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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic AgentsAnticholinergic Agents
Chapter 33
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic DrugsAnticholinergic 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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergics/ParasympatholyticsAnticholinergics/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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Effects of Blocking the Parasympathetic System
Effects of Blocking the Parasympathetic System
• Increase in heart rate
• Decrease in GI activity
• Decrease in urinary bladder tone and function
• Pupil dilation
• Cycloplegia
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pharmacodynamics of Anticholinergic Drugs
Pharmacodynamics of Anticholinergic Drugs
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic Agents and Their Indications
Anticholinergic Agents and Their Indications
• Atropine
– Blocks parasympathetic effects in many situations
• Dicyclomine (Antispas, Dibent, and others)
– Relaxes GI tract; treats hyperactive or irritable bowel
• Glycopyrrolate (Robinul)
– Adjunct in the treatment of ulcers
• Propantheline (Pro-Banthine)
– Adjunct in the treatment of ulcers
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AtropineAtropine
• 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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic DrugsAnticholinergic 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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic Drugs (cont.)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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic Drugs (cont.)Anticholinergic Drugs (cont.)
• Contraindications
– Allergy
– Any condition that could be exacerbated by blocking of the parasympathetic nervous system
• Glaucoma
• Peptic ulcer disease
• Prostatic hypertrophy
• Bladder obstruction
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic Drugs (cont.)Anticholinergic Drugs (cont.)
• Caution
– Breast feeding
– Spasticity and brain damage
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic Drugs (cont.)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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticholinergic Drugs (cont.)Anticholinergic Drugs (cont.)
• Drug-to-Drug Interaction
– Any other drug with anticholinergic activity
• Antihistamines
• Antiparkinson’s drugs
– Phenothiazines
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Use of Anticholinergic Agents Across the Lifespan
Use of Anticholinergic Agents Across the Lifespan
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Anticholinergic DrugsPrototype Anticholinergic Drugs
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Anticholinergic Drugs (Continued)
Prototype Anticholinergic Drugs (Continued)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Anticholinergic Drugs
Nursing Considerations for Anticholinergic Drugs
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
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
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
A. Patients with spasticity
Rationale: Caution: Breast feeding; spasticity and brain damage
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