Anticholinergic Agents -- Contraindications and Cautions
抗胆碱能药：禁忌症与注意事项
Anticipated peripheral anticholinergic effects include dry mouth, nausea, vomiting, paralytic ileus, and constipation related to decreased GI secretions and motility. In addition, other adverse effects may occur, including the tachycardia, palpitations, and hypotension related to the blocking of the suppressive cardiac effects of the parasympathetic nervous system; urinary retention and hesitancy related to a blocking of bladder muscle activity and sphincter relaxation; blurred vision and photophobia related to pupil dilation and blocking of lens accommodation; and flushing and reduced sweating related to a blocking of the cholinergic sites that stimulate sweating and blood vessel dilation in the skin.
Anticholinergics are contraindicated in the presence of allergy to any of these agents to avoid hypersensitivity reactions. In addition, they are contraindicated in narrow-angle glaucoma, GI obstruction, genitourinary (GU) obstruction, and prostatic hypertrophy, all of which could be exacerbated by the peripheral anticholinergic effects of these drugs, and in myasthenia gravis, which could be exacerbated by the blocking of acetylcholine-receptor sites at neuromuscular synapses. The safety and efficacy for use in children have not been established.
Administer these agents cautiously in the following conditions: tachycardia and other dysrhythmias and hypertension or hypotension because the blocking of the parasympathetic system may cause a dominance of sympathetic stimulatory activity, and hepatic dysfunction, which could interfere with the metabolism of the drugs and lead to toxic levels. They should be use during pregnancy and lactation only if the benefit to the mother clearly outweighs the potential risk to the fetus or neonate. In addition, use caution in individuals who work in hot environments because reflex sweating may be blocked, placing the individuals at risk for heat prostration.
The use of anticholinergics for Parkinson’s disease and parkinsonism is associated with CNS effects that relate to the blocking of central acetylcholine receptors, such as disorientation, confusion, and memory loss. Agitation, nervousness, delirium, dizziness, light-headedness, and weakness may also occur.
1. Which of the following suggestions would the nurse make to help a patient who is receiving an anticholinergic agent reduce the risks associated with decreased sweating?
A. Covering the head and using sunscreen
B. Ensuring hydration and temperature control
C. Changing position slowly and protecting from the sun
D. Monitoring for difficulty swallowing and breathing 2. Which of the following would the nurse be least likely to include when developing a teaching plan for a patient who is receiving an anticholinergic agent?
A. Encouraging the patient to void before dosing
B. Setting up a bowel program to deal with constipation
C. Encouraging the patient to use sugarless lozenges to combat dry mouth
D. Performing exercises to increase the heart rate
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答案 Answers 1. B. Ensuring hydration and temperature control
This drug blocks sweating, which is the body’s way of cooling off. This places the patient at an increased risk for heat stroke. Extremes of temperature should be avoided. 2. D. Performing exercises to increase the heart rate.
Exercises should be avoided because this drug blocks sweating. This placed the patient at increased risk for heat stroke
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