Anticholinergic

Anticholinergics are drugs that oppose the effects of acetylcholine. Acetylcholine is a neurotransmitter,
or a chemical messenger. It transfers signals between certain cells to affect how your body functions. In
essence, they also lyse and block the effects of parasympathetic nervous system (PNS) so they are also
called as parasympatholytics. Atropine is currently the only widely used anticholinergic drug. Other
common examples include meclizine, scopolamine and ipratropium.

Anticholinergics: Generic and Brand Names

Here is a table of commonly encountered anticholinergic agents, their generic names, and brand names:

Classification Generic Name Brand Name

atropine (generic)

ipratropium Atrovent

meclizine Bonine, Antivert

Anticholinergics

methscopolamine Pamine

scopolamine Transderm Scop

tiotropium Spiriva

Disease Spotlight: Gastrointestinal Ulcers

 Anticholinergics were once very widely used to decrease GI activity and secretions. However,
more specific and less toxic drugs are available now and the utilization of this drug class is now
limited.
 GI ulcers are basically erosions in the lining of the GIT caused by increased HCl production most
commonly from H. pylori infection. Patients with GI ulcers suffer from burning abdominal
pain, nausea, and acid reflux.
Therapeutic Action

The desired and beneficial actions of anticholinergics are as follows:

 Competitively blocking the ACh receptors at muscarinic cholinergic receptor sites

that are responsible for mediating the effects of the parasympathetic
postganglionic impulses.
 Atropine, the prototype drug, is derived from the plant belladonna. It is used to
depress salivation and bronchial secretions and to dilate the bronchi, but it can
thicken respiratory secretions (causing obstruction of airways).
 Atropine and scopolamine work by blocking only the muscarinic effectors in the
parasympathetic nervous system and the few cholinergic receptors in the SNS.

Indications

Anticholinergics are indicated for the following medical conditions:

 Prevention of nausea, vomiting, and dizziness associated with motion sickness.

 Adjunctive therapy for treatment of GI ulcers
 Decrease secretions before anesthesia or intubation
 Maintenance treatment of bronchospasm associated with COPD.
 Treatment of irritable or hyperactive bowel in adults.
Here are some important aspects to remember for indication of anticholinergics in
different age groups:

Children:

 More sensitive to the adverse effects of the drug (e.g. constipation, urinary

retention, heat intolerance, confusion).
 Dicyclomine is not recommended for use in children.

Adults:

 Adults should be cautioned of these drugs’ adverse effects.

 Use of these drugs among pregnant women is not allowed because they can
cross placenta and cause adverse effects to the fetus.

Older adults:
  Dose adjustment is needed as this age group is also more susceptible to drug side
effects.
 They are more likely to have toxic levels of the drug because of renal or hepatic
impairments.

Pharmacokinetics

Route Onset Peak Duration

IM 10-15 min 30 min 4h

IV Immediate 2-4 min 4h

Subcutaneous Varies 1-2 h 4h

Topical 5-10 min 30-40 min 7-14 d

T1/2: 2.5 h
Metabolism: liver
Excretion: urine

Here are the characteristic interactions of anticholinergics and the body in terms of
absorption, distribution, metabolism, and excretion:

Contraindications and Cautions

The following are contraindications and cautions for the use of anticholinergics:

 Allergy to any component of the drug. To prevent hypersensitivity reaction

 Glaucoma. Can be exacerbated by blockade of PNS.
 Intestinal atony, paralytic ileus, GI obstruction. Can be exacerbated with further
slowing of GI activity.
  Pregnancy. Potential adverse effects on the fetus.

Adverse Effects

Use of anticholinergic agents may result to these adverse effects:

 CNS: blurred vision, pupil dilation, photophobia, cycloplegia, increased

intraocular pressure, weakness, dizziness, insomnia
 CV: tachycardia, palpitation
 GI: dry mouth, altered taste perception, nausea, heartburn, constipation
 GU: urinary hesitancy and retention, heat prostration

Interactions

The following are interactions involved in the use of anticholinergics:

 Antihistamines, antiparkinsonisms, MAOIs, TCAs. These drugs also have

anticholinergic effects so incidence of anticholinergic effects increases.
 Phenothiazines. Decreased effectiveness of this drug.
 Burdock, rosemary, turmeric. Risk for exacerbated anticholinergic agents

Nursing Considerations

Here are important nursing considerations when administering anticholinergics:

Nursing Assessment:

These are the important things the nurse should include in conducting assessment,

history taking, and examination:

 Assess for contraindications or cautions (e.g., history of allergy to drug, GI

obstruction, hepatorenal dysfunction, etc.) to avoid adverse effects.
 Establish baseline physical assessment to monitor for any potential adverse
effects.
 Assess neurological status (e.g., orientation, affect, reflexes) to evaluate any CNS
effects.
 Assess abdomen (e.g., bowel sounds, bowel and bladder patterns, urinary
output) to evaluate for GI and GU adverse effects.
 Monitor laboratory test results to determine need for possible dose adjustments
and to identify potential toxicity.
 Nursing Diagnoses and Care Planning:

Here are some of the nursing diagnoses that can be formulated in the use of this drug
for therapy:

 Acute pain related to GI, CNS, GU, and CV effects

 Decreased cardiac output related to CV effects
 Impaired urinary elimination related to effects on the bladder
 Constipation related to GI effects

Implementation with Rationale

These are vital nursing interventions done in patients who are taking anticholinergics:

 Ensure proper administration of the drug to ensure effective use and decrease
the risk of adverse effects.
 Monitor patient response (e.g., blood pressure, ECG, urine output) for changes
that may indicate need to adjust dose.
 Provide comfort measures (e.g., sugarless lozenges, lighting control, small and
frequent meals) to help patient cope with drug effects.
 Provide patient education about drug effects and warning signs to report to
enhance knowledge about drug therapy and promote compliance.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug
therapy:

 Monitor patient response to therapy (improvement in condition being treated).

 Monitor for adverse effects (e.g., photophobia, heat intolerance, urinary
retention).
 Evaluate patient understanding on drug therapy by asking patient to name the
drug, its indication, and adverse effects to watch for.
 Monitor patient compliance to drug therapy.

References:
https://nurseslabs.com/anticholinergics-parasympatholytics/
look for explanation here:

https://www.healthline.com/health/anticholinergics

https://www.ncbi.nlm.nih.gov/books/NBK555893/