Ch. 14 - Anticholinergic Drugs; Part 2
Terms in this set (164)
They competively block the actions of acetylcholine at muscarinic receptors
Describe the action of muscarinic antagonists / anticholinergic drugs?
most are on structures innervated by parasympathetic nerves
Where are most muscarinic receptors located??
What kind of drug is Benadryl?
These drugs are also known as "parasympolytic drugs" or "antimuscarinic drugs" "muscarinic blockers" and "anticholinergic drugs"
NOT all cholinergic receptors
Anticholinergic drugs produce the selective blockade of muscarinic receptors , but not..
B/c anticholinergic drugs DECREASE the flow in the bladder; they hold the urine in.
-they make you dry
-they make you hot
-they make you confused
Why don't we give the anticholinergic drug: Benadryl, to elderly patients if they cannot void?
Certain drugs: Antihistamines, Tricyclic antidepressants, phenothiazine antipsychotics - because these have antimuscarinic actions
-b/c they have these antimuscarinic actions, those ontop of using regular muscarinic antagonists is like double dosing of a med that does the same thing. avoid these. or don't use !!!
What drugs should we use with caution, or not at all, for patients receiving other muscarinic antagonists. And why is this?
Atropine to bring the HR back up!!
*Atropine increases HR !!
When you have Bradycardia, what medication should you take?
this is the best-known muscarinic antagonist, and is found in nature
-Has no direct effect of its own
-Muscarinic receptor blockade
-It INCREASES heartrate
describe the mechanism of action for Atropine.
muscarinic receptor blockade
Atropine is a ____ blockade
what is the effect of Atropine on the:
-DECREASES secretions; dries you up. **does the exact opposite of muscarinic agonists !!! just remember that and you will be Gucci.
what is the effect of Atropine on the:
lungs: relaxes the bronchi (whereas, muscarinic agonists CONSTRICT the bronchi; opposites)
GI tract: decreases tone and motility of the GI tract (opposite of agonists)
Bladder: DECREASES tone and relaxes the detrusor muscles. Whereas agonists contract and increase tone to relieve retention. Atropine helps stop the voiding !!!
what is the effect of Atropine on the:
Smooth muscles of the lungs, GI tract, and bladder?
Mydriasis - dilation of the pupil
What is the effect of Atropine on the:
Effect of Atropine & other anticholinergic drugs/ muscarinic antagonists
means dilation of the pupil. What drug; muscarinic agonists or muscarinic antagonists do this as an effect?
mild excitation to hallucinations and delirium *esp. in the elderly
what is the effect of Atropine on the:
Central nervous system
-Dries up secretions before surgery
-used to treat Bradycardia- it increases HR
-Used as a Preanesthetic medication
-For disorders of the eye-eyedrops
-Intestinal hypertonicity & hypermotility
-muscarinic agonist poisoning treatment
-peptic ulcer disease
-asthma - it dries secretions
KNOW FOR A SELECT ALL THAT APPLY QUESTION.
What are all the therapeutic uses of Atropine; an anticholinergic drug?
-those with a tube
-NO WRIST BAND
-risk for difficulty swallowing
*follow 6 med. rights
what conditions dictate that a patient CANNOT take pills?
Lasts longer, for more convenience, gives a little release a little at a time
why would someone want to take an extended release tablet or capsule?
dryness !! - it is used to dry up secretions, and used for asthma treatment for that reason, but a SE is also dryness
what is a big big adverse effect of Atropine?
NOOO not a treatment for this. B/c a SE of Atropine is increased intraocular pressure. Which already happens with Glaucoma- don't want extra pressure.
Can Atropine treat Glaucoma? Why or why not.
-dry mouth (Exerostomia)
-Blurred vision and phototobia
-elevation of intraocular pressure - so this is NOT a treatment for glaucoma
List the adverse effects of Atropine.
Atropine - xerostomia.
- think of anticholinergic effects. dryness is one of them!
mean dry mouth. this is a big adverse effect of what drug?
Avoid combining atropine with other drugs capable of causing muscarinic blockade
Antihistamines, Tricyclic antidepressants, phenothiazine antipsychotics - because these have antimuscarinic actions
Muscarinic Antagonist: Atropine drug interactions. What drugs should you avoid when using Atropine?
