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Drug Class - Anticholinergics


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What do anticholinergics do?
competitively inhibit the action of acetylcholine
What does atropine treat? (2)
treats bradyarrhythmias

also used for an ophthalmic mydriatic)
What does ipratropium treat?
bronchospasm (inhalation) rhinorrhea (intranasal)
What does scopolamine treat? (2)
nausea and vomiting related to motion sickness and vertigo

(also used as an ophthalmic mydriatic)
How does propantheline and glycopyrrolate work? (2)
decreases gastric secretory
increases esophageal
sphincter tone
Which two anticholinergics are used as ophthalmic mydriatics?
Which 3 anticholinergics are used in the management of Parkinson's disease?
Which 2 anticholinergics are used as urinary tract spasmodics?
Which 4 drugs also have antimuscarinic properties?
Define muscarinic?

(FYI: anticholinergics are
pertaining to the effect of acetylcholine at parasympathetic postganglionic effector sites
How do the following four drugs affect acetylcholine at their cholinergic nerve fiber sites?

they inhibit the action of acetylcholine at sites innervated by postganglionic cholinergic nerves
Define cholinergic?
an agent that produces the effect of acetylcholine
What is the precursor to acetylcholine?
Define acetylated?
To bring an acetyl group into (an organic molecule)
Define acetyl?
The acetic acid radical CH3CO.
Choline is acetylated at the axon terminals (now it's acetylcholine) and is stored in clear spherical vesicles until it is released where?
at all motor terminals on
skeletal muscle
at synapses in para-
sympathetic and sympathetic

(FYI: there are SOME sympathetic ganglionic nerve neurons that are cholinergic as well as some of the terminals of the efferent olivocochlear tract ending on cochlear hair cells)
Where are muscarinic receptors found?
(A&P pg 524)
occur on all effector cells stimulated by postganglionic cholinergic fibers...meaning all parasympathetic target organs and a few sympathetic targets, such as eccrine sweat glands and some blood vessels of skeletal muscles
What is the effect of ACh binding to muscarinic receptors? And give an example?
BOTH inhibitory and excitatory depending on the target organ

for example, binding of ACh to cardiac muscle receptors slows heart activity, whereas ACh binding to receptors on smooth muscle of the GI tract increases its motility
What is vertigo and which medication is used to treat vertigo and motion sickness?
What therapeutic class does the medication fall in?

What is the medication's pharmacological class?
If the inner ear falls to receive enough blood flow, the more specific type of dizziness occurs-that is-vertigo. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear.



Do not use anticholinergics under the following conditions (contraindications)? (5)
narrow-angle glaucoma
severe hemorrhage
tachycardia (due to thyrotox-
icosis or cardiac
myasthenia gravis
Use anticholinergics cautiously in patients with?
urinary tract pathology
GI obstruction risk
chronic renal, hepatic,
pulmonary, or cardiac
There may be additive anticholinergic effects with other agents possessing anticholinergic activity. Other anticholinergic drugs may include? (4)
Symptoms of an additive anticholinergic effect are?
blurred vision
dry mouth
dry eyes
GI absorption of other drugs may be altered by anticholinergics because? (2)
GI motility is inhibited
there is increased transit
_______ may decrease absorption of orally administered anticholinergics.
What should be assessed frequently during anticholinergic IV drug therapy?
vital signs
What significant changes during anticholinergic IV drug therapy should be reported promptly?
heart rate
blood pressure
increase in ventricular
ectopy or angina
When taking anticholinergics, what should be monitored in elderly or surgical patients as the drug may cause urinary retention?
intake and output ratios
What GI interventions should be taken while taking anticholinergics?
assess for abdominal distention and auscultate for bowel sounds

constipation may become a problem

increasing fluids and adding bulk to the diet may help alleviate constipation
Potential Nursing Diagnoses?
Cardiac output, decreased
Oral mucous membrane,
Oral doses of atropine, glycopyrrolate, propantheline, or scopolamine should be administered when before meals?
30 minutes
How many hours before travel should Scopolamine transdermal patches be applied?
at least 4 hours
What might help relieve dry mouth associated with anticholinergic use? (4)
frequent rinses
sugarless gum
sugarless candy
good oral hygiene
Anticholinergics may cause _____?
What should patients taking ophthalmic preparations know?
they may cause blurred vision and impair ability to judge distances

dark glasses may be needed to protect eyes from bright light
Effectiveness of therapy can be demonstrated by? (6)
increase in heart rate
decrease in nausea and
vomiting related to motion
sickness or vertigo
dryness of mouth
dilation of pupils
decrease in GI motility
resolution of signs and
symptoms of Parkinson's
What are 15 anticholinergic drugs?
atropine Atro-Pen

benztropine {Apo-Benztropine}, Cogentin

biperidin Akineton

dicyclomine Bentyl, {Bentylol}, {Formulex}, {Spasmoban}

Logen, Lomanate, Lomotil, Lonox


glycopyrrolate Robinul, Robinul-Forte

hyoscyamine Anaspaz, A-Spas S/L, Cystospaz, Cystospaz-M, Donnamar, ED-SPAZ, Gastrosed, Levsinex, Levsin, Levbid, L-hyoscyamine, NuLev

ipratropium Atrovent

oxybutynin Ditropan, Ditropan XL

propantheline Pro-Banthine

scopolamine Isopto Hyoscine, Transderm-Scp, {Transderm-V}

tolterodine Detrol, Detrol LA

trihexyphenidyl Artane

trimethobenzamide Arrestin, Benzacot, Brogan, Stemetic, Tebamide, Tegamide, T-Gen, Ticon, Tigan, Tiject-20, Triban, Tribenzagan, Trimazide

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