CC Jan 2015 Anticholingergic toxicity

echoecho's version from 2015-07-03 15:57


Question Answer
Define anticholinergic syndrome?develops when a patient ingests 1 or more meds w/ anticholinergic properties
List common meds w/ anticholinergic properties?antihistamines, antinauseants, incontinence meds, TCA
True or false. The degree of anticholinergic activity can vary greatly among medications?true
What can increase the chance of anticholinergic syndrome?1) ingestion of a combination of these meds OR 2) over ingestion of a single agent (overdose)
Since there are medications that are available without a prescription that have anticholinergic properties, what should providers be aware of?anticholinergic toxicity
What antimuscarinic used for overactive bladder is OTC?oxybutynin patch (Oxytrol)
Anticholinergic syndrome may be predominately ____ , _____ or both?central; peripheral
In central anticholinergic syndrome, muscarinic blockade of acetylcholine receptors can lead to what symptoms?agitations, confusion, seizures, central hyperthermia
List two conditions that can occur in severe cases of central anticholinergic syndrome?respiratory depression; coma
*** Peripheral anticholinergic syndrome can lead to a wide array of symptoms. ______ is often the earliest sign. Comment on bowel sounds?tachycardia; decreased or absent bowel sounds
List the 6 manifestations of anticholinergic toxicity with mnemonic?1) Mad as a hatter (anxieity, agitation, confusion, disorientation, visual hallucinations, delirium, psychosis, seizure, coma) 2) Dry as a bone (dry skin from anhydrosis 3) Red as a beet (redness of skin as flushing due to venous dilation) 4) Blind as a bat (mydriasis seen by pupillary dilatation that is nonreactive resulting in poor accomodation and blurry vision 5)Hot as a hare (hyperthermia due to anhidrosis and inability to dissipate heat) 6) Full as a flask: urinary retention due to loss of detrusor contraction and lack of relaxation of the urethral sphincter
Give an example of what medications a patient could be taking to initiate anticholinergic toxicity?Scopolamine + Imodium + Benadryl + Xanax
True or false. Xanax has weak anticholinergic properties which alone would probably not be problematic but in conjunction with the other meds could lead to toxicitytrue
Management of anticholinergi syndrome consitsts of what?patient stablization and supportive measures (airway, breathing, circulation assessed and IV access obtained along w/ appropriate monitoring of cardiac status and pulse oximetry)
Cooling the patient can help prevent what?severe tissue injury, rhabdomyolysis and renal failure
How is agitation and seizures initially managed?benzodiazepines (even though these meds have possible mild anticholinergic effects)
How are arrhythmias and prolonged QTc treated?sodium bicarbonate
Most patients w/o severe symptoms are adequately treated wit ?supportive measure
What treatment is needed for a patient who has anticholinergic toxicity as a result of ingestion in non-obtunded patients?gastric decontamination (in non-obtunded patients, 1 gram/kg of activitated charcoal in a single dose administered even hours AFTER the ingestion since anticholinergic toxicity causes slowed peristalsis resulting in delayed gut emptying). In obtunded patients, gastric lavage is an option if administered WITHIN an hour of ingestion. Induced emesis is NOT recommended
Comment on Physostigmine as treatment for anticholinergic toxicity?option for moderate to severe anticholinergic toxicity (especially for patients with hemodhynamic instability, intractable seizures or severe agitation or psychosis).
How does Physotigmine work?it is an acetylcholinesterase inhibitor that binds reversibly to inhibit acetylcholinesterase in both peripheral and central nervous system.
*** Physostigmine crosses the ___ - _____ barrier and therefore can help to manage both ____ and ____ effects of anticholinergic meds. Physostigmine can lead to a rapid improvement in ____ status and ____ function?blood-braine; central; peripheral; mental; cognitive
How is Physostigmine given and what type of monitoring is required?IV; cardiac monitoring
Comment on Physostigmine repeat dosing and is it associated with shorter lengths of stay?usually repeat dosing is not needed; no shorter lengths of stay are not associated with its use
What type of patient should not be given Physostigmine?cases of prolonged PR or QRS intervals
What two meds may be used to help treat sinus tachycardia but neither agent is effective in treating the other s/s of anticholinergic syndrome?1) Metoprolol (Lopressor) 2) diltiazem (Cardizem)