Anticholinergics Flashcards
What plant are Anticholinergics derived from?
Belladonna
What does cycloplegia mean?
Paralysis of the eye
(muscles that are responsible for operating the lens of the eye)
What is mydriasis?
Dilated pupil
Anticholinergics
Mechanism of Action
- 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
Anticholinergics
Indications
- 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
What are the effects of BLOCKING the parasympathetic nervous system?
THINK: What are the effects of the Sympathetic nervous system???
- ⬆️ 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
Considerations for using Anticholinergics
In Children
- Often used in children
- Very precise doses according to weights
- More sensitive to adverse effects
Considerations for using Anticholinergics
In Adults
- Avoid driving until effects are known
- Avoid breastfeeding because of effects on infant
- Caution in pregnancy - weigh benefits vs risk
Considerations for using Anticholinergics
In Older Adults
- More likely to have adverse effects
- Reduced doses
- Safety precautions (fall risk)
Anticholinergic
Drug Names
- 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)
Anticholinergics
Contraindications
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
Anticholinergics
Adverse Effects
👁️ 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
Anticholinergics
Drug Interactions
🚫 Any other drug with anticholinergic activity: Antihistamines, Antiparkinsonism drugs, MAOIs, TCAs
🚫 Phenothiazines
🚫 Herbal therapies: belladonna, mandrake, moonflower, mushrooms
Anticholinergics
Assessment
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
Anticholinergics
Nursing Diagnoses
- 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
