Autonomic nervous system (ANS) Sometimes called the involuntary or visceral nervous system because it mostly functions with

little conscious awareness of its activity. Works with the endocrine system, to regulate internal functioning and maintain homeostasis. Functions Increased motility and secretions in the GI tract to promote digestion and adsorption of nutrients. Decreased heart rate and contractility to conserve energy and provide rest for heart. Constriction of bronchi, with increased secretions. Relaxation of the GI and urinary bladder sphincters, allowing evacuation of waste products. Pupilliary constriction, which decreases the light entering the eye and decreases stimulation of the retina. These activities are aimed at increasing digestion, absorption of nurtients, and building of essential proteins, as well as a general conservation of energy. Cholinergic transmission Four kinds of cholinergic nerves: 1. All preganglionic nerves in the ANS, both sympathic and parasympathic 2. Postganglionic nerves of the parasympathic system and a few SNS nerves, such as those that re-enter the spinal cord and cause body reactions such as sweating 3. Motor nerves on skeletal muscles 4. Cholinergic nerves within the CNS Ach is made by choline from the diet and packaged into storage vesicles to be released by the cholinergic nerve into the synaptic cleft. Ach is broken down to an inactive form almost immediately by acetylcholinestraterase. Parasympathic system receptors are classified as muscarinic or nicotine, depending on what response they have to these plant alkaloids.

General functions Works to regulate blood pressure, heart rate, respiration, body temperature, water balance, urinary excretion, and digestive functions, among other things. The minute-to-minute control exerted by this system results from interrelationship between opposing divisions of the autonomic system.

DIVISION OF THE AUTONOMIC NERVOUS SYSTEM Sympathetic nervous system (SNS) Anatomy Also called the thoracolumbar system. Is composed of CNS cells arising in thoracic or lumbar area of the spinal cord and long postganglionic axons that react with effector cells. The neurotransmitter used by the pregangiolionic cells is acetylcholine (Ach); the neurotransmitter used by the postganglionic celss is norepinephrine. Functions When stimulated, is responsible for the fight or flight response. It prepares the body for immediate reaction to stressors by increasing metabolism, diverting blood to big muscles, and increasing cardiac and respiratory function. Adrenergic Transmission Based on the effectors that they stimulate, SNS adregenic receptors are classified as alpha1-, alpha2-, beta1-, or beta2-receptors. Parasympathetic nervous system (PNS) Anatomy Also called craniosacral system It comprises CNS cells that arise in the cranium and sacral region of the spinal cord, long preganglionic axons that serete Ach, ganglia located very close to or within the effector tissue, and short postganglionic axons that also secrete ACh.
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Adrenergic Agent adrenergic agonists are drugs used to stimulate the adrenergic receptors within the SNS. They are also called sympathomimetic drugs because they mimic the effects of the SNS.

Drug theraphy across the life span Children are at greater risk for complications with the use of adrenergic agents, including tachycardia, hypertension, tachypnea, and gastrointestinal complications. It is good practice to have a second person check the dosage calculation before administering and children should be carefully monitored and supported during the use of these drugs. Adults Adults being treated with adrenergic agents for shock or shock-like states require constant monitoring and dosage adjustments based on thier response. Cautioned about the use of OTC drugs and alternative therapies that might increase the drug effects and cause serious adverse effects. Older adults Older patients are more likely to experience the adverse effects associated with these drugs. Because older patients often have renal or hepatic impairment, should be started on lower doses of the drugs and should be monitored very closely for potentially serious arrhythmias or blood pressure changes. I. Aplha- and beta-adrenergic agonists

Indications: treatment of hypotensive states or shock, bronchospasm, and some types of asthma. Contraindications: 1. Pheochromocytoma 2. Tachyarrhythmias ventricular fibrillation 3. Hypovolemia 4. Halogenated hydrocarbon general anesthetics 5. Any kind of peripheral vascular disease Adverse Effects: 1. SNS effects: a. Arrhythmias b. Hypertension c. Palpitations d. Angina e. Dyspnea(heart) and (CV)system 2. GI effects: a. nausea and vomiting 3. headache, sweating, and piloerection, rltd to the sympathetic stimulation Drugs interactions Inc. Effects fo tricyclic antidepressants and (MOAIs) can occur because of the increased. Norepinephrine levels or increased receptor stimulation that occurs with both drugs. With any other drugs that cause hypertension, there is an increased risk of hypertension. With ma huang, guarana, or caffeine may inc risk for overstimulation, including inc bp, stroke, and death. Drugs: dobutamine(Dobutrex) dopamine(intropin) prototype ephedrine(Pretz-D) epinephrine(Adrenalin, Sus-Phrine) metaraminol(Aramine) norepinephrine(Levophed) Nursing responsibilities: 1. assessment(history and examination) 2. use extreme caution in calculating and preparing doses of these drugs 3. always dilute drug before use, if it is not prediluted 4. monitor patient response closely and adjust dosage accordingly 5. maintain phentolamine on standby in case extravasation occurs 6. provide thorough patient teaching

