Fever anticholinergics

Agitated Increased Dilated Hallucinations, hypertension and tachycardia, dry skin, mucous membranes, flushed skin with fever Anticholinergic drugs... 

Two newer potent selective H -antagonists, terfenadine (23) (132) and astemizole (24) (133), have been developed which have neither the sedative nor the anticholinergic Habilities of the earlier agents. Both of these compounds have proven efficacious in the treatment of hay fever and produce very few side effects, prompting a re-evaluation of the role of antihistamines in asthma treatment. 

Heat prostration Heat prostration can occur with anticholinergic drug use (fever and heat stroke caused by decreased sweating) in the presence of a high environmental temperature. 

Overdose may produce anticholinergic effects, including unsteadiness, severe dizziness, somnolence, fever, facial flushing, dyspnea, nervousness, and irritability. 

Acute anticholinergic toxicity with fever, hallucinations, and tachycardia occurred in a 2.5-year-old boy from apphcations of calamine + diphenhydramine lotion (10). 

Acute overdosage with antimuscarinics produces both peripheral and CNS symptomatology. The quaternary ammonium compounds do not readily penetrate the CNS and thus exhibit minimal central effects even at toxic doses. Patients with anticholinergic toxicity will typically show peripheral symptoms including dry mouth, thirst, fixed dilated pupils, flushed face, fever, hot, dry, red skin, urinary retention, hyperthermia, hypotension, tachycardia, and increased respiratory rate. In addition to tachycardia, cardiac manifestations may include EKG abnormalities similar to those produced by quini-dine. Speech and swallowing may be impaired in association with blurred vision. Other peripheral signs and symptoms may include nausea and vomiting. 

Early signs of tricyclic antidepressant toxicity are due to anticholinergic effects and include tachycardia, mydriasis, dry mouth, low-grade fever, diminished bowel sounds, CNS excitation, and delirium. More serious toxicity is manifested by coma, respiratory depression, seizures, and cardiovascular toxicity including conduction disturbances, hypotension, ventricular arrhythmias, and asystole. Seizures cause hyperthermia, rhabdomyolysis, and metabolic acidosis. Clinical deterioration can be rapid and catastrophic in patients with tricyclic antidepressant overdose. Death most often occurs due to dysrhythmia and circulatory collapse. The typical therapeutic dose of a tricyclic antidepressant is 2-4 mg kg day Doses of 15-20 mg kg are potentially lethal. Therapeutic drug levels for most tricyclic antidepressants range from 100 to... 

Most antihistamines have anticholinergic atropine-like actions and cause a dry mouth and similar side-effects. The clinical uses of H, antihistamines are extensive, particularly for the symptomatic relief of allergy, such as hay fever and urticaria, and (together with corticosteroids) in the acute treatment of anaphylactic shock. Many antihistamines also have antinauseant properties and are used, for instance, to prevent travel sickness (though this property may well result from their anticholinergic actions). The older antihistamines produce drowsiness and this sedative action may be used to help sleep (e.g. promethazine). 

The acute poisoning that occurs with most antihistaminics does not cause severe CNS depression as would be expected based on their sedative properties, but is manifested by mydriasis, fever, flushing, CNS excitement, hallucinations, ataxia, athetosis, and convulsions. Some of these effects, which resemble those of atropine poisoning, may be due to their anticholinergic properties. Diazepam is an effective antidote to poisoning and should be used to reverse the CNS excitement and convulsions. 

The client should be aware of signs or symptoms of an anticholinergic crisis such as blurred vision, confusion, difficulty swallowing, and fever or flushing. This statement indicates the client needs more teaching concerning this medication. 

A. An overdose results in many symptoms similar to anticholinergic poisoning drowsiness, dilated pupils, flushed dry skin, fever, tachycardia, delirium, hallucinations, and myoclonic or choreoathetoid movements. Convulsions, rhab-domyolysis, and hyperthermia may occur with a serious overdose. 

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