Name of the Anticholinergics Drugs
- Hyoscine
- Dicyclomine
1.Hyoscine
| Hyoscine |
| Availability: hyoscyamine Tablets: 0.15 mg hyoscyamine sulfate Capsules (timed-release): 0.375 mg Elixir: 0.125 mg/5 ml Injection: 0.5 mg/ml Oral solution: 0.125 mg/ml Tablets: 0.125 mg Tablets (extended-release): 0.375 mg Tablets (orally disintegrating): 0.125 mg Tablets (sublingual): 0.125 mg |
| Indications and dosages Adjunct in GI tract disorders; pain and hypersecretion in pancreatitis; cystitis; renal colic; infant colic; acute rhinitis; rigidity, tremors, and hyperhidrosis in Parkinson’s disease; partial heart block due to vagal activity Adults and children ages 12 and older: 0.125 to 0.25 mg (sulfate) P.O. or S.L. two to four times daily, or 0.375 to 0.75 mg (extended-release sulfate) P.O. q 12 hours, or 0.25 to 0.5 mg (sulfate) subcutaneously, I.M., or I.V. two to four times daily p.r.n. Children ages 2 to 12: In children weighing approximately 50 kg (110 lb), 0.125 mg (sulfate) P.O. q 4 hours p.r.n.; in children weighing approximately 20 kg (40 lb), 0.0625 mg P.O. (sulfate); in children weighing approximately 10 kg (22 lb), 0.031 to 0.033 mg (sulfate) P.O. Don’t exceed 0.75 mg/day. Children ages 2 and younger: In children weighing approximately 7 kg (15 lb), 0.025 (sulfate) P.O. q 4 hours p.r.n.; in children weighing approximately 5 kg (11 lb), 0.0208 mg (sulfate) P.O. q 4 hours p.r.n.; in children weighing approximately 3.4 kg (7.5 lb), 0.0167 mg (sulfate) P.O. q 4 hours p.r.n.; in children weighing approximately 2.3 kg (5 lb), 0.0125 mg (sulfate) P.O. q 4 hours p.r.n. Before endoscopy or hypotonic duodenography Adults: 0.25 to 0.5 mg (sulfate) subcutaneously, I.M., or I.V. 5 to 10 minutes before procedure Preoperatively to inhibit salivation and excessive respiratory secretions Adults and children older than age 2: 5 mcg/kg (sulfate) I.M., I.V., or subcutaneously 30 to 60 minutes before anesthesia induction Muscarinic toxicity Adults: 1 to 2 mg (sulfate) I.V. Additional 1-mg doses may be given I.M. or I.V. q 3 to 10 minutes until muscarinic signs and symptoms subside; doses may be repeated if needed. Patient may need up to 25 mg during first 24 hours. For maintenance, 0.5 to 1 mg P.O. at intervals of several hours until signs and symptoms disappear. |
Mechanism of Action
Competitively inhibits acetylcholine action at autonomic nerve sites, relaxing smooth muscle and decreasing glandular secretions
Pharmacokinetics
- Metabolism
- Hepatic
- Metabolites: Tropic acid, tropine, hyoscyamine glucuronide
- Elimination
- Half-life: Tab (3.5 hr), SR (5-9 hr)
- Dialyzable: Yes; removed by hemodialysis and peritoneal dialysis
- Excretion: Majority excreted in urine as unchanged drug
Administration
- Administer 30 to 60 minutes before meals and at bedtime.
- Give bedtime dose at least 2 hours after last evening meal or snack.
- Be aware that hyoscyamine is given P.O. only, whereas hyoscyamine sulfate may be given P.O., I.M., I.V., sublingually, or subcutaneously.
- Know that a cholinerase reactivator (pralidoxime) is given concomitantly to treat muscarinic toxicity
Contraindications
- Hypersensitivity to anticholinergics, alcohol, sulfites, or tartrazine
- Angle-closure glaucoma, synechia
- GU or GI obstructive disease, severe ulcerative colitis
- Renal or hepatic disease
- Neonates or premature infants
Precautions :
- Cardiovascular disease, prostatic hypertrophy, reflux esophagitis, brain damage, autonomic neuropathy, hyperthyroidism, glaucoma, Down syndrome, spastic paralysis
- Elderly patients
- Pregnant (safety not established) or breastfeeding patients
- Infants and small children.
