Anticholinergic

Drugs

Department of Nursing
Dr. Lolita H. Avanzado
 Anticholinergics/Parasympatholytic

v are drugs that block the action

of acetylcholine.
v Acetylcholine is a
neurotransmitter, or a chemical
messenger. It transfers signals
between certain cells to affect
how the body functions.
 Anticholinergics
They also help block involuntary
muscle movements associated with
certain diseases such as Parkinson’s
disease.
Sometimes, they’re used before
surgery to help maintain body
functions while a person is treated with
anesthesia.
 Indications
Anticholinergics can treat a variety of
conditions, including:
v Urinary incontinence (loss of bladder
control)
v Overactive bladder (sudden,
uncontrolled urge to urinate)
v COPD (chronic obstructive pulmonary
disorder)common lung disease
v certain types of poisoning
v Parkinson’s Disease
 Actions
v Anticholinergics block acetylcholine from
binding to its receptors on certain nerve
cells. They inhibit actions called
parasympathetic nerve impulses.
v These nerve impulses are responsible for
involuntary muscle movements in the:
1. Gastrointestinal tract
2. Lungs
3. Urinary tract
4. Other parts of the body
 Actions
v The nerve impulses help control
functions such as:
1. salivation
2. digestion
3. urination
4. mucus secretion
 Actions
v Blocking acetylcholine signals can
decrease:
1. involuntary muscle movement
digestion
2. mucus secretions
v Anticholinergics can also be used
as muscle relaxants during surgery
to assist with anesthesia.
v They help keep the heartbeat
normal
v relax the person
v decrease saliva secretions
 Side Effects
v Dizziness
v severe drowsiness
v Fever
v Severe hallucinations
v Clumsiness and slurred speech
v Fast heartbeat
v Flushing and warmth of the skin
v Confusion
v Trouble breathing
 Side effects
v dry mouth
v blurry vision
v constipation
v drowsiness
v sedation
v memory problems
 Side effects
v trouble urinating
v delirium
v decreased sweating
v decreased saliva
Common Examples of anticholinergic

v atropine
v Meclizine
v scopolamine
v ipratropium.
v belladonna alkaloid
v Atrovent Nasal Spray
 Common examples
v clidinium.
v cyclopentolate (Cyclogyl)
v darifenacin (Enablex)
v dicylomine.
v fesoterodine (Toviaz)
v benztropine mesylate (Cogentin)
 Nursing Assessments
v Assess for contraindications or cautions (e.g., history
of allergy to drug, GI obstruction, hepatorenal
dysfunction) to avoid adverse effects.
v Establish baseline physical assessment to monitor for
any potential adverse effects.
v Assess neurological status (e.g., orientation, affect,
reflexes) to evaluate any CNS effects.
v Assess abdomen (e.g., bowel sounds, bowel
and bladder patterns, urinary output) to evaluate
for GI and GU adverse effects.
v Monitor laboratory test results to determine need for
possible dose adjustments and to identify potential
toxicity.
 Nursing Diagnoses and Care Plan

v Acute pain related to GI, CNS, GU,

and CV effects
v Decreased cardiac output related
to CV effects
v Impaired urinary elimination related
to effects on the bladder
v Constipation related to GI effects
 Implementation with Rationale

v Ensure proper administration of the

drug to ensure effective use and
decrease the risk of adverse effects.
v Monitor patient response
(e.g., blood pressure, ECG, urine
output) for changes that may
indicate need to adjust dose.
 Implementation with Rationale

v Provide comfort measures (e.g.,

sugarless lozenges, lighting control,
small and frequent meals) to help
patient cope with drug effects.
v Provide patient education about
drug effects and warning signs to
report to enhance knowledge
about drug therapy and promote
compliance.
 Evaluation

v Monitor patient response to therapy

(improvement in condition being treated).
v Monitor for adverse effects (e.g.,
photophobia, heat intolerance, urinary
retention).
v Evaluate patient understanding on drug
therapy by asking patient to name the
drug, its indication, and adverse effects to
watch for.
v Monitor patient compliance to drug
therapy.
Cholinergic Drugs
 Cholinergic agonists/
parasympathomimetics

v act at the same site as the

neurotransmitter acetylcholine (ACh)
v increase the activity of the ACh
receptor sites throughout the body
v These receptor sites are found
throughout the body so their
stimulation produces similar effects
when parasympathomimetics nervous
system is activated.
v they are also called
as parasympathomimetics.
v Cholinergic agonists can either be
direct- or indirect-acting cholinergic
agonists.
v Under indirectly-acting cholinergic
agonists, there are agents for
Alzheimer’s and Myasthenia Gravis.
 Direct-acting cholinergic agonists

v are usually used for treatment of

neurogenic bladder atony in
children
v relieve pressure on glaucoma
patients
v treatment of symptoms of
dry mouth in patients with Sjogren’s
syndrome (a conditions that causes
dry mouth and eye).
 Indirect-acting cholinergic agents