Muscarinic antagonist: Atropine, gives general ____ therapy
cholinesterase inhibitor poisoning
-also used for ophthalmology - but NOT for Glaucoma.
also used for: Alzheimer's & Myasthenia Gravis
Atropine; AtroPen is used for what kind of poisoning treatment?
-on chest or upper back
- on hairless area
Where should you put a transdermal patch?
Oxybutynin (Ditropan XL, Oxytrol, Gelnique)
-Extended release tablets
Transdermal patch and gel
Anticholinergic Drugs for Overactive Bladder: Name these specific drugs used for this treatment.
What are the characteristics of an overactive bladder?
Overview of treatment?
Introduction to anticholinergic therapy for OAB ?
OXYBUTYNIN - SE, DRUG INTERACTIONS, AVAILABLE FORMS.
discard it in a red box
where do you put a transdermal patch when it's finished being used?
-bypasses the gut
-goes right into the tissue
Name the advantages of a transdermal patch to treat an overactive bladder
-If patient has patch on, they CANNOT go for an MRI. B/c the MRI will BURN THE PATCH into the patient's skin.
-always check for a patch before an MRI
-NEVER cover the patch with a dressing - this adds absorbance and gives a larger dose
what is very important education to know/tell about the transdermal patch - for overactive bladder and for anything else it is treating.
Oxybutynin (Ditropan XL, Oxytrol, Gelnique)
This is an anticholinergic agent that acts primarily at M3 muscarinic receptors
-anticholinergic side effects are very common
-treats overactive bladder
This anticholinergic drug is used to treat overactive bladder and has the greatest degree of M3 selectivity
Anticholinergic drugs - because they make patients confused, dry, hot, hold in urine
what class of drugs is designated as potentially innapropriate for use in geriatric patients??
naturally in plants
where is Atropine found?
what drug's mechanism of action involves producing its effects through competitive blockade at muscarinic receptors
no - they have no direct effect of their own, they just block.
-muscarinic agonists are called direct-acting ***
do receptor antagonists have a direct effect?
all responses to atropine result from preventing receptor activation by endogenous acetylcholine (or by drugs that act as muscarinic agonists)
what do all responses to Atropine cause?
At therapeutic doses, Atropine works at muscarinic receptors
*it's a muscarinic antagonist, so it blocks the affects of acetylcholine at these receptor sites
what receptor does Atropine work on??
-heart rate drops
-secretions increase (bronchial, gastric acid, saliva, sweat)
-smooth muscles contract; of the lungs - constrict, less O2, of the bladder and Gi tract to promote emptying of both
If Bethanechol works to activate and mimic acetylcholine at muscarinic receptor sites, what happens?
**this drug is meant to raise HR (know: b/c muscarinic agonists decrease HR. always think the opposite)
what are the effects of Atropine on the heart?
**think since it's a muscarinic antagonist the effects will be opposite of muscarinic agonists - which increase secretions...
so Atropine will DRY SECRETIONS of the bronchial, gastric acid, saliva, and sweat---there will be less secretions.
what are the effects of Atropine on the Exocrine glands?
*opposite of the effects from muscarinic agonists.
-By preventing the activation of muscarinic receptors on smooth muscles, atropine will cause RELAXATION of the bronchi, urinary bladder (decreased tone) and GI tract (decreased tone) --- when these organs are relaxed they do not excrete anything. * when they contract they will empty (think that a baby needs contractions to come out, similar..)
*drug will have no effect of a blockade if there is no presence of a muscarinic agonist in order to block!!!
what are the effects of Atropine on smooth muscles??
on the iris sphincter causes MYDRIASIS. Eyes dilate and get larger when muscarinic antagonists block acetylcholine at muscarinic receptors.
what is the effect of atropine on the eyes?
at therapeutic doses, it can cause the CNS to have mild excitation.
toxic/high doses can cause hallucinations and delirium -> can resemble psychosis.
extremely high doses can cause coma, resp. arrest, and death
what is the effect of atropine on the CNS?
at therapeutic doses?
at toxic/high doses?