Stimulate all of the adrenergic receptors in the SNS. They induce a fight-orfight response and are frequently used to treat shock.

Pharmacokinetics: generally absorbed rapidly injection or passage through mucous membranes. Metabolized in liver and excreted in urine. Should be used during pregnancy and lactation only if benefits clearly outweigh any potential risks for both mother and fetus. Action: the effects of the sympathomimetic drugs are mediated by the adrenergic receptors in target organs.

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II. Alpha-Specific Adregenic Agonists Action: therapeutic effects come from the stimulation of alpha receptors within SNS. Indications: varied, depending on route and the drug being used. Clonidine(hypertension), Phenylephrine(cold and allergy) and Midodrine(orthostatic hypotension). Pharmacokinetics: generally well absorbed and reach peak levels in a short period20 to 45 minutes. Metabolized in the liver and excreted in urine, and during pregnancy and lactation should be use only if clearly benefits outweights any risks. Contraindication presence of allergy to the specific drug pregnancy CV disease or vasomotor spasm Thyrotoxicosis or diabetes Lactation Renal or hepati impairment Adverse effects: Anxiety, restlessness, depression,fatigue, strange dreams, blurred vission and personality changes Arrhythmias, ECG changes, blood pressure changes and peripheral vascular problems Nausea and vomiting anorexia Genitourinary effects Drugs interactions Phenylephrine combined with MAOIs can cause severe hypertension, headache and hyperpyrexia Increased sympathomimetic effects occur when phenylephrine is combined with tricyclic antidepressants(TCAs) Clonidine has a decreased antihypertensive effect if taken with TCAs, and a paradoxical hypertension occurs if it is combined with propranolol. Midodrine can precipitate increased drug effects of digoxin, beta-blockers and many antipsychotics. Such combinations should be avoided Drugs: clonidine(catapres) midodrine(ProAmantine) phenylephrine(Neo-Synephrine) Prototype Nursing responsibilities: assessment(history and examination do not discontinue drug abruptly dont not dicontinue drug before surgery; mark the patients chart and monitor blood pressure carefully during surgery. Monitor V/S output regularly, even with ophthalmic preparations When giving phenylephrine intravenously, maitain an alpha-blocking agent on standby Provide care and comfort measures Provide thorough patient teaching, including dosage, potential adverse effects, safety measures, warning signs of problems, and proper administration for each route used II. Beta-Specific Adrenergic Agonists Used to manage and treat bronchial spasm, asthma, and toher obstructive pulmonary conditions.

MOA/Indications Therapeutics effects; increased heart rate, conductivity, and contractility; bronchodilation; increased blood flow to skeletal muscles and splanchnic beds; and relaxation of the uterus are the drugs desired effects. Indicated for the treatment of shock to increase cardiac activity; with cardiac arrest and certain ventricular arrhythmias to stimulate cardiac activity and conduction. Effective in treating heart blocks in transplanted hearts. Pharmacokinetics: Rapidly distributed after injection; it is metabolized in the liver and excreted in the urine. The half-life is relatively short-less than 1hr. Should be used during pregnancy and lactation only if the benefits clearly outweights any potential risks for both mother and fetus. Contraindications and Caution Isoproterenol is contraindicated in the presence of allergy to the drug or any components of the drug; with pulmonary hypertension; during anesthesia with halogenated hydrocarbons. With eclampsia, uterine hemorrhage, and intrauterine death Pregnancy and lactation With diabetes, thyroid disease, vasomotor problems, degenerative heart disease, or history of stroke. Adverse effects

