Chapter 33

Anticholinergic Agents

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

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 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
– Exert little or no effect at the neuromuscular
junction

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 Effects of Blocking the
Parasympathetic System

• Increase in heart rate

• Decrease in GI activity

• Decrease in urinary bladder tone and function

• Pupil dilation

• Cycloplegia

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Pharmacodynamics of
Anticholinergic Drugs

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 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
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 Atropine
• 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
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 Anticholinergic Drugs
• Action
– Competitively block the acetylcholine receptors
at the muscarinic cholinergic receptor sites
• Indications
– Decrease secretions
– Restore cardiac rate and blood pressure
– Reduce pylorospasm and hyperactive bowel
– Relax uterine hypertonicity

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 Anticholinergic Drugs (cont.)

• Pharmacokinetics

– Well absorbed

– Widely distributed throughout the body

– Cross the blood–brain barrier

– T½ varies based on route and drug

– Excreted in the urine

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 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
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Anticholinergic Drugs (cont.)

• Cautions

– Breast feeding

– Spasticity and brain damage

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

• Drug-to-drug interactions

– Any other drug with anticholinergic activity

 Antihistamines

 Antiparkinson drugs

– Phenothiazines

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Use of Anticholinergic Agents
Across the Lifespan

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Prototype Anticholinergic Drugs

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 Nursing Considerations for
Anticholinergic Drugs

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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