DIfferent receptors need different dosage levels. Very high doses can cause problems in the CNS like coma, resp. arrest, or death
(stomach and bronchial smooth muscle need higher doses)
because of receptor sensitivity what is important to know about Atropine given to patients?
It suppresses gastric acid secretions.
Muscarinic antagonists dry up secretions!
How can Atropine treat peptic ulcer disease?
dilates the bronchi so patient can breathe more and have more space for O2!
-because of the side effects on other systems: heart, exocrine glands, eyes etc
How does Atropine help treat asthma
why is this not the drug of choice to treat asthma or peptic ulcer disease?
Topically to the eye (eyedrops)
-parenterally; IM, IV, SubQ
-rapidly absorbed after admin. and spreads to all tissues including the CNS !!
half life of 3 hours
what routes is Atropine given?
b/c the cardiac effects of atropine can help during surgery.
-procedures that stimulate baroreceptors (BP) of the carotid body can initiate a reflex of slowing the heart during surgeries - causing bradycardia. Since this reflex is mediated by muscarinic receptors on the heart, pretreatment with Atropine can prevent a dangerous plummet in heart rate
ATROPINE IS USED TO KEEP THE HEART RATE UP !!
Why can Atropine be used therapeutically as a preanesthetic medication?
Atropine - muscarinic antagonist/anticholinergic drug can help therapeutically to stop/dry secretions
Because some anesthetics irritate your respiratory tract, this stimulates secretions from your saliva, nasal, pharyngeal, and bronchial glands. If these secretions are excess, this can interfere with respirations. - What medication can be given to this patient to stop their excessive secretions
-causes mydriasis when pupils dilate
-paralysis of the ciliary muscle (bc if the eyes are dilating, they are focusing farther. Constricting would be focusing on close objects....which involves contraction of the ciliary muscle to near focus which is not needed with this drug)
By blocking muscarinic receptors in the eyes, atropine causes what effects?
Used to dilate eyes and paralyze the ciliary muscle so it does not contract - which is used during ocular exams (eyedrops they put in you before you get an eye exam) and before ocular surgery.
*important so your eyes are not contracting during exam or surgery! Atropine paralyzes the ciliary muscle to stay still!!!
Describe the ophthalmic uses of Atropine? Therapeutic use
Atropine ! HR is increased bc of the blockade of cardiac muscarinic receptors - which reverses the parasympathetic effect of slowing the heart (opposite effect. bc when cardiac muscarinic receptors are activated, heart rate slows down upon activation. by blocking this activation with Atropine, we can increase HR!)
Therapeutic drug to treat Bradycardia?
How does this drug do this?
Atropine can decrease the tone and motility of the intestinal smooth muscle.
*used for intestinal hypertonicity and hypermotility (tone and motility)
By blocking muscarinic receptors in the intestine, Atropine helps the intestines how therapeutically?
By doing so, Atropine helps decrease the motility of the intestines. Helpful in conditions like: dysentery and diverticulitis
-When taken for these disorders, Atropine helps reduce frequency of BOWEL MOVEMENTS associated with abdominal cramps
(with muscarinic antagonists - there is less emptying !!! unlike muscarinic agonists. antagonists kind of pause the bowel)
Why can Atropine be helpful by its action of decreasing tone and motility of the intestines?
Atropine is the antidote !!
what is the antidote to poisoning by agents that activate muscarinic receptors?
Atropine - a muscarinic antagonist / anticholinergic drug - by blocking the muscarinic receptors, atropine can reverse all signs of muscarinic poisoning
what's the antidote for muscarinic poisoning (caused by mushrooms, cholinesterase inhibitors, or muscarinic agonists)
because it decreases/suppresses secretions of gastric acid. - but when given, this drug is not strong enough to block only these receptors and others get blocked along with it - causing many muscarinic side effects.
Atropine is used for rare cases of this condition. It is not 1st choice.
1st choice meds for peptic ulcer disease would be: antibiotics, histamine, proton pump inhibitors
Although not commonly used for this, How is Atropine used to help treat peptic ulcer disease?
Because Atropine dilates the lungs, does bronchial dilation to improve respirations!
