Presentation
The patient presented with acute delirium and was successfully treated with physostigmine. [ncbi.nlm.nih.gov]
Entire Body System
- Fever
Image copyright (C) British Broadcasting Corporation A study has linked commonly used medicines, including over-the-counter treatments for conditions such as insomnia and hay-fever, to dementia. [bbc.com]
The quantity of saliva prodiced during surgery and incidence of fever were recorded. [ncbi.nlm.nih.gov]
Mild Anticholinergic Toxicity Moderate Anticholinergic Toxicity Severe Anticholinergic Toxicity Tachycardia Flushed face Mydriasis and blurred vision Dry mouth and skin Fever Agitated delirium Urinary retention Hypertension Hyperthermia CNS depression [rch.org.au]
Fever was finally attributed to a rather clinically nonsignificant, short-term infection, unable to be specified by laboratory and imaging methods. [dx.doi.org]
- Rigor
[…] home residents. 8, 9 We conclude that there is some reason to be concerned that long-term anticholinergic drug use might increase the subsequent risk of dementia, even though this conclusion needs to be confirmed by longer and more methodologically rigorous [ti.ubc.ca]
[…] cognitive decline, suggesting causality. 8 But a single blind RCT in Norway found no improvements in cognitive function eight weeks after reducing anticholinergic drugs in patients at nursing homes. 9 And a systematic review has concluded that “very little rigorous [bmj.com]
Until these new alternatives undergo rigorous comparative trials, oxybutynin will remain first-line in pharmacotherapy in Australia. [nps.org.au]
Gastrointestinal
- Constipation
This commonly leads to constipation and potentially to more severe complications such as bowel obstruction and ischemia. [ncbi.nlm.nih.gov]
The most important are central anticholinergic effects and include dry mouth, blurred vision, nausea, constipation, postural hypotension, dizziness, headache and tachycardia. [dictionary.cambridge.org]
Constipation Anticholinergics slow digestion by affecting the ability of the intestines to contract. They also cause decreased secretions to provide moisture to intestinal contents. Constipation is a common side effect that results. [livestrong.com]
- Decreased Bowel Sounds
Peripheral inhibition is variable - but the symptoms may include: hot, dry skin, flushed appearance, mydriasis, tachycardia, decreased bowel sounds and urinary retention. [rch.org.au]
This may involve peripheral receptors (eg, in the heart, salivary glands, sweat glands, gastrointestinal tract, and genitourinary tract) with resulting tachycardia, hyperthermia, dry skin and mucous membranes, mydriasis, decreased bowel sounds and urinary [ncbi.nlm.nih.gov]
Jaw & Teeth
- Xerostomia
[…] secretion and xerostomia. © 2017 John Wiley & Sons A/S and The Gerodontology Association. [ncbi.nlm.nih.gov]
‘The administration of antihypertensive and anticholinergic medications also impairs salivary functions and promotes xerostomia.’ [en.oxforddictionaries.com]
Cardiovascular
- Tachycardia
All five patients presented with classic signs and symptoms of anticholinergic toxicity, which included tachycardia, hot, dry and flushed skin, markedly dilated and fixed pupils, and pronounced delirium. [ncbi.nlm.nih.gov]
An overdose can result in anticholinergic syndrome, which manifests in disorientation, hyperthermia, tachycardia, and/or coma. [amboss.com]
- Hypertension
We suggest that adding dexmedetomidine as an adjunctive agent in the therapy of anticholinergic toxidrome may relieve the symptoms of agitation, psychosis, tachycardia, and hypertension, without the attendant risk of respiratory depression associated [ncbi.nlm.nih.gov]
- Orthostatic Hypotension
[…] an·ti·cho·lin·er·gic | \ -ˌkō-lə-ˈnər-jik \ Definition of anticholinergic : opposing or blocking the physiologic action of acetylcholine The more sedating tricyclic antidepressant drugs … are more likely to produce orthostatic hypotension and such adverse [merriam-webster.com]
Factors significantly associated with a risk of a fall were: a prior history of a fall in the previous 12 months (adjusted odds ratio [aOR] = 7.24, 4.06-12.89), orthostatic hypotension ([aOR] = 2.84; 1.39-5.79), or prescription of antidepressants ([aOR [ncbi.nlm.nih.gov]
hypotension author only provided incidences, at least 34% Roux 1983 Tiapride no side effects reported ‐‐ Johnston 1972 Thioridazine No untoward effects were observed or reported at any time during the study ‐‐ Davidsen 1979 Levomepromazine Dry mouth [cochranelibrary.com]
hypotension (severe drop in systolic blood pressure when standing up suddenly) and significantly increased risk of falls in the elderly population.[16] Older patients are at a higher risk of experiencing CNS side effects. [en.wikipedia.org]
hypotension Constipation Dysphagia Excessive sweating Heat intolerance Urinary Sexual dysfunction. [www2.kumc.edu]
Skin
- Flushing
All five patients presented with classic signs and symptoms of anticholinergic toxicity, which included tachycardia, hot, dry and flushed skin, markedly dilated and fixed pupils, and pronounced delirium. [ncbi.nlm.nih.gov]