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CNS effects; restlessness, anxiety, fear, tremor, fatigue, and headache. CV effects; tachycardia, angina, myocardial infarction, and palpitations. Pulmonary effects; difficulty in breathing, coughing, and bronchospasm to sever pulmonary edema GI effects; nausea, vomiting, and anorexia Sweating, pupil dilation, rash, and muscle cramps. Drug interactions Increased sympathomimetic effects if this drug taken with other sympathomimetic drugs. With beta-adrenergic blockers can decreased therapeutic effects. Drugs albuterol bitolterol isoetharine isoproterenol(Prototype) levalbuterol metaproterenol pirbuterol salmeterol terbutaline Nursing responsibilities any known allergies to any drug physical assessment, screening for baseline status before biginning theraphy monitor patient pulse and blood pressure carefully during administration maintain a beta-adrenergic blocker on standby when giving parenteral isoproterenol use minimal doses of isoproterenol needed to achieve desired effects arrange for supportive care and comfort measures, including rest and environmental control provide thorough patient teaching, including the name of the drug, dosage, anticipated adverse effects offer support and encourgement Adrenegic Blocking Agents or sympatholytic drugs, lyse or block the effects of the SNS.

Adults -

are at greater risk for complications associated with the use of adrenergid blocking agents, including bradycardia, difficulty in breathing, and changes in glucose metabolism. Dosage for these agents needs to be calculated from the childs body weight and age. Children should be carefully monitored and supported during the use of these drugs.

Cautioned about the many adverse effects associated with the drugs. With diabetes need to be re-educated about ways to monitor themselves for hyperglycemia and hypoglycemia With severe thyroid disease are also at highrisk when taking these drugs, (should be monitored very closely). Teratogenic Older adults Are more likely to experience the adverse effects associated with these drugs Because older patients often also have renal or hepatic impairment Should be started on lower doses of the drugs and should be monitored very closely for potentially serious arrhythmias or blood pressure changes. Alpha- and Beta-Adrenergic Blocking Agents Drugs that block all adrenergic receptors are primarily used to treat cardiac-related conditions. MOA/Indications Block all of the receptor sites within the SNS, which results in lower blood pressure, slower pulses, and increases renal perfusion with decreased renin levels. Indicated to treat essential hypertension, alone or with diuretics Pharmacokinetics Well absorded and distributed throughout the body Metabolized in the liver and excreted in the urine Are not recommended for use in children younger than 18yrs. Contraindications With bradycardia or heart blocks Asthma Shock or CHF Pregnancy and lactation With diabetes Bronchospasm Adverse effects I. -

Drug theraphy across the lifespan Children

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SNS effects; dizziness, paresthesias, insomnia, depression, fatigue, and vertigo GI effects; nause, vomiting, diarrhea, anorexia and flatulence CV effects; cardiac arrhythmias, hypotension, CHF, pulmonary edema, and cerebrovascular accident, or stroke Respiratory effects; bronchospasm, cough, rhinitis, and bronchial obstruction Decreased exercise tolerance, hypoglycemia, and rash.

Drug interactions Combine with enflurane, halothane, or isoflurance anesthetics can increased risk of excessive hypotension Effectiveness of diabetic agents is increased Carvedilol with verapamil or diltiazem is potentially dangerous conduction system disturbances Drugs amiodarone bretylium carvedilol guanadrel guanethidine labetalol(prototype) Nursing responsibilities any known allergies to these drugs screening for baseline status and any potential adverse effects do not discontinue abruptly after chronic theraphy consult with the physician about withdrawing the drug before surgery encourage patient to adopt lifestyle changes monitor for orthostatic hypotention and provide safety precautions monitor for any sign of liver failure provide thorough patient teaching offer support and encouragement II. Alpha-Adrenergic Blocking Agents

Pharmacokinetics Rapidly asborbed after injection and is exreted in the urine. Cautioned with pregnancy and lactation Contraindications Presence of allergy to this similar drugs -coronary artery deisease or myocardial infaction Pregnancy and lactation Adverse effects Hypotension, orthostatic hypotension, angina, MI, cerebravascular accident, flushing, tachycardia, and arrhythmia Weakness and dizziness Nausea, vomiting, diarrhea Drug interactions Ephedrine and epinephrine amy have decreased hypertensive and vasoconstrictive effects if they are taken concomitantly with phentolamine Increased hypotension may occur if this drug is combined with alcohol, which is also vasodilator. Drug -phentolamine(prototype) Nursing responsibilities Monitor heart rate and blood pressure very carefully Inject phentolamine directly into the area of extravasation of epinephrine or dopamine to prevent local cell death Arrange for supportive and comfort measures Provide thorough patient teaching Offer support and encouragement III. Alpha1-Selective Adrenergic Blocking Agents Are drugs that have a specific affinity for alpha1-receptors. MOA/indications Block the postsynaptic alpha1-receptor sites, causing a decrease in vascular tone and a vasodilation that leads to a fall in blood pressure without the reflex tachycardia that occurs when the presynaptic alpha2receptor sites are also blocked. Used to treat BPH or hypertension, alone or as part of a combination therapy. Pharmacokinetics Well absorbed and undergo extensive hepatic metabolism. Cautioned to pregnancy and lactation Contarindications

