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18-4 Anticholinergic
Table 18-4 Anticholinergics
| Generic (Brand) | Route and Dosage | Uses and Considerations |
|---|---|---|
| Glycopyrrolate (Robinul) | GI disorders:A: PO: 1–2 mg b.i.d./t.i.d.IM/IV: 0.1-0.2 mg t.i.d./q.i.d.Preoperative:A: IM: 4.4 mcg/kg 30 min-1 h before surgery | Presurgery to reduce secretions and for peptic ulcer. Contraindicated in clients with narrowangle glaucoma, obstructive GI tract, ulcerative colitis. Pregnancy category: B; PB: UK; t½: 1-4.5 h |
| hyoscyamine SO4 (Cystospaz, Anaspaz, Levsin) | A: PO/SL: 0.125-0.25 mg t.i.d./q.i.d. a.c. and at bedtimeSR: 0.375-0.75 mg/q12hsubQ/IM/IV: 0.25-0.5 mg b.i.d./q.i.d., PRNC: 2–10 y: half adult dose or individualized | Treatment of peptic ulcer and IBS. Controls gastric secretion and spastic bladder. Contraindicated in clients with narrow-angle glaucoma and severe ulcerative colitis. Pregnancy category: C; PB: 50%-60%; t½: 3.5 h |
| isopropamide iodide (Darbid) | A: PO: 5 mg b.i.d. or q12h; may increase to 10 mg b.i.d. | To treat peptic ulcer and IBS. Not for use in children under 12 y. Pregnancy category: C; PB: UK; t½: UK |
| methscopolamine bromide (Pamine) | A: PO: 2.5 mg a.c. and 2.5-5.0 mg at bedtime | Treatment of peptic ulcer, IBS. Avoid use in clients with prostatic hypertrophy and intestinal atony. Pregnancy category: C; PB: UK; t½: UK |
| oxyphencyclimine HCl (Daricon) | A: PO: 5–10 mg b.i.d., t.i.d. | For peptic ulcer, IBS. Not for use in children under 12 y. Pregnancy category: C; PB: UK; t½: UK |
| propantheline bromide (Pro Banthine) | A: PO: 15 mg a.c. t.i.d.; 30 mg at bedtime; max: 120 mg/dElderly: 7.5 mg a.c. t.i.d.; max: 90 mg/d | Antispasmodic for peptic ulcer, IBS. Also used for pancreatitis and urinary bladder spasm. Pregnancy category: C; PB: UK; t½: 9 h |
| scopolamine hydrobromide (also hyoscine hydrobromide) | Preoperative:A: PO: 0.5-1 mgsubQ/IM/IV: 0.3-0.6 mgC: subQ: 0.006 mg/kg or 0.2 mg/m2; max: 0.3 mgMotion sickness:A: PO: 0.3-0.6 mg; transderm patch: 1 patch behind ear q72h | For preanesthetic drug, IBS, motion sickness, and delirium. Contraindicated in clients with narrow-angle glaucoma, obstructive GI disease, severe ulcerative colitis, and paralytic ileus. Pregnancy category: C; PB: 30%; t½ 8 |
| cyclopentolate HCl (Cyclogyl) | 0.5%-2%, sol, 1–2 gtt | For mydriasis and cycloplegia for eye examination |
| tropicamide (Mydriacyl Ophthalmic) | 0.5%-1% sol, 1–2 gtt | For mydriasis and cycloplegia for eye examination |
| homatropine (Isopto Homatropine) | 2%-5% sol, 1–2 gtt | For mydriasis and cycloplegia (paralysis of ciliary muscle resulting in loss of accommodation) for eye examination |
| benztropine mesylate (Cogentin) | Parkinsonism:A: PO: IV: Initially 0.5-1.0 mg/d in 1–2 divided doses (larger dose at bedtime); maint: 0.5-6 mg/d in 1–2 divided dosesEPR: A: PO: 1–2 mg, b.i.d. | Treatment of parkinsonism and drug-induced extrapyramidal syndrome |
| biperiden lactate (Akineton) | Parkinsonism:A: PO: 2 mg t.i.d./q.i.d.IM/IV: 2 mg q30min for 4 dosesElderly: PO: 2 mg in 1 or 2 divided doses | Treatment of parkinsonism and drug-induced extrapyramidal syndrome |
| procyclidine HCl (Kemadrin) | Parkinsonism:A: PO: 2.5-5 mg p.c. t.i.d.; maint: 10–20 mg/d | Treatment of parkinsonism and drug-induced extrapyramidal syndrome |
| ipratropium bromide (Atrovent) | A: Inhal: 2 inhal q.i.d.C: >3 y: Inhal: 1 or 2 inhal t.i.d. | Anticholinergic bronchodilator to treat chronic obstructive pulmonary disease by blocking action of acetylcholine at bronchial smooth muscle sites, promoting bronchodilation. Pregnancy category: B; PB: UK; t½: UK |
| tolterodine tartrate (Detrol, Detrol LA) | A: PO: 2 mg b.i.d. or 4 mg SR daily | To decrease urinary frequency, urgency, and incontinence.Mode of Action: Blocks cholinergic (muscarinic) receptors selectively in urinary bladder |
| trihexyphenidyl HCl (Artane, Trihexy) | Parkinsonism:A: PO: Initially 1–2 mg/d; increase to 6–10 mg/d in 3 divided doses; max: 15 mg/dlExtrapyramidal symptoms (drug induced):A: PO: 1 mg/d; increase to 5–15 mg/d in divided doses | To decrease involuntary symptoms of parkinsonism or drug-induced parkinsonism by inhibiting acetylcholineMode of Action: Blocks cholinergic (muscarinic) receptors to decrease involuntary movements. |
| atropine sulfate | A: PO/IM/IV: 0.4-0.6 mg q4-6h PRNC: PO/IM/IV: 0.01 mg/kg/dose; max: 0.4 mg/dose, q4-6h, PRN | Preoperative medication to reduce salivation, increase heart rate, dilate pupils; Inhibition of acetylcholine by occupying the receptors; increase heart rate by blocking vagus stimulation; promote dilation of the pupils by blocking iris sphincter muscle |
| dicyclomine HCl (Bentyl, Antispas, Di-Spaz) | A: PO: 10–20 mg t.i.d./q.i.d.IM: 20 mg q6hC: >2 y: PO: 10 mg t.i.d./q.i.d. | For IBS. Avoid use in clients with narrow-angle glaucoma, severe ulcerative colitis, paralytic ileus. Pregnancy category: B; PB: UK; t½: 9–10 h |
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