Propantheline

INTRODUCTION

Indications

Adjunctive therapy in the treatment of peptic ulcer disease.

Unlabeled Use: Antisecretory or antispasmodic agent.

Action

Competitively inhibits the muscarinic action of acetylcholine, resulting in decreased GI secretions. Therapeutic Effects: Reduction of signs and symptoms of peptic ulcer disease.

Adverse Reactions/Side Effects

CNS: confusion, dizziness, drowsiness, excitement. EENT: blurred vision, mydriasis, photophobia. CV: tachycardia, orthostatic hypotension, palpitations. GI: constipation, dry mouth. GU: urinary hesitancy, urinary retention. Derm: rash. Misc: decreased sweating.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.

• If used to treat peptic ulcer, monitor any changes in symptoms such as decreased abdominal pain and improved appetite to help document whether drug therapy is successful.

• Be alert for decreased sweating and increased body temperature (hyperthermia), especially during exercise. Notify physician of a prolonged or persistent elevation in body temperature.

• Monitor signs of urine retention (difficult urination, painful or distended abdomen). Excessive urinary retention may require dose adjustment by physician.

• Monitor and report excessive confusion, excitement, or other alterations in mental status.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Because of the risk of arrhythmias and impaired thermoregulation, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged vision problems, skin rash, or GI problems (constipation, dry mouth).

Pharmacokinetics

Absorption: Incompletely absorbed from the GI tract.

Distribution: Distribution not known. Does not cross the blood-brain barrier.

Metabolism and Excretion: Inactivated in the upper small intestine.

Half-life: Unknown.