-though bc atropine also causes drying and thickening of secretions - effects can be harmful to these patients with asthma. it's now rarely used for asthma.
How can Atropine be used, not as a 1st choice - though, to help patients with asthma improve their respirations ?
it may be combined with analgesics such as morphine to relax biliary tract smooth muscle - helps alleviate discomfort.
REMEMBER - muscarinic antagonists work on smooth muscles by relaxing them !!!!!!
Biliary colic is characterized by intense abdominal pain brought on by passage of a gallstone through the bile duct. Why would a patient with this condition receive Atropine?
B/c - blockade of muscarinic receptors on salivary glands causes dryness of secretions, it can inhibit salivation production!
-this is uncomfortable, effects swallowing, --> tooth decay, gum problems, oral infections
alleviate by: sipping fluids, chewing sugar free gum
You can predict side effects of Atropine based on knowledge of muscarinic receptor function.
(think: these receptors are at heart, exocrine glands, eyes, and smooth muscle)
-Why is a side effect dry mouth (xerostomia)?
- means dry mouth
-sips of water, chew sugar free gum
-Altoids, Chewing gum, Biotene dry mouth free gum, treat mouth with a saliva substitute, use alcohol-free mouthwash (Biotene products)
avoid sugary gum & hard candy to prevent tooth decay
education: For the patient taking Atropine they have a side effect of xerostomia. What can the nurse teach them about handling this SE?
-Preanesthetic Med; keeps heart rate up during surgery when given before
-Preventing excessive secretions; dries up secretions
-Eye disorders; given as drops to paralyze ciliary muscle and promote mydriasis before eye exam or eye surgery
-Braycardia - rises HR
-Intestinal Hypertonicity & Hypermotility - decreases tone and motility of intestines smooth muscles; good for dysentery and diverticulitis; decreases frequency of bowel movements associated with abdominal cramps
-Reverses muscarinic poisoning
-Sometimes for peptic ulcer disease,asthma,and biliary colic to promote comfort by relaxing smooth muscle
Name all the therapeutic uses for Atropine.
B/c the blockage against muscarinic receptors on the ciliary muscle and the sphincter of the iris can paralyze these muscles.
-paralysis of the ciliary muscle focuses the eye for far vision -note: I WAS WRONG WHAT I SAID ABOUT THIS BEFORE (contracting this muscle is for near vision, paralyzing it is for far vision) ---> this causes nearby vision to be blurry
*warn patients about this side effect. only happens when atropine is used on ocular muscarinic receptors - or receptors in the eye.
How can Atropine cause Blurred vision as a side effect?
-SE of atropine.
-B/c this drug paralyzes the sphincter of the iris preventing the pupil to constrict - therefore, this renders the eye from adapting to bright light bc
*education: wear dark sunglasses if intolerance to light becomes a problem while on this medication. Keep hospital lighting low !!
this means extreme sensitivity to light. What drug is this a side effect of and why?
SE of Atropine. causes photophobia and blurred vision when blocking the muscarinic receptors in the eyes
The patient has photophobia and is ordered to wear dark sunglasses for protection. What medication may they be taking?
SE of Atropine is elevation of intraocular pressure - caused by paralysis of the iris sphincter.
- Contra. for Glaucoma - there's already too much IOP with that.
How might the med Atropine increase intraocular pressure? What does this contraindicate then?
all anticholinergic drugs - because the increase IOP in the eyes !
*use drug with caution for patients at risk for having glaucoma
what type of drugs are contraindicated for patients with Glaucoma bc of its increased intraocular pressure?
because the blockage of receptors in the urinary tract reduces pressure within the bladder and increases the tone of the urinary sphincter and trigone ---> produce urinary hesitation or rentention
TREAMTENT FOR THIS SE: treat with Bethanechol or catheterize patient if needed
*may minimize risk by voiding right before taking atropine!
How is urinary retention an adverse effect of Atropine??
-because muscarinic blockade DECREASES the tone of intestinal smooth muscle. there's a delay in transit now bc the smooth muscle is not contracting and moving things around to be expelled. so patient has constipation when things aren't moving
TREAT: increase fiber, fluids, physical activity, give laxative if its severe.
