ANTICHOLINERGICS

PHARMACOLOGIC PROFILE
General Use
Atropine—Bradyarrhythmias. Ipratropium—bronchospasm (inhalation) and rhinorrhea
(intranasal). Scopolamine—Nausea and vomiting related to motion sickness and vertigo.
Propantheline and glycopyrrolate—Decreasing gastric secretory activity and increasing
esophageal sphincter tone. Atropine and scopolamine are also used as ophthalmic mydriatics.
Benztropine, biperidin, and trihexyphenidyl are used in the management of Parkinson’s disease.
Oxybutynin and tolterodine are used as urinary tract spasmodics.
General Action and Information
Competitively inhibit the action of acetylcholine. In addition, atropine, glycopyrrolate, propantheline,
and scopolamine are antimuscarinic in that they inhibit the action of acetylcholine at
sites innervated by postganglionic cholinergic nerves.
Contraindications
Hypersensitivity, narrow-angle glaucoma, severe hemorrhage, tachycardia (due to thyrotoxicosis
or cardiac insufficiency), or myasthenia gravis.
Precautions
Geriatric and pediatric patients are more susceptible to adverse effects. Use cautiously in patients
with urinary tract pathology; those at risk for GI obstruction; and those with chronic renal,
hepatic, pulmonary, or cardiac disease.

Interactions
Additive anticholinergic effects (dry mouth, dry eyes, blurred vision, constipation) with other
agents possessing anticholinergic activity, including antihistamines, antidepressants, quinidine,
and disopyramide. May alter GI absorption of other drugs by inhibiting GI motility and increasing
transit time. Antacids may decrease absorption of orally administered anticholinergics.
NURSING IMPLICATIONS
Assessment
● Assess vital signs and ECG frequently during IV drug therapy. Report any significant changes in
heart rate or blood pressure or increase in ventricular ectopy or angina promptly.
● Monitor intake and output ratios in elderly or surgical patients; may cause urinary retention.
● Assess patient regularly 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
● Decreased cardiac output (Indications).
● Impaired oral mucous membrane (Side Effects).
● Constipation (Side Effects).
Implementation
● PO: Administer oral doses of atropine, glycopyrrolate, propantheline, or scopolamine 30 min
before meals.
● Scopolamine transdermal patch should be applied at least 4 hr before travel.
Patient/Family Teaching
● Instruct patient that frequent rinses, sugarless gum or candy, and good oral hygiene may help
relieve dry mouth.
● May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness
until response to medication is known.
● Ophth: Advise patients that ophthalmic preparations may temporarily blur vision and impair
ability to judge distances. Dark glasses may be needed to protect eyes from bright light.
Evaluation/Desired Outcomes
● 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.

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