the nicotinic receptors

True/False

Answer 7

False

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

Question 8

What are the effects of blocking the Parasympathetic system?

Answer 8

●Increase in heart rate
●Decrease in GI activity
●Decrease in urinary bladder tone and function
●Pupil dilation (mydriasis)
●Cycloplegia

Question 9

What should we know when children are taking anticholinergic agents?

Answer 9

They are often used in children.
Children are more sensitive to adverse effects.

Question 10

What should we know when adults are taking anticholinergic agents?

Answer 10

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

Question 11

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

Answer 11

More likely to have adverse effects
Reduce doses
Institute safety precautions

Question 12

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

Answer 12

Atropine
Dicyclomine
Glycopyrrolate
Ipratropium
Meclizine
Oxybutynin chloride
Scopolamine
Tiotropium
Tolterodine

Question 13

Why do we give a patient anticholinergic drugs?

Answer 13

○Decrease secretions
○Decrease bronchospasm
○Restore cardiac rate and blood pressure
○Pylorospasm and hyperactive bowel
○Relax uterine hypertonicity
○Atropine- antidote to cholinergic crisis (overdose)

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, stenosing peptic ulcer disease, prostatic
hypertrophy, bladder obstruction

Question 15

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

Answer 15

○Cardiac arrhythmias, tachycardia, myocardial ischemia
○Impaired liver or kidney function
○Pregnancy and lactation
○Hypertension
○Spasticity or brain damage

Question 16

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

Answer 16

○Blurred vision
○Mydriasis
○Cycloplegia
○Photophobia
○Palpitations, tachycardia
○Dry mouth, altered taste perception
○Urinary hesitancy and retention
○Constipation
○Decreased sweating; predisposition

Question 17

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

Answer 17

○Any other drug with anticholinergic activity
■Antihistamines
■Antiparkinsonism drugs
■MAOIs - Monoamine oxidase inhibitors
■TCAs - Tricyclic antidepressants
○Phenothiazines
○Herbal therapies

Question 18

What assessment should we do before administering an anticholinergic agent to a patient?

Answer 18

○Assess for contraindications and cautions
○Perform a physical assessment
○Assess neurological status, including level of orientation, affect, reflexes, and
papillary response
○Monitor vital signs and cardiopulmonary status; auscultate lung sounds.
○Obtain an ECG
○Assess abdomen; auscultate bowel sounds; evaluate bowel and bladder
patterns; monitor urinary output; palpate bladder for possible distention
○Monitor renal function studies

Question 19

What nursing diagnosis can we expect to make when preparing to give a patient anticholinergics?

Answer 19

○Impaired comfort related to GI, CNS, GU, and cardiovascular effects
○Altered cardiac output related to cardiovascular effects
○Constipation related to GI effects
○Urinary retention related to bladder relaxation effects
○Injury risk related to CNS effects
○Thermal injury risk related to decrease in ability to sweat
○Nonadherence related to adverse drug effects
○Knowledge deficiency regarding drug therapy

Question 20

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

Answer 20

○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
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