MOA/indications Specifically block the alpha-receptors of the SNS. At therapeutic levels, they do not block beta-receptors. Used to diagnose and manage episodes of pheochromocytoma. Phentolamine is also used to rescue cells injured by norepinephrine or dopamine extranvasation; it causes vasodilation and a return of blood flow to the area.
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Pregnancy and Lactations Presence of CHF and renal failure with hepatic impairment Adverse effects CNS effects: dizziness, weakness, fatigue, drowsiness, and depression. GI effects: nausea, vomiting, abdominal pain, and diarrhea CV effects: arrhythmias, hypotension, edema, CHF, and angina Drug interaction With any other vasodilating or antihypertensive drugs may increased hypotensive effects Drugs alfuzosin(Uroxatral) doxazosin(Cardura) prazosin(Minipress) tamsulosin(Flomax) terazosin(Hytrin) Nursing responsibilities Monitor blood pressure, pulse, rhythm, and cardiac output regularly Established safety precautions if CNS effects or orthostatic hypotension occurs Provide small frequent feeding Arrange for supportive care and comfort measures Provide thorough patient teaching Offer support and encouragement Beta-Adrenergic Blocking Agents -used to treat cardiovascular problems and to prevent reinfarction after MI -propranolol(Inderal) wasonce the most prescribed drug in the country MOA/indications Used to block the beta-receptors within the SNS. These drugs are sude ofr a wide range of problems, including hypertension, stage fright, migraines, angina, and essential tremors. Pharmacokinetics Absorbed in GI tract and undergo hepatic metabolism. Food with propranolol increase bioavailability, but was not found with other beta-adrenergic blocking agents. Contraindication With bradycardia or heart blocks, shock, or CHF With bronchospasm, COPD, or acute asthma
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Pregnancy and lactation With diabetes and hypoglycemia With thyrotoxicosis and with hepatic dysfunction Adverse effects CNS effects: fatigue, dizziness, depression, paresthesias, sleep disturbances, memory loss, and disorientation. CV effects: bradycardia, heart block, CHF, hypotension, and peripheral vascular insufficiency. Pulmonary effects: difficulty breathing, coughing, and bronchospasm to severe pulmonary edema and bronchial obstruction. GI effects: nausea, vomiting, diarrhea, gastric pain, and even colitis Genitourinary effects: decreased libido, impotence, dysuria, and Peyronies disease. Decreased exercise tolerance, hypoglycemia and hyperglycemia and liver changes. Drug interactions Paradoxical hypertension occurs when beta-blockers are given with clonidine, ad an increased rebound hypertension with clonidine withdrawal may also occur. Decreased antihypertensive effect occurs when beta-blockers are given with NSAID With epinephrine may occur initial hypertensive episode followed by bradycardia With insulin or antidiabetic agents, here is a potential for change in blood glucose levels.

IV.

Drugs carteolol(Cartrol) nadolol(Corgard) penbutolol(Levator) pindolol(Visken) propanolol(Inderal) Prototype sotalol(Betapace, Betapace AF) timolol(Biocadren, Timoptic) Nursing responsibilities Do not stop these drugs abruptly after chronic theraphy but taper gradually over 2 weeks Continuosly monitor nay patient receiving an intravenous form of these drug Arrange supportive and comfort measures Provide thorough patient teaching

