Pharmacologic: anticholinergics, antimuscarinics
IM: Given preoperatively to decrease oral and respiratory secretions. IV: Treatment of sinus bradycardia and heart block. PO: Adjunctive therapy in the management of peptic ulcer and irritable bowel syndrome. IV: Reversal of adverse muscarinic effects of anticholinesterase agents (neostigmine, physostigmine, or pyridostigmine). IM, IV: Treatment of anticholinesterase (organophosphate pesticide) poisoning. Inhalation: Treatment of exercise-induced bronchospasm.
Inhibits the action of acetylcholine at postganglionic sites located in Smooth muscle, Secretory glands, CNS (antimuscarinic activity). Low doses decrease Sweating, Salivation, Respiratory secretions. Intermediate doses result in Mydriasis (pupillary dilation), Cycloplegia (loss of visual accommodation), Increased heart rate. GI and GU tract motility are decreased at larger doses. Therapeutic Effects: Increased heart rate. Decreased GI and respiratory secretions. Reversal of muscarinic effects. May have a spasmolytic action on the biliary and genitourinary tracts.
Adverse Reactions/Side Effects
CNS: drowsiness, confusion, hyperpyrexia. EENT: blurred vision, cycloplegia, photophobia, dry eyes, mydriasis. CV: tachycardia, palpitations, arrhythmias. GI: dry mouth, constipation, impaired GI motility. GU: urinary hesitancy, retention, impotency. Resp: tachypnea, pulmonary edema. Misc: flushing, decreased sweating.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.
Watch for signs of pulmonary edema, including cough, shortness of breath, rapid breathing (tachypnea), chest pain, and labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.
If treating inflammatory bowel diseases, monitor any changes in symptoms (decreased abdominal pain, decreased diarrhea, improved appetite) to help document whether drug therapy is successful.
If treating exercise-induced bronchospasm, assess lung volumes, breath sounds, respiratory rate, and other symptoms (wheezing, dyspnea, shortness of breath) during exercise (See Appendices I, J, K). Report changes in pulmonary function to help document the effects of drug therapy in treating this problem.
Be alert for decreased sweating and altered/increased body temperature (hyperpyrexia). Notify physician of a prolonged or persistent elevation in body temperature.
Because of the risk of arrhythmias, impaired thermoregulation, and pulmonary problems (edema, exercise-induced asthma), use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).