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Anticholinergics
Pharm - Fundamentals
25
Medical
Graduate
08/27/2012

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Cards

Term
Effect of antimuscarinics: Ocular
Definition
Mydriasis, relaxation of ciliary muscle -> flatten lens for far vision, inhibition of lacrimation.
Term
Effect of antimuscarinics: Cardiac
Definition
Standard doses increase HR and conduction by blocking vagal stimulation.
Very low doses may initially decrease HR by blocking presynaptic receptors.
Term
Effect of antimuscarinics: Respiratory
Definition
Bronchodilation and inhibition of secretions.
Term
Effect of antimuscarinics: GI/Urinary
Definition
Relax GI tract wall (but not sphincters), inhibit gastric acid secretion, relax detrusor muscle.
Term
Effect of antimuscarinics: CNS
Definition
Tertiary amines (atropine and scopolamine) can penetrate CNS. Scopolamine is generally more sedating than atropine. Atropine first causes stimulation before sedation. High doses can cause confusion/halucinations.
Term
Effect of antimuscarinics: Other
Definition
Inhibition of sweating, may lead to hyperthermia and then cutaneous vasodilation (note: this is a reflex, not a direct action).
Term
Atropine
Definition
Anti-muscarinic. Uses: mydriasis for eye exam (outdated); induce cycloplegia (ciliary muscle paralysis) in children for determination of refractive error; sinus bradycardia and AV block; reduction of salivary and resp. secretions and to prevent airway obstruction in patients under anesthesia (outdated); reduce intestinal spasms and pain; reduce gastric acid secretion (outdated); reverse muscarine or AChE-I poisoning; prevent muscarinic side effects in patients receiving neostigmine or AChE-I; as an antidiarrheal
Term
Scopolamine
Definition
Anti-muscarinic. Used for motion sickness, sedative. Applied as a patch.
Term
Tropicamide
Definition
Fast but short-acting mydriatic agent.
Term
Cyclopentolate
Definition
Fast but short-acting mydriatic agent.
Term
Homatropine
Definition
Fast but short-acting mydriatic agent.
Term
Ipratropium
Definition
Quaternary amine anti-muscarinic. Taken by inhalation, causes bronchodilation, used in COPD.
Term
Tiotropium
Definition
Quaternary amine anti-muscarinic. Taken by inhalation, causes bronchodilation, used in COPD. Similar to Ipratropium but longer-acting.
Term
Tolterodine
Definition
Anti-muscarinic. Used to manage overactive bladder, relaxes detrusor to allow for more filling. Contraindicated for patients with narrow-angle glaucoma.
Term
Dicyclomine
Definition
Anti-muscarinic. Relaxes intestinal smooth muscle. Used for irritable bowel.
Term
Glycopyrrolate
Definition
Anti-muscarinic. Low doses used to inhibit secretions (e.g. to make intubation easier). Used to prevent excessive generalized sweating and to prevent muscarinic side effects in patients receiving neostigmine (used preferentially over atropine for this use).
Term
Benztropine
Definition
Anti-muscarinic. Used to relieve extrapyramidal symptoms in Parkinson's patients or patients taking antipsychotics.
Term
Antimuscarinic side-effects
Definition
Block "ddumbbelss": xerostomia, mydriasis and cycloplegia, anhidrosis and cutaneous vasodilation, constipation, difficulty urinating, tachycardia, confusion, sedation, delirium. (Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter)
Term
Other drugs with anti-muscarinic activity
Definition
Antihistamines, tricyclics (which are antidepressants) and phenothiazine antipsychotics.
Term
Depolarizing nicotinic agonists (blockers)
Definition
Act by initially activating nACh receptors but then rendering them inactive from persistent depolarization.
Term
Actions of nicotine
Definition
Stimulation of autonomic ganglia followed by blockade (does-dependent), stimulation of adrenal medulla (may see effects of increased epi) and stimulation of CNS: alerting response, change in respiration.
Term
Nicotine toxicity symptoms
Definition
Nausea, vomiting, salivation, diarrhea, cardio effects (depends on state of patient before whether patient shows tachy/bradycardia, etc.), lethargy, confusion, seizures, coma, diaphoresis, tremors, fasiculations, weakness, paralysis, increased epi.
Term
Hexamethonium
Definition
Non-depolarizing ganglionic blocker. Was used as an anti-hypertensive.
Term
Trimethaphan
Definition
Non-depolarizing ganglionic blocker. Was used for aortic dissection as it lowers BP and prevents the sympathetic reflex.
Term
Mecamylamine
Definition
Non-depolarizing ganglionic blocker. Was used for hypertension, can be used to improve GI absorption. Recent interest for use in Tourette Syndrome.
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