Prophylaxis anticholinergics

Keepers, G.A., Clappison, V.J., and Casey, D.E. (1983) Initial anticholinergic prophylaxis for neuroleptic-induced extrapyramidal syndromes. Arch Gen Psychiatry 40 1113—1117. 

TCAs are usually well tolerated at the lower doses used for migraine prophylaxis, but anticholinergic effects may limit use, especially in elderly patients or those with benign prostatic hyperplasia or glaucoma. Evening doses are preferred because of sedation. 

Rimantadine (Flumadine) [Antiviral] Uses Prophylaxis Rx of influenza A viral Infxns but not for HlNl swine flu Action Antiviral Dose Adults Feds >9 y. 100 mg PO bid Feds 2-9 y. 5 mg/kg/d PO, 150 mg/d max daily w/ severe renal/hepatic impair elderly initiate w/in 48 h of Sx onset Caution [C, -] w/ cimetidine avoid w/ PRG, breast-feeding Contra Component amantadine allergy Disp Tabs SE Orthostatic X BP, edema, dizziness, GI upset, X Sz threshold Interactions T Effects W/ cimetidine i effects W/ acetaminophen, ASA EMS Concurrent EtOH usage may result in light-headedness, confusion, syncope, and hypotension OD May cause N/V, tremors, Szs, anticholinergic Sxs, ventricular arrhythmias give IV fluids... 

The practitioner should be alert to the possible inoculation into the eye of any drug or substance with anticholinergic properties, including plants, cosmetics, perfumes, or medicines. Unilateral fixed and dilated pupils have been reported after the use of antiperspi-rants, transdermal scopolamine (Transderm Scop) for the prophylaxis of motion sickness, and from direct droplet contamination associated with the use of anticholinergic aerosols for treatment of acute asthma and other airflow obstructions. 

Disopyramide phosphate is recommended orally as a prophylaxis of either unifocal or multifocal premature ventricular contractions and ventricular tachycardia. It also exhibits both anticholinergic and local anaesthetic properties. 

But children with VUR, nonneurogenic bladder-sphincter dysfunction and dysfunctional elimination syndromes remain at significant risk for a breakthrough UTI despite antibiotic prophylaxis, anticholinergic therapy, timed voiding and regular bowel evacuation (Koff et al. 1998). 

Medical response, treatment and prevention (prophylaxis) to nerve agent exposure are ever expanding fields of research [6,12,13]. Atropine, which rapidly reverses cholinergic over expression at synapse junctions, is the most commonly used anticholinergic. Mark I kits, which contain 2 mg atropine with an autoinjector for intramuscular use, are issued to US military personnel [2]. Recommended initial field doses for atropine are 2, 4 or 6 mg with re-treatment every 5-10 min depending on the symptoms. In addition, oximes reactivate cholinesterase enzymes, ensuring normal function. Mark I kits also include 600 mg autoinjectors of 2-pralidoxime chloride (2-PAM Cl) with initial field doses of 600, 1200 or... 

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