1. Anticholinergic Agents
Chapter 33:
Anticholinergic Agents

2. Anticholinergic Drugs
Action
Used to block the effects of acetylcholine
Lyse, or block effects of the PNS; also called parasympatholytic agents
Uses (better drugs are available now)
Decrease GI activity and secretions (treat ulcers)
Decrease parasympathetic activities to allow the sympathetic system to become more dominant

3. Anticholinergics/Parasympatholytics
Derived from the plant Belladonna
Block only the muscarinic effectors in the PNS and cholinergic receptors in the SNS
Act by competing with acetylcholine for the muscarinic acetylcholine receptor sites
Do not block the nicotinic receptors
Have little or no effect at the neuromuscular junction

4. Effects of Blocking the Parasympathetic System
Increase in heart rate
Decrease in GI activity
Decrease in urinary bladder tone and function
Pupil dilation
Cycloplegia

5. Use of Anticholinergic Agents Across the Lifespan

6. Pharmacodynamics of Anticholinergic Drugs

7. Anticholinergic Agents and Their Indications
Atropine -Blocks parasympathetic effects in many situations
Depresses salivation and bronchial secretions
Dilates the bronchi
Inhibits vagal responses in the heart
Relaxes the GI and genitourinary tracts
Inhibits GI secretions
Causes mydriasis
Causes cycloplegia

8. Anticholinergic Agents and Their Indications
Dicyclomine (Antispas, Dibent, and others)
Relaxes GI tract; treats hyperactive or irritable bowel
Glycopyrrolate (Robinul)
Adjunct in the treatment of ulcers
Propantheline (Pro-Banthine)

9. Anticholinergic Drugs
Actions
Blocks the acetylcholine receptors at the muscarinic cholinergic receptor site
Indications
Decrease secretions
Restore cardiac rate and blood pressure
Pylorospasm and hyperactive bowel
Relax uterine hypertonicity

10. Anticholinergic Drugs (cont.)
Pharmacokinetics
Well absorbed
Widely distributed throughout the body
Cross the blood brain barrier
T ½ varies based on route and drug
Excreted in the urine

11. Anticholinergic Drugs (cont.)
Contraindications
Known allergy
Any condition that could be exacerbated by blocking of the parasympathetic nervous system
Glaucoma
Peptic ulcer disease
Prostatic hypertrophy
Bladder obstruction

12. Anticholinergic Drugs (cont.)
Caution
Breast feeding
Spasticity and brain damage

13. Anticholinergic Drugs (cont.)
Adverse Reactions
Blurred vision
Mydriasis
Cycloplegia
Photophobia
Palpitations, bradycardia
Dry mouth, altered taste perception
Urinary hesitancy and retention
Decreased sweating; predisposition to heat prostration

14. Anticholinergic Drugs (cont.)
Drug-to-Drug Interaction
Any other drug with anticholinergic activity
Antihistamines
Antiparkinson’s drugs
Phenothiazines
MAOI’s and tricyclic antidepressants

15. Nursing Considerations for Anticholinergic Drugs
Assess:
History and Physical Exam
Known allergy, glaucoma; stenosing peptic ulcer, intestinal atony, paralytic ileus, GI obstruction, severe ulcerative colitis, and toxic megacolon;
Prostatic hypertrophy and bladder obstruction; cardiac arrhythmias, tachycardia, and myocardial ischemia
Myasthenia gravis, pregnancy, impaired renal and hepatic function

16. Nursing Considerations for Anticholinergic Drugs Cont.
Assess:
Neurological status, including level of orientation, affect, reflexes, and papillary response
VS, CV status, ECG as appropriate
Bowel and bladder patterns
Renal function labs as appropriate

17. Prototype Anticholinergic Drugs

18. Prototype Anticholinergic Drugs (Continued)

19. Question
In which group of patients would the healthcare provider use caution in prescribing anticholinergic medications? A. Patients with spasticity B. Patients with myasthenia gravis C. Patients with Parkinson’s disease D. Patients with hyperactive reflexes

20. A. Patients with spasticity
Answer
A. Patients with spasticity
Rationale: Caution: Breast feeding; spasticity and brain damage