v are used for myasthenia gravis and Alzheimer’s

disease.
v Myasthenia gravis is a chronic muscular disease
caused by defect in neuromuscular transmission. It is
thought to be an autoimmune disease in which
antibodies to own ACh receptors are made.
v As fewer receptor sites become available, patients
begin to have progressive weakness and lack of
muscle control.
v Alzheimer’s disease is a progressive disorder of
neural degeneration leading to marked loss of
memory and the ability to carry on activities of daily
living.
 Therapeutic Action
v Direct-acting cholinergic
agonists occupy receptor sites for
ACh on the membranes of the
effector cells causing increased
stimulation.
v Effects include slowed heart rate
and decreased myocardial
contractility, vasodilation,
bronchoconstriction
 Therapeutic Action
v increased bronchial mucus
secretion
v increased GI activity and secretions
v increased bladder tone
v relaxation of GI and bladder
sphincters,
v pupil constriction.
 Indications
Treatment of:
v myasthenia gravis
v antidote for nondepolarizing
neuromuscular junction blockers
increased survival after exposure to
nerve gas
v Treatment of mild to moderate
Alzheimer’s disease
 Indications
v Bethanechol has specific affinity for the cholinergic
receptors in the urinary bladder and is used to treat
non-obstructive postoperative
and postpartum urinary retention to treat neurogenic
bladder atony. It directly increases detrusor muscle
tone and relaxes the sphincters to improve bladder
emptying.
v Carbachol is an ophthalmic agent used to induce
miosis or pupil constriction. It can relieve the
increased intraocular pressure of glaucoma
v Cevimeline and pilocarpine bind to muscarinic
receptors throughout the body and are used to
increase secretions in the mouth and GI tract and
relieve symptoms of dry mouth. They are approved
for use in adults and are given three times a day,
often with meals.
 Contraindications and Cautions

v Allergy to any component of the drug. To

prevent hypersensitivity reaction
v Bradycardia, intestinal/urinary tract
obstruction. Can be exacerbated by the
stimulation of cholinergic receptors
v Pregnancy. Uterus could be stimulated
and labor induced
v Asthma, coronary disease, peptic ulcer
arrhythmias, epilepsy parkinsonism. Can be
exacerbated by effects of parasympathetic
stimulation
v Hepatic or renal dysfunction. Can interfere
with metabolism and excretion of drugs
 Adverse Effects
v CNS: miosis, blurred vision, headaches,
dizziness, drowsiness
v CV: bradycardia, heart block,
hypotension, cardiac arrest
v GI: nausea, vomiting,
cramps, diarrhea, increased salivation,
involuntary defecation
v GU: urinary urgency
v Others: flushing, increased sweating
 Interactions
v NSAIDs. Increased risk of GI
bleeding
v Theophylline. Increased levels if
combined with tacrine.
Nursing Considerations for Cholinergic
Agonists

Nursing Assessment
v Assess for contraindications or cautions
(e.g. history of allergy to drug, GI
obstruction, pregnancy or lactation
status, etc.) to avoid adverse effects.
v Establish baseline physical assessment
to monitor for any potential adverse
effects.
v Assess orientation, affect, reflexes to
monitor CNS drug effects.
v Assess vital signs, especially pulse
and blood pressure to monitor for possible
excess stimulation of the cardiac system.
v Assess abdomen, auscultating for bowel
sounds and palpating for distention.
v Monitor intake and output, noting any
complaints of urinary urgency to monitor
for drug effects on the urinary system.
Nursing Diagnosis and Care Planning

v Acute pain related to GI effects

v Decreased cardiac output related
to CV effects
v Impaired urinary elimination related
to effects on the bladder
 Implementation
v Administer oral drug on empty
stomach to decrease nausea and
vomiting.
v If drug is given intravenously,
administer slowly to avoid severe
cholinergic effects.
v Monitor patient response closely (e.g.,
blood pressure, ECG, urine output) to
arrange to adjust dose accordingly to
ensure the most benefit.
v Maintain a cholinergic-blocking drug
on standby such as atropine to use as
an antidote for excessive doses of
cholinergic drugs.
v Discontinue drug if excessive salivation,
diarrhea, emesis, or frequent urination
becomes a problem to decrease the
risk of severe adverse reactions.
v Provide safety precautions if the
patient reports poor visual acuity in
dim light to prevent injury.
v Provide comfort measures (e.g.,
quiet room, support and relaxation
measures) to help patient cope
with drug effects.
v Provide patient education about
drug effects and warning signs to
report to enhance knowledge
about drug therapy and promote
compliance.
 Evaluation
v Monitor patient response to therapy
(improvement in condition being
treated).
v Monitor for adverse effects (e.g. GI
upset, CNS changes, CV changes).
v Evaluate patient understanding on
drug therapy by asking patient to
name the drug, its indication, and
adverse effects to watch for.
v Monitor patient compliance to drug
therapy.