How is constipation an adverse effect of atropine??
Bc a SE of atropine (muscarinic antagonist) and other types is DECREASED TONE of intestines - > leads to constipation
why would muscarinic antagonists be contraindicated for patients with intestinal atony - which is a condition in which intestinal tone is low.
no sweat - means decreased secretions from sweat glands.
So this would be a SE of Atropine - muscarinic antagonist / anticholinergic drug
-blockage of sweat glands.
-Sweat is how we cool off....if we cannot cool off, patient is at risk for HYPERTHERMIA -too hot.
TREAT: avoid activities that may overheat them
this is a deficiency or absence of sweat. What is this a side effect of do you think?
If such patient cannot produce sweat, what are they at risk for and why??
body's natural way to cool off. If we cannot sweat we may get hyperthermia
why do we sweat?
Yes, it may be a SE. the point of the medication is to INCREASE HR , but use drug with caution...
-blocking the cardiac muscarinic receptor eliminates the parasympathetic effect on the heart (which lowers HR) --> so anticholinergic agents can cause tachycardia.
*educate patients on safety
Can patients taking atropine get tachycardia??
-it's a muscarinic antagonist. So it dries up secretions in the lungs. It thickens and dries bronchial secretions which may cause bronchial plugging.
-although these drugs can be used to treat asthma, they can also do harm ***
why are patients with asthma at risk when they take atropine??
*avoid combination with these drugs
Because of their anticholinergic actions, these drugs can greatly enhance the antimuscarinic effects of Atropine and related agents.... so we want to avoid these specific drugs if a patient is taking any type of muscarinic antagonist/anticholinergic
SYSTEMIC. Think bc of the risk of side effects being systemic for asthma, biliary colic, and peptic ulcer disease especially. that is why atropine is not first choice bc of its broad and systemic side effects!
Atropine provides local/systemic therapy???
-this is a pre-filled auto-injector for IM therapy to treat this kind of muscarinic poisoning
-use Atropen immediately at exposure to poisoning
-goes into lateral thigh
-directly thru clothes if needed IM
what is used specifically to treat muscarinic poisoning; but specifically for cholinesterase inhibitor poisoning??
muscarinic poisoning from cholinesterase inhibitors *** specific. its an IM injection needed asap
what does AtroPen treat?
there's 4 specific ones:
1. urinary urgency (a sudden, compelling desire to urinate)
2. urinary frequency (voiding 8 or more times in 24 hours)
3. nocturia (waking up 2 or more times to void)
4. urge incontinence (involuntary leakage of urine associated with a strong urge to void)
what are the symptoms of an overactive bladder??
voiding 8 or more times in 24 hours
explain urinary frequency
involuntary contractions of the bladder detrusor muscle (which is the smooth muscle component of the bladder wall) - when this contracts, the body is emptying and voiding
*these contractions are called detrusor instability or detrusor over activity
In most cases, urge incontinence results from what??
stress incontinence ; activities like exertion, sneezing, coughing, laughing - things that increase pressure within the abdominal cavity
involuntary urine leakage caused by activities
-behavioral therapy - try this FIRST
2 primary modes of treatment for an overactive bladder include:
-these are tried before drug therapy;
-schedule voiding, timing fluid intake, kegel exercises to strengthen, avoid caffeine
drug therapy: diuretic to increase detrusor muscle activity / contractions!
*peripheral tibial nerve stimulation may help
name some forms of behavioral therapy that could help a pt overcome an overactive bladder
-they block muscarinic receptors on the bladder detrusor and they inhibit bladder contractions so there's less urge to void (the contractions of this detrusor muscle is what makes apt void)
*these drugs cause side effects systemic bc they are block receptors elsewhere and not just in the bladder
When drug therapy is indicated to treat an OAB , what class of drugs do we use? How do these drugs work
1. using long-acting formulations
2.using drugs that don't cross the blood brain barrier
3. using drugs that are selective for muscarinic receptors in the bladder
how can we reduce anticholinergic side effects??