V. -

Offer support and encouragement

Beta1-Selective Adrenergic Blocking Agents Do not block the beta1-receptors that are responsible for bronchodilation and therefore are preferred in patients with respiratory problems MOA/Indications Therapeutic effects: related to thier ability to selectively block beta1receptos in the SNS. These effects are useful in treating hypertension and chronic anina and can help to prevent reinfarction after an MI by decreasing cardiac workload and oxygen consumption. Opthalmic form, to decrease intraocular pressure and to treat open-angle glaucoma. Pharmacokinetics Are absorbed from GI tract, metropolol when taking with food may bioavailability increased. And crosses the blood-brain barrier and may cause more CNS effects than acebutolol and atenolol, which do not cross. Contraindications With sinus bradycardia Heart block Cardiogenic shock CHF Hypotension Pregnancy and lactation Diabetes Thyroid disease COPD Adverse effects CNS effects: fatigue, dizziness, depression, paresthesias, sleep distrubances, memory loss, and disorientation CV effects: bradycardia, heart block, CHF, hypotension, and peripheral vascular insufficiency Pulmonary effects: rhinitis to bronchospasm and dyspnea GI effects: nausea, vomiting , diarrhea, gastric pain an even colitis Genitourinary effects: decreased libido, impotence, dysuria, and Peyronies disease. Decreased exercise tolerance, hypoglycemia and hyperglycemia, and liver chages Drug interactions Decreased hypertensive effect occurs if these drugs are given with clonidine, NSAIDs, rifampin, or barbiturates.
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Initial hypertensive episode followed by bradycardia if these drugs are given with epinephrine. Increased serum level and increased toxicity of intravenous lidocaine will occur if it is given with these drugs. With prazosin can increased risk for postural hypotension With verapamil, cimetidine, methimazole, or propylthiouracil(increased effects)

Drugs acebutolol(Sectral) atenolol(Tenoromin) betaxolol(Kerlone, Betoptic) bisoprolol(Zebeta) esmolol(Brevibloc) metroprolol(Lopressor, Toprol XL Nursing responsibilities do not stop these drugs abruptly after chronic therapy consult with the physician about discountinuing give oral forms with food continuously monitor any patient receiving an intravenous form of these drugs arrange supportive and comfort measures provide thorough patient teaching offer support and encouragement Cholinergic Agents are chemicals that act at the same site as the neurotransmitter acetylcholine(ACh), stimulating the parasympathetic nerves, some nerves in the brain, and the neuromuscular junction. Drug therapy across the lifespan Children more susceptible to the adverse effects associated with the cholinergic agents children should be monitored closely if these agents are used and should receive appropriate supportive care. Adults cautioned about the many adverse effects that can be anticipated when using a cholinergic agent. Older adults older patients are more likely to experience the adverse effects associated with these drugs

because older often have renal or hepatic impairment

I. Direct-Acting Cholinergic Agonists -react with the Ach receptor sites to cause cholinergic stimulation MOA/Indications Act at cholinergic receptors in the peripheral nervous system to mimic the effects of Ach and parasympathetic stimulation. They are used to cause miosis and to treat glaucom; one agent is available to treat neurogenic bladder and bladder atony postoperative to increase GI secretions and relieve the dry mouth of Sjogrens syndrome. Pharmacokinetics Generally well absorbed and have relatively short half-lives, ranging from1to 6 hours. Unknown metabolism and excretion but is believed to occur at the synaptic level. And also unkown whether it can cross the placenta. Contraindication Used sparingly because of the potential undesirable systemic effects of parasympathetic stimulation. Contraindicated in the presence of any condition that would be exacerbated by parasympathetic effects. Cautioned (Pregnancy and lactation) Adverse effects Nausea, vomiting, cramps, diarrhea, increased salivation, and involuntary defecation Bradycradia, heart block, hypotension, and even cardiac arrest related to the cardiac-suppressing effects of the parasympathetic nervous system. Drug interactions With acetylcholinesterase inhibitors there is an increased risk of cholinergic effects Drug bethanechol(Duvoid, Urecholine) carbachol(Miostat) cevimeline(Evoxac) pilocarpine(Pilocar) Nursing responsibilties ensure proper administration of ophthalmic preparation administer oral drug on an empty stomach monitor patient response closely provide safety precautions if the patient reports poor visual acuity in dim light provide thorough patient teaching offer support and comfort measures
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monitor patient response to drug monitor for adverse effects II. Indirect-Acting Cholinergic Agents

