The patient presented with acute delirium and was successfully treated with physostigmine. [ncbi.nlm.nih.gov]

• Falling

  No association was detected between the scores and the risk of a fall (p > 0.05). [ncbi.nlm.nih.gov]

• 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]

• Crying

  An 80-year-old man with Alzheimer's dementia presented with wandering, depressed mood with crying, somatic worries, anedonism and suicide recurrent ideas. [ncbi.nlm.nih.gov]

  The withdrawal signs include irritability and excessive crying, tremors, hyperactive reflexes, increased respiratory rate, increased stools, sneezing, yawning, vomiting and fever. [web.archive.org]

• Congestive Heart Failure

  Potential impacts of the use of drugs with anticholinergic activity can include worsening of existing health conditions such as ischemic heart disease/angina, benign prostatic hyperplasia, congestive heart failure, and cognitive decline. [cpsa.ca]

  In fact, researchers remain uncertain about the validity of the findings because medications with possible anticholinergic effects are used for many diseases (eg, hypertension, congestive heart failure); therefore, the results may, after all, reflect [pharmacytimes.com]

• Dyspnea

  As exercise tolerance and the ability to undertake everyday activities are often compromised in COPD, primarily due to dyspnea, any reduction in dyspnea will be an important treatment goal. [ncbi.nlm.nih.gov]

  […] the shoulder results from contraction of the ipsilateral trapezius Cranial Nerve XII – Hypoglossal nerve Evaluation: Have the patient stick out their tongue and move it side to side “Bulbar weakness” - Symptoms such as dysphagia, dysarthria, diplopia, dyspnea [www2.kumc.edu]

• Bronchial Spasm

  … anticholinergic drugs used to treat a broad range of conditions, from overactive bladder to bronchial spasms. — Melinda Beck [merriam-webster.com]

• 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]

• Dysphagia

  Autonomic dysfunction early in the disease course, generally suggests Shy Drager syndrome (a form of multiple system atrophy) – see below (MSA in “Parkinson’s Plus” Syndromes list) Autonomic symptoms seen in PD include Orthostatic hypotension Constipation Dysphagia [www2.kumc.edu]

  […] not meaningful due to the patients underlying condition.To assess severity of impairment of geriatric patients, the AFGIB (Ärztliche Arbeitsgemeinschaft zur Förderung der Geriatrie in Bayern) developed the 4D+S scale assessing dementia, depression, dysphagia [journals.plos.org]

• 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]

• 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]

• 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]

• 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]

• Urinary Incontinence

  incontinence (5 to 8 episodes vs. ≥9 episodes of urgency urinary incontinence in a 3-day period), and site. [nejm.org]

  Urinary incontinence surgery: When other treatments aren’t enough. Available online at: http://www.mayoclinic.com/health/urinary-incontinence-surgery/WO00126 Weiss, B. D. (2005). Selecting medications for the treatment of urinary incontinence. [web.archive.org]

  Urinary Incontinence in Women: Types, Causes, and Treatments for Bladder Control Urinary incontinence in women is a common problem. Overactive bladder (OAB), stress incontinence, and urge incontinence can be... [medicinenet.com]

  The primary outcome measures were the mean decrease in urge urinary incontinence episodes and the mean decrease in the frequency of micturition. [ncbi.nlm.nih.gov]

  The most commonly used anticholinergic-type drugs were medicines for treating depression, antihistamines for allergies such as hay-fever or to aid sleep/promote drowsiness, and drugs to treat urinary incontinence. [bbc.com]

• Nocturia

  Micturition number per 24 hours, daytime frequency, urgency, the PPIUS score, the IPSS question 4 score and IPSS QoL score improved significantly in the combination therapy group, but changes in total IPSS, nocturia episodes, and safety outcomes did not [ncbi.nlm.nih.gov]

  […] cycloplegia First drug of choice in unstable (symptomatic) sinus bradycardia (IV) Premedication: prior to intubation to decrease salivary, respiratory, and gastric secretions Ophthalmology: uveitis Urinary urgency, urge incontinence, urinary frequency and/or nocturia [amboss.com]

  […] bladder capacity Frequency, urgency, nocturia New/worsened: Urge, Stress, Mixed Detrusor overactivity (about 20% of continent persons) Frequency, urgency, nocturia Urge; Mixed; DHIC Increased postvoid residual (< 50 mL) Frequency, nocturia New/worsened [web.archive.org]

  Most patients also have frequency and nocturia. It is thought to be caused by an overactive detrusor muscle surrounding the bladder. Overactive bladder syndrome can cause significant discomfort and is more common in older persons. [aafp.org]

• Urinary Urgency

  urgency, urge incontinence, urinary frequency and/or nocturia (symptoms resulting from, e.g., overactive bladder syndrome) Antiparkinsonian effect ( Parkinson disease ) and ↓ extrapyramidal symptoms ( EPS ) Antidote for anticholinesterase poisoning and [amboss.com]

  Anticholinergic drugs are used for their positive clinical benefits including their effects on urinary urgency and incontinence and for bronchodilation when they are inhaled. There are also numerous negative effects. [cpsa.ca]

  Overactive Bladder (OAB) Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate... [medicinenet.com]

  C5 C6 C7 C8 T1 Question : Upon further examination, he is found to have hyperreflexia in his legs with upgoing toes, and he is complaining of urinary urgency and retention. [www2.kumc.edu]

• Urge Urinary Incontinence

  The primary outcome measures were the mean decrease in urge urinary incontinence episodes and the mean decrease in the frequency of micturition. [ncbi.nlm.nih.gov]

  Once daily controlled versus immediate release oxybutynin chloride for urge urinary incontinence. J Urol 1999;161:1809-12. Burgio KL, Locher JL, Goode PS. Combined behavioral and drug therapy for urge incontinence in older women. [nps.org.au]

  Refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol 2008 ;180: 217 - 222 4. Visco AG, Brubaker L, Richter HE, et al. [nejm.org]

• 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]

• Memory Impairment

  Central effects may include drowsiness, memory impairment, hallucinations, delirium, excitement and/or restlessness. [i] With aging, a decrease in central cholinergic activity is seen. [cpsa.ca]

  impairment, cognitive impairment e.g. [ti.ubc.ca]

  Blurred vision Dry mouth Dry eyes Decreased urine production Decreased sweat production Constipation Memory impairment Delirium Confusion When possible, the use of anticholinergics should be avoided in the elderly because anticholinergic side effects [medicinenet.com]

  After long term administration, tolerance to sedation and psychomotor impairment is likely to develop, but not to memory disturbances. [link.springer.com]

  Side effects Author/Year Substance Type of side effect Percentage Ginsberg 1983 Tiapride Drowsiness (moderate to mild), mild gastric intolerance 38.1% Lechin 1989 Pimozide Physical and mental retardation, hand tremors, memory impairment, involuntary movements [cochranelibrary.com]

• 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]

No untoward effects occurred as a result of treatment with physostigmine. [ncbi.nlm.nih.gov]

Discussing reporting deficiencies: prognosis research is frequently confounded by poor reporting and possible publication bias. [cochranelibrary.com]

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]

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]

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]

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]