Extended release capsules
-these reduce SE of anticholingergics by providing a STEADY but relatively low level drug - thereby avoiding the high peak levels that can cause intense side effects
what long-acting formulations are used as drug therapy to help treat overactive bladder???
why are these preferred to treat OAB
they are unable to cause SE of CNS effects
why do we want to use drugs therapy or OAB that cannot cross the blood brain barrier - why would this be an advantage?
name the muscinaric receptor subtypes
check patients EKG for any changes in their QT interval - these drugs cause a prolonged QT interval
if a patient is on Haldol, or any type of anticholinergic drug, what is a priority for the nurse to do?
if their QT interval becomes abnormal ---> watch their EKG for their heart's condition
For the patient taking anticholinergic drug therapy, when would it be necessary to stop the drug?
this muscinaric receptor is found only in the heart
M1 * CNS is most important...think number 1
Describe this muscinaric subtype:
Located in the salivary glands and CNS
since it's in salivary glands and CNS....
-salivation is promoted
THhink of the location of msucinaric receptor subtype M1. if activated, what happens?
salivary glands -> salivation
bladder->contracts detrusor to void
GI smooth muscle --> Increase tone and motility
Eyes->iris sphincter contracts to miosis
Eyes --> ciliary muscle ->contracts for near vision/accommodation
eyes->lacrimal glands->tearing up
where are M3 muscinaric receptor subtypes located.
if activated, what happens?
dry mouth - no saliva produced
-confusion, hallucinations, impaired cognitive functioning
If muscinaric M1 receptor subtypes are blocked off, what is the effect (opposite of activation)
activated - bradycardia
blocked - tachycardia
If muscinaric M2 receptor subtypes are activated what happens?what happens if they are blocked?
-relaxation of smooth muscles; decreased pressure in GI tract and bladder, decreased tone and motility -> constipation, no voiding, no bowel movement, intestines decreased motility, eyes relax and dilate for mydriasis, ciliary muscles relax --> blurred vision, eyes are dry since no tears are made
What happens if M3 muscinaric receptor subtypes are blocked???
CNS & salivary glands = M1
Heart = M2
everything but heart and CNS = M3
what muscinaric receptor effects CNS ??
which one effects the heart?
they all block M3
YES. we want sufficient blockade of M3 to reduce symtpoms of OAB - but not so much to cause urinary retention
There are 6 approved anticholinergic drugs approved to treat overactive bladder. All work by blockade of what muscinaric receptor subtype???
Is this blockade good?
what type of drug are these: Ditropan XL, Oxytrol, Gelnique? What is their trade name? what are they for?
muscinaric M3 receptors
Anticholinergic drugs that are used to treat OAB act primarily at what receptors??? they block these receptors
only approved for OAB. it's an anticholinergic. has 3 trade names.
-rapidly absorbed in the GI tract
-it can penetrate the BBB
What is Oxybutynin approved to treat?
*it has the anticholinergic side effects
CNS: can be confusion, hallucinations, insomnia, nervousness, agitation
Describe the side effects of Oxybutynin.
combination of any other anticholinergic agent along with Oxybutynin will INTENSIFY the already present anticholinergic effects !!!
Why don't we want to use Oxybutynin (an anticholinergic...so also a muscinaric antagonist) along with antihistamines, tric. antidepressants, phenothiazine antipsychotics
-Available In 5 forms.
-short acting: syrup & immediate release tablets
-long-acting: ER tablets, transdermal patch, topical gel
-LESS INTENSE IN LONG ACTING FORMS
What available forms are the for Oxybutynin?
-in what form are anticholinergic effects less intense?
-absorption of the med is slow and steady
-it bypasses metabolism in the intestinal wall
why is the transdermal patch that treats OAB unique?
This drug that is used to treat OAB has the greatest degree of M3 receptor selectivity
-so this will not affect HR or CNS
This drug that treats OAB can reduce OAB symptoms while having NO effect on M1 receptors (CNS & Salivary glands) In the brain or M2 receptors (in the heart)
Yes! No effect on heart or CNS (M1 & M2)
Is Darifenacin as an OAB drug well tolerated?
-dry mouth and constipation and other M3 related SE
*most common SE is dry mouth, others include dyspepsia, gastritis, and headache
what are the two main SE of OAB drug Darifenacin
-although it doesn't effect M1 or M2 receptors, it still does block M3 receptors so it has these SE
-it's well tolerated
-half life of 12 hours. long.
