THE PROBLEMS OF ANTICHOLINERGIC ADVERSE-EFFECTS IN OLDER PATIENTS
THE PROBLEMS OF ANTICHOLINERGIC ADVERSE-EFFECTS IN OLDER PATIENTS
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DOI：
10.2165/00002512-199303040-00004
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发表时间：
1993-07-01
期刊：
影响因子：
2.8
通讯作者：
FEINBERG, M
中科院分区：
文献类型：
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作者：
FEINBERG, M
在描述阻断毒蕈碱胆碱能系统的药物的自主效应时，人们经常引用这句老话：“红得像甜菜，干得像骨头，瞎得像蝙蝠，热得像野兔，疯得像帽匠。”这些影响可能是微妙的或戏剧性的，但可以被忽视或低估为老年的自然后果。老年患者可能对药物的抗胆碱能作用特别敏感，因为生理和病理生理变化往往伴随着衰老过程。使用多种药物是老年患者的常见发现，可能导致药效学和药代动力学药物相互作用，从而增强抗胆碱能作用。虽然分泌物减少、后肠蠕动减慢、视力模糊、心率加快、热耐受不良、镇静和可能的轻度意识模糊等典型抗胆碱能问题可能对健康状况相对较好的年轻患者造成不适，但这些影响对老年患者可能是灾难性的。即使是最常见的口干等外周抗胆碱能症状也会降低沟通能力，易患营养不良，促进粘膜损伤、假牙错配或龋齿，并增加继发于唾液抗菌活性丧失的严重呼吸道感染的风险。瞳孔散大和不能调节将损害近视力，并可能在易感患者中引发窄角型青光眼，但不太明显地可能导致事故风险增加，包括福尔斯。在存在抗胆碱能激发的情况下，便秘和排尿犹豫的躯体主诉可能导致粪便嵌塞或尿潴留。心脏效应的耐受性可能较差。心率增加可能会诱发或加重心绞痛。最后，由抗胆碱能药物引起的体温调节障碍，可阻断出汗能力，导致危及生命的体温过高。中枢抗胆碱能作用范围从镇静、轻度意识模糊和无法集中注意力到明显的谵妄。即使是轻微的影响也会降低功能并增加依赖性。在任何级别的护理中，失去独立性都会增加护理人员的负担，成本，最重要的是。许多与年龄相关和疾病相关的疾病可能使老年患者易发生抗胆碱能药物毒性。处方药物时仔细注意抗胆碱能作用，患者教育，定期审查整个药物方案，并熟悉抗胆碱能毒性的体征和症状，将有助于降低药物引起的问题的风险。
The old saying 'red as a beet, dry as a bone, blind as a bat, hot as a hare, mad as a hatter' is often quoted when describing the autonomic effects of drugs that block the muscarinic cholinergic system. These effects may be subtle or dramatic, yet can be overlooked or discounted as a natural consequence of old age. Elderly patients can be particularly sensitive to the anticholinergic action of drugs because of physiological and pathophysiological changes that often accompany the aging process. The use of multiple drugs, a common finding in older patients, may result in pharmacodynamic and pharmacokinetic drug interactions that heighten anticholinergic effects. While the classic anticholinergic problems of decreased secretions, slowed pstrointestinal motility, blurred vision, increased heart rate, heat intolerance, sedation and possibly mild confusion, may be uncomfortable for a younger patient in relatively good health, these effects can be disastrous for older patients.Even the most common peripheral anticholinergic complaint of dry mouth can reduce the ability to communicate, predispose to malnutrition, promote mucosal damage, denture misfit or dental caries, and increase the risk of serious respiratory infection secondary to loss of antimicrobial activity of saliva. Mydriasis and the inability to accommodate will impair near vision and may precipitate narrow angle glaucoma in predisposed patients, but less obviously could lead to an increased risk of accidents, including falls. Somatic complaints of constipation and urinary hesitancy, could, in the presence of anticholinergic challenge, result in faecal impaction or urinary retention. Cardiac effects may be poorly tolerated. Increases in heart rate may precipitate or worsen angina. Finally, thermoregulatory impairment induced by anticholinergics, which block the ability to sweat, may lead to life threatening hyperthermia.Central anticholinergic effects range from sedation, mild confusion and inability to concentration to frank delirium. Even mild effects can reduce function and increase dependency. At any level of care, the loss of independence increases the caregiver burden, costs, and most importantly. can negatively affect quality of life.Many age-related and disease-related conditions may predispose elderly patients to anticholinergic drug toxicity. Careful attention to anticholinergic effects when prescribing drugs, patient education, regular review of the entire drug regimen, and familiarity with the signs and symptoms of anticholinergic toxicity will help to reduce the risk of drug-induced problems.