Drug Class - Anticholinergics
Terms
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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?
(2) - 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
activity
increases esophageal
sphincter tone - Which two anticholinergics are used as ophthalmic mydriatics?
-
atropine
scopolamine - Which 3 anticholinergics are used in the management of Parkinson's disease?
-
benztropine
biperidin
trihexyphenidyl - Which 2 anticholinergics are used as urinary tract spasmodics?
-
oxybutynin
tolterodine - Which 4 drugs also have antimuscarinic properties?
-
atropine
glycopyrrolate
propantheline
scopolamine -
Define muscarinic?
(FYI: anticholinergics are
ANTI-muscarinic - 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?
atropine
glycopyrrolate
propantheline
scopolamine - 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?
- choline
- 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?
(2) -
at all motor terminals on
skeletal muscle
at synapses in para-
sympathetic and sympathetic
ganglia
(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.
scopolamine
antiemetic
anticholinergic - Do not use anticholinergics under the following conditions (contraindications)? (5)
-
hypersensitivity
narrow-angle glaucoma
severe hemorrhage
tachycardia (due to thyrotox-
icosis or cardiac
insufficiency)
myasthenia gravis - Use anticholinergics cautiously in patients with?
-
urinary tract pathology
GI obstruction risk
chronic renal, hepatic,
pulmonary, or cardiac
disease - There may be additive anticholinergic effects with other agents possessing anticholinergic activity. Other anticholinergic drugs may include? (4)
-
antihistamines
antidepressants
quinidine
disopyramide -
Symptoms of an additive anticholinergic effect are?
(4) -
blurred vision
constipation
dry mouth
dry eyes - GI absorption of other drugs may be altered by anticholinergics because? (2)
-
GI motility is inhibited
there is increased transit
time - _______ may decrease absorption of orally administered anticholinergics.
- Antacids
- What should be assessed frequently during anticholinergic IV drug therapy?
-
vital signs
ECG - 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?
(3) -
Cardiac output, decreased
Oral mucous membrane,
altered
Constipation - 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 _____?
- drowsiness
- 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
disease - What are 15 anticholinergic drugs?
-
atropine Atro-Pen
benztropine {Apo-Benztropine}, Cogentin
biperidin Akineton
dicyclomine Bentyl, {Bentylol}, {Formulex}, {Spasmoban}
difenoxin/atropine
Logen, Lomanate, Lomotil, Lonox
diphenoxylate/atropine
Motofen
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