In what form is OAB drug Darifenacin delivered???
what's its most common SE?
Darifenacin. this is because it does not have any effect on M1 or M2 receptors, only blocks M3 ones.
This drug that treats OAB does NOT effect heart rate, cognition, or memory.
-has half life of 50 hours. once a day dosing. very long acting.
This OAB drug is similar to Darifenacin, only it is not as M3 receptor selective
Darifenacin is more M3 selective
What is the benefit of using Darifenacin over Solifenacin to treat overactive bladder?
-well think, it's an anticholinergic, that is not as selective as other OAB drugs, so more SE.
-Dry mouth *
-Blurred vision *
also ; dyspepsia, urinary retention, headache, nasal dryness,
Name some adverse effects of Solifenacin;
OAB drug anticholinergic - Solifenacin.
This is because it prolongs QT interval
Which overactive bladder drug therapy puts patients at risk for developing fatal dysrhythmia??? Why?
Solifenacin - ask...bc I thought all anticholinergic drugs prolonged this
what OAB drug prolongs QT interval
*DYSRYTHMIAS - because they prolong QT interval.
specifically know that Solifenacin does as an OAB drug.
With any anticholinergic drug, patients are prone to ___
pt can go into cardiac arrest
Why is it dangerous if QT interval gets prolonged?
YES. they can cause hypotension, nausea, dryness...
can transdermal patches cause side effects??
*big SE of transdermal patches is hypotension
When BP drops below what number, this is when pt will start showing symptoms of low BP/hypotension.
to dry secretions
What is Glycopyrate used for?
anticholinergic/muscinaric antagonist. Has actions similar to Atropine but with 2 exceptions
what kind of drug is this?? Scopolamine
This anticholinergic drug has actions similar to Atropine, but with 2 exceptions;
1. therapeutic doses of this drug cause sedation (atropine causes CNS excitation)
2. this drug suppresses emesis and motion sickness (Atropine does not suppress this)
anticholinergic in patch form
what form is Scopolamine in?
*atropine causes CNS excitation - they're opposties
therapeutic doses of this drug produces sedation
Scopo= At therapeutic doses it causes sedation
Atropine=at therapeutic doses causes CNS excitation
Scopo=suppresses emesis and motion sickness
What are the differences between Atropine and Scopolamine?
-SUPPRESSES MOTION SICKNESS *
-Produces cycloplegia (paralysis of ciliary muscle) and mydriasis (dilation) for eye procedures
-Produces preanesthetic SEDATION and obstetric amnesia
*drops BP, makes you sleepy and tired, dilates and paralyzes your eyes for surgery, stops motion sickness
List the purposes for anticholinergic Scopolamine:
cycloplegia - which is a purpose of the anticholinergic drug Scopolamine
this term means paralysis of ciliary muscle
what drug's purpose?
drops BP, makes you sleepy and tired, dilates and paralyzes your eyes for surgery, stops motion sickness
Ipratropium bromide - anticholinergic
This muscinaric antagonist is topicl route/ it's an inhaler
*patients take a Bronchodilator and atropine together
1. treats asthma
2. treats COPD
3. treats rhinitis caused by allergies or the common cold (treats with nasal spray)
***think of its purposes... it's an inhaler !!!
*helps with excess mucus, it dries up secretions!
Name the therapeutic uses for Ipratropium bromide
Inhaler - Ipratropium bromide
what anticholinergic drug has the purpose of treating asthma, COPD, and rhinitis caused by common cold
Topical inhalation thru inhaler
-nasal spray for rhinitits
What are the routes for anticholinergic drug: Ipratropium bromide
dry mouth, blurred vision, urinary hesitancy, constipation
list the adverse effects of anticholinergic Ipratropium bromide
Name a type of antisecretory anticholinergic used to dry up secretions and suppress gastric acid secretions
This is a drying agent for people who cannot handle their excess secretions. its literal job as a drug is to DRY SECRETIONS
IV or IM
-it's an antisecretory anticholinergic drug used to DRY UP SECRETIONS
-there's an oral solution for kids used to treat drooling
what routes can we administer Glycopyrrolate ??? what's it for?
contact the HCP. NEVER DOUBLE UP ON THIS MEDICATION. EVER.
