Antidepressant Medications
Gary W. Jay in Practical Guide to Chronic Pain Syndromes, 2016
The major adverse effects of TCAs are secondary to cholinergic/muscarinic receptor blockade, histaminergic blockade (H1, H2), as well as blockade of the dopaminergic system. The anticholinergic side effects predominate and can include blurred vision, xerostomia, sinus tachycardia, constipation, urinary retention, confusion, and memory dysfunction. Histaminergic blockade can induce sedation, weight gain, dizziness, and hypotension. It also potentiates the effects of other CNS depressants. Alpha-1 adrenergic blockade can be associated with postural hypotension and dizziness. Blockade of dopaminergic receptors can induce extrapyramidal syndrome, dystonia, akinesia, neuroleptic malignant syndrome, tardive dyskinesia, and endocrine changes. Tachycardia and prolonged PR and QRS intervals with membrane stabilization can occur. The QT interval can become prolonged (1, 2).
Polypharmacy and Rational Prescribing
K. Rao Poduri in Geriatric Rehabilitation, 2017
Anticholinergic medications are neither used to treat one specific condition nor do they belong to one class of medications; however, the associated side effects make them an extremely high-risk group of medications in the older adult population. These medications increase morbidity and mortality for the older adult [60]. Medications with the most anticholinergic properties include TCAs, typical antipsychotics, antihistamines (e.g., diphenhydramine, promethazine, and hydroxyzine), paroxetine, methocarbamol, meclizine, scopolamine, agents to treat urinary incontinence (e.g., oxybutynin and tolterodine), and atropine to name a few [60,72]. The degree of anticholinergic properties is clinically measured as the anticholinergic burden (ACB) of a medication. The most common adverse effects of medications with a high ACB (i.e., 1 or 2) include dry mouth, blurred vision, decreased sweating, delirium, sedation, urinary retention, and constipation. In the older adult population, these medications should be avoided and alternatives used whenever possible [60,73,61].
Cerebrovascular accidents, intracranial tumors, and urologic consequences
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Medical management of symptoms can be difficult in this patient population, and surgical management can be fraught with complications.13 α-Blockers have the unfortunate side effects of dizziness and hypotension, which is especially detrimental to functioning and rehabilitation of these patients. Additionally, especially when there is baseline impairment, anticholinergic medications have negative effects on cognitive functioning.70 Imipramine is another drug that can be used for patients with urge and/or mixed incontinence. It has anticholinergic properties and it also prevents reuptake of norepinephrine, which will increase bladder outlet resistance.71 Duloxetine may have benefit for women with mixed symptoms, but it remains unavailable for this indication in the United States (Figure 21.6).
Massively elevated creatine kinase levels in antihistamine-induced rhabdomyolysis
Published in Baylor University Medical Center Proceedings, 2020
Karan N. Ramakrishna, Amish Shah, Carlos D. Martinez-Balzano
Given the above clinical findings suggestive of acute anticholinergic toxicity, severe rhabdomyolysis, and AKI, the patient was admitted to the intensive care unit for further management. He was started on aggressive intravenous volume expansion and a safety companion was stationed in his room. Over the next 36 hours, he received 6 L of intravenous crystalloid (normal saline). His urine output improved from 30 cc/h at presentation to 100 cc/h after 24 hours. The CK levels showed a dramatic decrease over the next 24 hours, with an exponential fall to 215,318 IU/L (Figure 1). An accompanying improvement in his mental status was also noted, with return to baseline mentation within 24 hours of initiation of treatment. On day 4 of admission, his CK level had improved to 25,589 IU/L. Renal function also showed improvement with consistent robust urine output (100 cc/h) and improvement in azotemia and electrolyte abnormalities (Table 1). Clinical signs of anticholinergic toxicity had resolved. He did not undergo hemodialysis. He was subsequently transferred to the inpatient psychiatric unit for the management of his depression.
Pharmacotherapeutic management of atopic keratoconjunctivitis
Published in Expert Opinion on Pharmacotherapy, 2020
Ibtesham T Hossain, Priyanka Sanghi, Bita Manzouri
Oral antihistamines relieve pruritus and may reduce nocturnal eye rubbing. First-generation H1 receptor antagonists exhibit sedating side effects due to the lipophilic nature of the molecule resulting in penetration of the blood-brain barrier. Furthermore, these antagonists are nonselective and exert cross-reactivity on H2 receptors resulting in cardiac arrhythmias [32]. Other anticholinergic effects include dry mouth, blurred vision, urinary retention, and dry eyes. Second-generation H1 receptor antagonists (astemizole, fexofenadine, terfenadine, cetirizine, loratadine, ebastine, mizolastin, bepotastin, rupatadine, and bilastine) are more commonly used in allergic eye disease; they are non-sedating with less anticholinergic activity, although dry eyes may still occur. Bilastine was introduced in 2014 and is a potent selective second-generation H1 receptor antagonist. It is excreted largely unaltered in urine as well as feces and has fractional penetration of the blood-brain barrier. The efficacy of bilastine in improving nasal and ocular symptoms in patients with allergic rhinitis has been demonstrated in a large number of clinical trials [33]. However, there is no clear evidence of efficacy in atopic keratoconjunctivitis.
Association between anticholinergic medication uses and the risk of pneumonia in elderly adults: a meta-analysis and systematic review
Published in Annals of Medicine, 2023
Mindan Wu, Zhixuan Li, Wenchuan Zheng, Jia Zhuang, Shuhan Wu, Qipeng Zhou, Junfu Cai, Houzhen Zheng, Guixing Zeng, Weilin Zhang, Shengbin Zhang, Maohuang Lin, Xianyang Zhong, Qichuan Zhang
Recently, more and more attention has been paid to whether medication uses contributes to the higher risk of pneumonia in elderly people, except for the known risk factors. Anticholinergic drugs are frequently prescribed to the elderly adults. Anticholinergic medication includes drugs from a wide range of therapeutic categories which are used in a variety of diseases. Drugs with anticholinergic properties account for 23% of the ambulatory patients and nearly 60% of nursing home residents. They nonselective act on muscarinic receptor antagonist and thus cause many side effects centrally and peripherally. Pharmacokinetic and pharmacodynamic properties are changing related with age, therefore the older patients are more susceptible to anticholinergic drugs. Therefore, the American Geriatric Society 2019 have defined some anticholinergic drugs as inappropriate medications and should be avoided in elderly patients [4].
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