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—↓ gastric secretory activity and ↑ esophageal sphincter tone. Atropine and scopolamine are also used as ophthalmic mydriatics. Benztropine and trihexyphenidyl—Parkinson's disease. Oxybutynin and tolterodine—Overactive bladder.

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 ↑ 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 heart rate or BP 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

• Administer oral doses of 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.
• 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.
• Decreased urinary frequency, urgency, and urge incontinence.