If a patient is taking Glycopyrrolate and his secretions are nt drying up, or he continues to drool saliva constantly, what should the nurse do?
check the Glycopyrrolate amount in their body!
If patient is on a medication to dry up their secretions, they are going to have trouble voiding. For the patient on Glycopyrrolate that cannot void, what should the nurse do?
and reduce secretions! - gastric secretions too
Glycopyrrolate antisecretory anticholinergic
this anticholinergic works to reduce salivation
Dicyclomine - only used oral or IM.
NEVER IV ROUTE
This muscinaric antagonist is indicated for irritable bowel syndrome (spastic colon, muscus colitis) and functional bowel disorders like diarrhea and hypermotility.
think of the name itself.... it's used only for eye surgery purposes....
- Mydriatic-cycloplegics. Name literally says its purpose. the 5 drugs involved are: 2 of them are atropine and scopolamine
This muscinaric antagonist is a class of 5 sub mucinaric antagonists that produce mydriasis and cycloplegia (paralyze ciliary muscle) in eye procedures.
Centrally acting anticholinergics - benztropin (Cogentin) and to treat drug-induced parkinsonism - they block msucarinic receptors in the CNS
These types of anticholinergics are used to treat Parkinson's disease
centrally acting anticholinergics - central bc they work by blocking muscinaric receptors in the CNS **** benztropin (Cogentin) is 1.
These drugs treat parkinsons and drug-induced parkinsons disease
YES. It can shut down your organs.
can muscinaric poisoning effect your ograns at all?
certain msuhrooms; natural products
cholinesterase inhibitors - only treated with AtroPen injections!
-any drugs with antimuscinaric effects; antihistamines, etc
these can all cause toxicity
name the sources that can cause muscinaric poisoning
-give antidote: Physostigmine !!
-give the antidote and always minimize intestinal absorption of that toxic agent as much as possible (activated charcoal will minimize absorption)
what is the treatment for anti muscinaric poisoning/toxicity ??
to treat urinary retention
#1 use for Bethanechol is?
this is the antidote for anti muscinaric poisoning
the nurse doesn't do it
how does the nurse observe someone who has an enlarged prostate?
-check patients EKG as a priority
When a patient is on anticholinergic drugs, there's always risk for a dysrhythmia. So the nurse should make what a priority and do what ?
Photophobia - sensitive to light
CNS defects-hallucinations, delirium
Hot, dry, flushed skin
---death can result from respiratory depression secondary to blockage of receptor blockage in the brain
*body is toxic...this is what happens.
*these symptoms are similar to a psychotic episode. which is why u must do a psych test for these patients.
Name the symptoms of toxicology of muscinaric antagonists
Physostigmine. By inhibiting cholinesterase, Physostigmine causes acetylcholine to accumulate at all cholinergeric junctions
the most effective antidote to antimuscarinic poisoning is ____, an inhibitor of acetylcholinesterase
you MUST differentiate between antimuscincaric poisoning and an actual psychotic episode --> this poisoning often resembles psychosis (hallucinations and delirium due to CNS effects)
*important because some antipsychotic meds has antimuscarinic properties of their own, and will intensify symptoms if given to a victim with antimus. poisoning
What is CRUCIAL to know regarding anti muscinaric poisoning? aside from knowing the antidote is physosigmine
-usualy not difficult, bc a psychotic episode usually wont have dry mouth, hyperthermia, and dry skin, but it will have the CNS effects of hallucinations and delirium. Test it.
with what condition is it very important to differentiate between a psychotic episode or something else??
what would be the antidote for an overdose of Bethanechol???? where it became toxic
what is the antidote for muscinaric poisoning?
what is the antidote for antimuscinaric poisoning?
they have the same affects as antimuscinaic durgs / msucinaric antagonists / anticholinergics --- same effect. do NOT take two of these drugs at the same time. If so --> toxic levels. Will need Physostigmine as antidote
antidepressants, antihistamines, these are both considered what type of drugs? think.
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