Anticholinergic (sympathetic)

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S/Sx:

• Hot as a hare: low grade body temperature 

• Blind as a bat: mydriasis (dilated pupils)

• Dry as a bone: dry mouth, dry eyes, decreased skin

  • examine axilla and groin (where dryness is uncommon)​

• Red as a beet: flushed face

• Mad as a hatter: delirium

  • speech may be soft, mumbling word salad​ (cotton balls in mouth)

  • hallucinations

  • delirium

  • coma

  • seizures

• sinus tachycardia

• hypertension

• decreased bowel sounds

• constipation

• urinary retention

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Common anticholinergic medications

• dimenhydrinate (Gravol)

• low-potency antipsychotics

• benztropine

• atropine

• antihistamines

• Tricyclic Antidepressants

• Jimsonweed

• Amanita muscaria mushrooms

• Parasympatholytic medications

• Scopolamine

• Hyoscyamine

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Management

• benzodiazepines

• precedex

• avoid physical restraints

• rhabdomyolysis

• avoid antipsychotics

• control hyperthermia

• physostigmine

  • anticholinesterase 

  • Obtain EKG prior to administration to rule out Bradycardia, intraventricular conduction delay or AV Nodal block

  • Contraindicated in uncontrolled Asthma or Wheezing

  • Contraindicated in Seizure disorder​