Anticholinergic syndrome (overdose) Etiology Clinical features Dry mouth, warm, flushed skin, thirst, tachycardia, arrhythmias, mydriasis, confusion, and agitation Possibly anticholinergic delirium : Excessive use of tricyclic antidepressants (or other [amboss.com]
- Decreased Sweating
Side effects can include: dry mouth blurry vision constipation drowsiness sedation hallucinations memory problems trouble urinating confusion delirium decreased sweating decreased saliva Dementia warning Long-term use of anticholinergics, as well as use [healthline.com]
Peripheral effects include drying of the mouth and eyes, decreasing sweating, constipation and tachycardia. Central effects may include drowsiness, memory impairment, hallucinations, delirium, excitement and/or restlessness. [cpsa.ca]
sweating/dry skin Bladder Difficulty starting urination/impaired bladder emptying Urinary retention/overflow incontinence Subtle and not-so-subtle toxicity Students often learn the adverse effects of anticholinergics from a mnemonic, e.g.: “Blind as [ti.ubc.ca]
The features of toxicity at peripheral and central receptors can be remembered using the following mnemonic "Hot as a hare": Fever "Red as a beet:" Flushed skin "Blind as a bat": Mydriasis "Dry as a bone": Dry mouth, dry eyes and decreased sweating "Mad [rch.org.au]
Anticholinergic drugs decrease the activity of muscles in the gut and reduce production of sweat, saliva, digestive juices, urine, and tears. [medicinenet.com]
Psychiatrical
- Auditory Hallucination
On presentation to the ED, the patient was noted to be disorientated and appeared to be responding to visual and auditory hallucinations; he was trying to touch imaginary objects. The Glasgow Coma Score (GCS) was 13/15. [ncbi.nlm.nih.gov]
Urogenital
- Urinary Retention
Potential adverse effects include blurred vision, dry mouth, constipation and urinary retention A lack of ability to urinate.. [parkinson.org]
When drugs with anticholinergic effects are given to immobilized patients such as those with severe depression, close observation including monitoring of urine volume is needed to prevent IVCS caused by drug-induced urinary retention, and subsequent PE [ncbi.nlm.nih.gov]
The number of such drugs is larger than most clinicians realize. 3 Lists vary, 4 and may not include drugs whose active metabolites are potently antimuscarinic, 5 or which often cause typical AC adverse effects such as dry mouth or urinary retention. [ti.ubc.ca]
Urinary retention may contribute to the agitation. Bladder scan will reveal the need for a urinary catheter. The use of decontamination / enhanced elimination depend on the actual medication exposure, and should be discussed with a toxicologist. [rch.org.au]
retention and paralytic ileus ), and the heart runs alone ( tachycardia ).” [amboss.com]
Neurologic
- Confusion
A 33-year-old man with a history of recreational benztropine abuse presented to the emergency department with confusion, abdominal pain, and distention. An abdominal radiograph revealed gross fecal loading. [ncbi.nlm.nih.gov]
Older individuals are susceptible to confusion and hallucinations on anticholinergics, so these agents should be avoided in people older than 70. [parkinson.org]
Confusion and Memory Loss The elderly suffer increased risk of confusion and memory loss while taking anticholinergic drugs. [livestrong.com]
- Agitation
The patients were violently agitated, and physical restraint was required. Initial treatment with benzodiazepines did not diminish their combative behavior. [ncbi.nlm.nih.gov]
[…] severe postoperative agitation following a general anaesthetic. [academic.oup.com]
The characteristic feature of toxicity at central receptors is agitated delirium. [rch.org.au]
- Seizure
Half an hour after routine fundoscopy, a 62-year-old man experienced two generalized seizures with respiratory arrest and required intubation and mechanical ventilation. The patient was treated with physostigmine and made a full recovery. [ncbi.nlm.nih.gov]
Treat seizures with benzodiazepines Treat hypoglycaemia Treat hyperthermia with cooling measures. Antipyretics are unhelpful. Reassurance and management in a quiet area may be sufficient for those with mild signs/symptoms. [rch.org.au]
January 13, 2013 AGENTS anti-histamines anti-parkinsonians atropine anti-spasmodics mydriatics skeletal muscle relaxants plants CLINICAL FEATURES delirium tachycardia dry and flushed skin dilated pupils myclonus hyperthermia urinary retention bowel sounds seizures [lifeinthefastlane.com]
Also life threatening complications such as ventricular arrythmias, rhabdomyolysis and seizures can occur. It can be difficult to distinquish from the… CONTINUE READING References Publications referenced by this paper. [semanticscholar.org]
- Stupor
The varied presentation of the syndrome ranging from somnolence, confusion, amnesia, delayed recovery, stupor, coma to agitation, hallucinations, dysarthria, ataxia, delirium makes it difficult to diagnose accurately - hence a diagnosis of exclusion. [academic.oup.com]
Signs And Symptoms : Serious overdose with hydrocodone is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle [web.archive.org]
