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Anticholinergic medications are used to manage and treat a wide range of diseases. This activity illustrates the indications, action, and contraindications for anticholinergic drugs as valuable agents in managing cholinergic toxicity, urinary incontinence, Parkinson disease, respiratory disorders, cardiovascular disease, and numerous other diseases. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the interprofessional team in the care of patients with the disorders mentioned above and related conditions. Objectives: Identify the mechanism of action of anticholinergic drugs. Describe the potential adverse effects f anticholinergic drugs. Review the need for monitoring patients when using anticholinergic drugs. Summarize interprofessional team strategies for improving care coordination and communication to advance anticholinergic drugs and improve outcomes. Access free multiple choice questions on this topic.

Toxicity from anticholinergic medications is essentially an extreme version of the previously mentioned central and peripheral adverse effects. Clinical characteristics of anticholinergic toxicity include anhidrosis, anhidrotic hyperthermia, vasodilation-induced flushing, mydriasis, urinary retention, and neurological symptoms, including delirium, agitation, and hallucinations. The memory aid “red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, full as a flask’ often serves as means of remembering the common symptoms of anticholinergic toxicity.[21] Absent bowel sounds and tachycardia are among the first indications of acute anticholinergic toxicity. Anticholinergic toxicity is considered a clinical diagnosis, and there is currently no available testing to support the diagnosis.[21]

Anticholinergic medications are quite prevalent throughout the healthcare system, and many drugs that are not used explicitly for their anticholinergic properties still have anticholinergic side effects. The entire interprofessional healthcare team, including all clinicians (MDs, DOs, NPs, and PAs), nurses, and pharmacists, need to be well-versed in both the therapeutic and adverse properties of anticholinergic drugs. This is most important regarding the contribution of anticholinergics to adverse events. The team should monitor the overall anticholinergic burden, attempt to limit unnecessary use of anticholinergic medications, and pay special attention to high-risk groups such as the elderly and those receiving treatment for depression and schizophrenia. When prescribing agents with anticholinergic properties, clinicians need to be aware of other such agents the patient may already be taking; this is where a pharmaceutical consult can prove helpful, with the pharmacist performing complete medication reconciliation and reporting back to the prescriber. Nurses can instruct the patient on proper administration and also counsel them regarding the onset of potential adverse events so that if they occur, the patient will recognize their onset early and be able to reach out to members of the interprofessional team for appropriate intervention; this can be contact with the nursing staff or even the pharmacist where the pick up their medication. Once any team member has been alerted or perceives an issue, it must be communicated to all members of the healthcare team and noted in the patient's chart or electronic health record (EHR). With interprofessional communication and collaborative efforts, these medications can exert their therapeutic effects with a reduced chance of causing adverse events, leading to improved patient outcomes. [Level 5]