Ppt chapter 33

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Anticholinergic AgentsAnticholinergic Agents

Chapter 33


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


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


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


Pharmacodynamics of Anticholinergic Drugs

Pharmacodynamics of Anticholinergic Drugs


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


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


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


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



• Contraindications

– Allergy

– Any condition that could be exacerbated by blocking of the parasympathetic nervous system

• Glaucoma

• Peptic ulcer disease

• Prostatic hypertrophy

• Bladder obstruction



• Caution

– Breast feeding

– Spasticity and brain damage



• Adverse Reactions

– Blurred vision

– Mydriasis

– Cycloplegia

– Photophobia

– Palpitations, bradycardia

– Dry mouth, altered taste perception

– Urinary hesitancy and retention

– Decreased sweating; predisposition to heat prostration



• Drug-to-Drug Interaction

– Any other drug with anticholinergic activity

• Antihistamines

• Antiparkinson’s drugs

– Phenothiazines


Use of Anticholinergic Agents Across the Lifespan

Use of Anticholinergic Agents Across the Lifespan


Prototype Anticholinergic DrugsPrototype Anticholinergic Drugs


Prototype Anticholinergic Drugs (Continued)

Prototype Anticholinergic Drugs (Continued)


Nursing Considerations for Anticholinergic Drugs

Nursing Considerations for Anticholinergic Drugs

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation


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


AnswerAnswer

A. Patients with spasticity

Rationale: Caution: Breast feeding; spasticity and brain damage

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Ppt chapter 33