Question

what are The effects of cholinergic blocking drugs are numerous. Consider your patient is elderly. What are some strategies that you could employ to keep your patient safe, in particular related to the side effects of these medications?   . please I need help those question.please send me typing answer because I don't understand hand wrtting thanks

Answer 1

An Anticholinergic or the Cholinergic blocking agent are the chemical substances that blocks the Neurotransmitter Acetylcholine in the Central as well as Peripheral Nervous system. These are the agents that inhibit the parasympathetic nerve impulses by selectively blocking the binding of acetylcholine to the receptors in the nerve.

The anticholinergic agents can be further classified in accordance to the specific targets on the receptors present in the Central or peripheral nervous system:

1. Antimuscarinic Agents: These are the type of agents that blocks the activity of Muscarinic acetylcholine receptors.
2. Ganglionic Blockers: These are the agents that inhibit transmission between preganglionic and postganglionic neurons in the Autoimmune nervous system.
3. Neuromuscular Blockers: As name suggests these blocks the neuromuscular junction causing the paralysis of affected skeletal muscles.

The nerves of the parasympathetic system are responsible for involuntary movement of smooth muscles, for example present in GI Tract, Lungs, Urinary Tracts etc.

The elderly patients can be very sensitive to the anticholinergic actions of the drugs due to the physiological and pathological changes that accompany the old aging process. The use of multiple drugs, a very common finding in the older patients which may result in complicated pharmacodynamic or pharmacokinetic drug interactions that may have synergetic effects on Anticholinergic effects. While the major anticholinergic peroblems are the decreased secretions, blurred vision, slowed GI motility, elevated heart rate, heat intolerance, dizziness and mild confusion, may be uncomfortable feeling for young patient but these may prove to be disastrous for older patients.

Even the most common side effect like dry mouth can reduce the ability to communicate, promote mucosal damage, predispose to malnutrition, denture misfit etc. and may even increase the risk of respiratory infection due to loss of antimicrobial activity of saliva.

Somatic complains of constipation or urinary blockage could be the anticholinergic effects leading to the faecal impaction or urinary retention.

The old patients very poorly tolerated to the cardiac effects that may increase the heart rate or even worse causing angina.

The side effects like blurred vision may impair the near vision and may cause narrow angle glycoma in pre-diagnosed patients.

And thermoregulatory effects induced by drug which block the ability to sweat may even lead to life threatening Hyperthermia. And so on. The effects like sedation, mild confusion and inability to concentrate will increase their dependency on others. At any level of care, the loss of independency increases the burden, cost and most importantly can negatively affect the quality of life.

Careful attention to the anticholinergic effects when prescribing drugs, educate the patient and the regular review of drug regimen will help to reduce the risk of Anticholinergic agent induced problems.