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INTRODUCTION

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hyoscyamine (hi-oh-sye-a-meen)

Anaspaz, A-Spas S/L, Cystospaz, Cystospaz-M, Donnamar, ED-SPAZ, Gastrosed, Levsinex, Levsin, Levbid, L-hyoscyamine, NuLev

Classification

Therapeutic: antispasmodics

Pharmacologic: anticholinergics

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Indications
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Control of gastric secretion, visceral spasm, hypermotility in spastic colitis, spastic bladder, pylorospasm, and related abdominal cramps. Decreases symptoms of various functional intestinal disorders, including mild dysenteries, diverticulitis, infant colic, biliary and renal colic. Adjunctive therapy in peptic ulcer disease, irritable bowel syndrome, neurogenic bowel disturbances. Decreases pain and hypersecretion associated with pancreatitis. Relief of symptoms of acute rhinitis. Decreases rigidity and tremors associated with parkinsonism and controls related sialorrhea and hyperhidrosis. May also be used to manage anticholinesterase poisoning. Management of cystitis or renal colic. Management of some forms of heart block due to vagal activity. IM, IV, SC: Facilitation of diagnostic hypotonic duodenography; may also increase radiologic visibility of the kidneys. Preoperative administration decreases secretions and blocks bradycardia associated with some forms of anesthesia and related surgical agents.

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Action
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Inhibits the muscarinic effect of acetylcholine in smooth muscle, secretory glands, and the CNS. Small doses ↓ salivary and bronchial secretions and ↓ sweating; intermediate doses dilate the pupil, inhibit accommodation, ↑ heart rate (vagolytic action); large doses ↓ GI and GU motility, further ↑ in dose ↓ gastric acid secretion. Therapeutic Effects: ↓ secretions with ↓ GI and GU symptomatology. ↑ heart rate.

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Adverse Reactions/Side Effects
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CNS: confusion/excitement (especially in geriatric patients), dizziness, flushing, headache, insomnia, lightheadedness (IM, IV, SC), nervousness. EENT: blurred vision, cycloplegia, ↑ intraocular pressure, mydriasis, photophobia. CV: palpitations, tachycardia. GI: dry mouth, altered taste perception, bloated feeling, constipation, nausea, paralytic ileus, vomiting. GU: erectile dysfunction, urinary hesitancy/retention. Derm: ↓ sweating, urticaria. Local: local irritation (IM, IV, SC). Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, fever (especially in children), suppression of lactation.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

  • If used to treat bowel disorders, monitor any improvements such as decreased abdominal pain, decreased diarrhea, and improved appetite to help document whether drug therapy is successful.

  • Monitor signs of intestinal paralysis (paralytic ileus), including nausea, lack of bowel sounds or movements, abdominal bloating/distention, and vomiting. Report these signs to the physician immediately.

  • Be alert for decreased sweating and altered/increased body temperature (hyperpyrexia). Notify physician of a prolonged or persistent elevation in body temperature.

  • Monitor and report ...

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