Anticholinergics Flashcards

1
Q

What plant are Anticholinergics derived from?

A

Belladonna

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2
Q

What does cycloplegia mean?

A

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

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3
Q

What is mydriasis?

A

Dilated pupil

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4
Q

Anticholinergics
Mechanism of Action

A
  • 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

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5
Q

Anticholinergics
Indications

A
  • 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
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6
Q

What are the effects of BLOCKING the parasympathetic nervous system?

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

A
  • ⬆️ 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
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7
Q

Considerations for using Anticholinergics
In Children

A
  • Often used in children
  • Very precise doses according to weights
  • More sensitive to adverse effects
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8
Q

Considerations for using Anticholinergics
In Adults

A
  • Avoid driving until effects are known
  • Avoid breastfeeding because of effects on infant
  • Caution in pregnancy - weigh benefits vs risk
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9
Q

Considerations for using Anticholinergics
In Older Adults

A
  • More likely to have adverse effects
  • Reduced doses
  • Safety precautions (fall risk)
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10
Q

Anticholinergic
Drug Names

A
  • 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)
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11
Q

Anticholinergics
Contraindications

A

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

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12
Q

Anticholinergics
Adverse Effects

A

👁️ 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

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13
Q

Anticholinergics
Drug Interactions

A

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

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14
Q

Anticholinergics
Assessment

A

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

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15
Q

Anticholinergics
Nursing Diagnoses

A
  • 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
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16
Q

Anticholinergics
Implementation/Patient Teaching

A
  • 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