Adverse reactions
- CNS: confusion, excitement, nervousness, dizziness, light-headedness, headache, insomnia
- CV: palpitations, tachycardia
- EENT: blurred vision, cycloplegia, increased intraocular pressure, mydriasis, photophobia
- GI: nausea, vomiting, constipation, bloating, dry mouth, paralytic ileus
- GU: urinary hesitancy or retention, erectile dysfunction, lactation suppression Skin: flushing, decreased sweating, urticaria, local irritation (with I.M., I.V., or subcutaneous use)
- Other: altered taste, allergic reactions (including fever), heat intolerance, anaphylaxis
Patient monitoring
- Watch for adverse reactions.
- Check for mental status changes, such as confusion.
- Evaluate fluid intake and output.
- Assess patient’s response to temperature changes (especially hot weather). Drug may cause heat intolerance, predisposing patient to heat stroke.
Patient teaching
- Tell patient to take on empty stomach 30 to 60 minutes before meals and at least 2 hours after last evening meal or snack.
- Instruct patient with urinary hesitancy to empty bladder before taking.
- Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and herbs mentioned above.
2.Dicyclomine
| Dicyclomine |
| Availability : Capsules: 10 mg Solution for injection: 10 mg/ml Syrup: 10 mg/5 m |
| Indications and dosages Irritable bowel syndrome in patients unresponsive to usual interventions Adults: 20 mg P.O. or I.M. q.i.d.; may increase up to 160 mg/day |
Mechanism of Action:
Thought to exert direct effect on GI smooth muscle by inhibiting acetylcholine at receptor sites, thereby reducing GI tract motility and tone
Pharmacokinetics
- Metabolism: Extensive
- Half-life: 1.8 hr
- Excretion: Urine (80%); feces (8%)
Administration
- Give 30 to 60 minutes before meals; give bedtime dose at least 2 hours after evening meal
- Don’t administer by I.V. route.
- Don’t give by I.M. route for more than 2 days.
Contraindications
- Hypersensitivity to drug
- GI or genitourinary tract obstruction
- Severe ulcerative colitis
- Reflux esophagitis
- Unstable cardiovascular status
- Glaucoma
- Myasthenia gravis
- Breastfeeding
- Infants younger than 6 months
Adverse reactions
- CNS: confusion, drowsiness, lightheadedness (with I.M. use), psychosis
- CV: palpitations, tachycardia
- EENT: blurred vision, increased intraocular pressure
- GI: nausea, vomiting, constipation, heartburn, decreased salivation, dry mouth, paralytic ileus
- GU: urinary hesitancy or retention, erectile dysfunction, decreased lactation
- Skin: decreased sweating, rash, itching, urticaria
- Other: pain and redness at I.M. site, allergic reactions including anaphylaxis
Patient monitoring
- Stay alert for anaphylaxis.
- Monitor vital signs and fluid intake and output. Ask patient about palpitations.
- Assess for light-headedness, confusion, and rash after I.M. injection.
- Evaluate patient’s vision, particularly for blurring and other signs and symptoms of increasing intraocular pressure.
- Assess bowel pattern, particularly for signs and symptoms of paralytic ileus.
Patient teaching
- Instruct patient to take drug 30 to 60 minutes before meals and to take bedtime dose at least 2 hours after evening meal.
- Advise patient not to take antacids or adsorbent antidiarrheals within 2 hours of dicyclomine. 2Urge patient to promptly report rash, abdominal pain, decreased urinary output, or absence of bowel movements.
- Caution patient to avoid driving or other hazardous activities until he knows how drug affects concentration, vision, and alertness. 2Instruct patient to avoid exposure to high temperatures and to immediately notify prescriber if fever and decreased sweating occur in high environmental temperature.
- Advise patient to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Nursing Considerations
- Assess patient for tachycardia before giving dicyclomine; heart rate may increase.
- Don’t give drug by I.V. route.
- Watch for symptoms of hypersensitivity, such as agitation and pruritus. They usually resolve within 48 hours of stopping drug.
- During long-term use, assess patient for chronic constipation and fecal impaction, and take corrective measures, as prescribed.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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