[…] switching from subject to subject OR Altered level of consciousness (any of the following count as altered level of consciousness) Vigilant Hyperalert Overly sensitive to environmental stimuli Startled very easily Lethargic Drowsy but easily aroused Stupor [www2.kumc.edu]
- Agitated Delirium
The characteristic feature of toxicity at central receptors is agitated delirium. [rch.org.au]
The onset of symptoms is dose-dependent and includes ataxia, disorientation, short-term memory loss, confusion, hallucinations, psychosis, agitated delirium, seizures, coma, respiratory failure and cardiovascular collapse.[ 13 ] Furthermore, clinical [ncbi.nlm.nih.gov]
[…] noted that escalating doses of benzodiazepines enhance the risk of intubation. [25] Severe delirium or difficulty in the management of agitation could also be treated with antipsychotic drugs in low doses, such as haloperidol and droperidol. [dx.doi.org]
Treatment
No untoward effects occurred as a result of treatment with physostigmine. [ncbi.nlm.nih.gov]
Prognosis
Discussing reporting deficiencies: prognosis research is frequently confounded by poor reporting and possible publication bias. [cochranelibrary.com]
Etiology
In 6/30 the population comprised SCI patients with neurogenic bladder alone; the remainder included mixed neurogenic etiologies. [ncbi.nlm.nih.gov]
Etiology Drugs and medications with anticholinergic effects include the following: Anticholinergics: Atropine, scopolamine, benztropine, glycopyrrolate, ipratropium Antihistamines: Diphenhydramine, promethazine, doxylamine Antipsychotics: Chlorpromazine [unboundmedicine.com]
‘In each of these cases, once the iatrogenic etiology of this syndrome was recognized, the patients' symptoms improved rapidly and dramatically with administration of anticholinergic medication.’ [en.oxforddictionaries.com]
Causes include: Obstruction – prostate hypertrophy, urethral stricture, cystocele, pelvic mass Hypocontractility – associated with both muscular and neurologic etiologies. [web.archive.org]
Anticholinergic syndrome (overdose) Etiology Clinical features Dry mouth, warm, flushed skin, thirst, tachycardia, arrhythmias, mydriasis, confusion, and agitation Possibly anticholinergic delirium : Excessive use of tricyclic antidepressants (or other [amboss.com]
Epidemiology
METHODS: This retrospective cohort database study used the Hispanic Established Populations for the Epidemiologic Study of the Elderly cohort. [ncbi.nlm.nih.gov]
He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]
Epidemiology Anticholinergic poisoning occurs either from intentional ingestion of certain plants or over-the-counter medications (e.g., Jimson weed, diphenhydramine) (Can J Emerg Med 2007;9(6):467) or from accidental overdosing (e.g., medical noncompliance [unboundmedicine.com]
Next, we included the Center for Epidemiologic Studies Depression Scale score category at each visit in the model rather than a history of depressive symptoms. [doi.org]
J Fr Ophtalmol, 21(6): 415-24 [ CR ] [ PM ] [ CHE ] [ EČ ][ GS ] Lin, L.L., Shih, Y.F., Tsai, C.B., Chen, C.J., Lee, L.A., Hung, P.T., Hou, P.K. (1999) Epidemiologic study of ocular refraction among schoolchildren in Taiwan in 1995. [scindeks.ceon.rs]
Pathophysiology
Elderly patients can be particularly sensitive to the anticholinergic action of drugs because of physiological and pathophysiological changes that often accompany the aging process. [ncbi.nlm.nih.gov]
Antidepressants: Amitriptyline, nortriptyline, imipramine, desipramine Antiparkinson drugs: Benztropine, trihexyphenidyl Mydriatics: Cyclopentolate, homatropine, tropicamide Muscle relaxants: Cyclobenzaprine Plants: Belladonna, Jimson weed, Amanita mushrooms Pathophysiology [unboundmedicine.com]
PATHOPHYSIOLOGY Normal micturition (urination) depends on several factors working synchronously. Many pathological processes and age-related changes can result in UI. [web.archive.org]
Schizophrenia research, 147(1): 103-9 [ PM ] [ EČ ][ GS ] Dean, B. (2011) Understanding the role of inflammatory-related pathways in the pathophysiology and treatment of psychiatric disorders: evidence from human peripheral studies and CNS studies. international [scindeks.ceon.rs]
This last point is important because the pathophysiological changes in the brains of patients with AD require several years to occur. 16 Finally, these studies did not take into account that certain anticholinergics are used to manage insomnia and depression [doi.org]
Prevention
Controller Medications Prevent asthma symptoms from occurring Can reduce and/or prevent: Inflammation and scarring in the airways Tightening of the muscle bands around the airways (bronchospasm) Do not show immediate results, but work slowly over time [pamf.org]
Others are used to prevent nausea, vomiting, and motion sickness. Anticholinergics and antispasmodics are also used in certain surgical and emergency procedures. [mayoclinic.org]
When drugs with anticholinergic effects are given to immobilized patients such as those with severe depression, close observation including monitoring of urine volume is needed to prevent IVCS caused by drug-induced urinary retention, and subsequent PE [ncbi.nlm.nih.gov]