Pharmacologic Profile

General Use

Atropine: Bradyarrhythmias; also used as ophthalmic mydriatic. Ipratropium: Bronchospasm (inhalation) and rhinorrhea (intranasal). Scopolamine: Nausea and vomiting related to motion sickness and vertigo. Glycopyrrolate: Inhibits salivation and excessive respiratory secretions. Benztropine: Parkinson disease; also used to manage drug-induced extrapyramidal effects. Umeclidinium: Chronic obstructive pulmonary disease. Tiotropium: Chronic obstructive pulmonary disease and asthma. Darifenacin, fesoterodine, oxybutynin, solifenacin, and tolterodine: Overactive bladder.

General Action and Information

Competitively inhibit the action of acetylcholine. In addition, atropine, glycopyrrolate, 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

Older adults 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 ↑ transit time. Antacids may ↓ absorption of orally administered anticholinergics.

Nursing Implications

Assessment

• Assess vital signs and ECG frequently during IV drug therapy. Report any significant changes in HR or BP promptly.
• Assess respiratory status (rate, breath sounds, degree of dyspnea) before administration and at peak of medication effect for inhalers.
• Monitor intake and output in older adults 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.

Implementation

• PO: Administer oral doses of glycopyrrolate 1 hr before or 2 hr after meals.
• Scopolamine transdermal patch should be applied ≥4 hr before travel.
• Tiotropium capsules are for inhalation only and must not be swallowed.

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.
• Advise patient that tiotropium and umeclidinium are not to be used for acute bronchospasm attacks but may be continued during an acute exacerbation.
• 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 disease.
• Decreased urinary frequency, urgency, and urge incontinence.