Are acetylcholinesterase inhibitors. They block acetylcholinesterase to prevent it from breaking down ACh in the synaptic cleft. Agents used to treat myasthenia gravis Newer agents used to treat Alzheimers disease. MOA/indications Work by blocking acetylcholinesterase at the synaptic cleft. This blocking allows the accumulation of ACh released form the nerve endings and leads to increased and prolonged stimulation of ACh receptor sites at all of the postsynaptic cholinergic sites. Treatment for myasthenia gravis and alzheimers disease Pharmacokinetics Well absorded and distributed throughout the body. Drugs used to treat myasthenia gravis do not cross the blood-brain barrier Fro Alzheimers disease are metbaolized int he liver by the cytochrome P450 system Contraindications With bradycardia or intestina or urinary tract obstruction Pregnancy and lactation With asthma, coronary disease, peptic ulcer, arrhythmias, epilepsy or parkinsonism. Adverse effects GI effects: nausea, vomiting, cramps, diarrhea, increased salivation, and involuntary defecation CV effects: bradycardia, heart block, hypotension, and even cardiac arrest Urinary tract effects: sense fo urgency CNS cholinergic effects: miosis and blurred vision, headaches, dizzeiness, and drowsiness Flushing and increased sweating Drug interactions With NSAIDs may increased risk of GI bleeding Effect of anticholinesterase drugs is decreased if they are taken in combiation with any cholinergic drugs Theophylline levels can be increased up to twofold if combined with tacrine Drugs ambenonium(Mytelase) donepezil(Aricept) prototype edrophonium(Tensilon, Enlon) -

galantamine(Razadyne) neostigmine(Prostigmine) pyridostigmine(Regonol, Mestinon) rivastigmine(Exelon) tacrine(Cognex) Nursing responsiblities if the drug is given intravenously, administer it slowly maintain atropine sulfate on standby as an antidote in case of overdose or severe choloinergic reaction. Discontinue the drug if excessive salivation, diarrhea, emesis, or frequent urination becomes a problem Administer te oral durg with meals Mark the patients chart and notify the surgeon if the patient is to undergo surgery Monitor the patient being treated for Alzheimers Disease for nay progress The patient being treated for myasthenia gravis and a significant other should recive instruction in durg adminstration, warning signs of drug overdose, and signs and symptoms ro report iimmedidiately III. Drug Reversing agent

pralidoxime(Protopam Chloride)

-antidote for irreversible acetylcholinesterase-inhibiting drugs. -does not crss the blood-brain barrier, and it is most useful for treating peripheral drug effects. Anticholinergic Agents block the effects of acetylcholine at acholinergic receptor sites also called parasympatholytic drugs because they blokc the effects of the parsympathetic nervous system. Drug therapy across the lifespan Children are often more sensitive to the adverse effects of the drugs, including constipation, urinary retention, heat intolerance, and confusion child should be closely watched and monitored for adverse effects, and appropriate supportive measures should be instituted. Adults
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they should be encouraged to void before taking the medication if urinary retention or hesitancy is a problem. Safety precautions may be needed if blurred vision and dizziness occur. Older adults Dosage should be reduced, and the patient should be monitored very closely Because older patients are more susceptible to heat intolerance owing to decreased body fluid and decreased sweating, extreme caution should be used when an anticholinergic drug is given. MOA/indication Competitively block the acetylcholine receptors at the muscarinic cholinergic receptor sites that are responsible for mediating the effect of the parasympathetic postganglionic impulses. Blcking of the parasympathetic system causes an increase in heart rate, decrease in GI activity, decrease in urinary bladder tone and function, and pupil dilation and cycloplegia. Pharmacokinetics Well absorbed after administration Widely distributed throughout the body and cross the blood-brain barrier Their half-life vary with route and drug Excreted in the urine Cautioned in pregnancy and lactation Contraindication Glaucoma Stenosing peptic ulcer intestinal atony paralytic ileus, GI obstruction, severe ulcerative colitis, and toxic megacolon Prostatic hypertrophy and bladder obstruction Cardiac arrhythmias,tachycardia, and myocardial ischemia Impaired liver or kidney Myasthenia gravis Pregnancy and lactation Adverse effects CNS effect: blurred vision, pupil dilation and resultant photophobia, cycloplegia and increased intraocular pressure Weakness, dizziness, insomia, mental confusion, and excitments Drymouth, nausea, altered taste, heartburn, constipation, bloated feelings and paralytic ileus Tachycardi and palpatation Urinary hesitancy and retention Drug interactions The incidence of anticholinergic effects increases if these drugs are combined with any other drugs with anticholinergic activity, including -

antihistamines, antiparkinsonism drugs, MAOIs, TCAs. And advised to avoid OTC drugs Drug atropine(generic) dicyclomine(Antispas, Dibent) glycopyrrolate(Robinul) propantheline(Pro-Banthine) scopolamine(Trandsdermal Scop)

Nursing responsibities ensure proper administration of the drug ensure adequate hydration and temperature control provide comfort measures monitor patient response closely provide thorough patient teaching offer support and encouragement

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