ANTICHOLINERGIC

An anticholinergic agent is a substance that blocks the neurotransmitter

acetylcholine in the central and the peripheral nervous system. An example of an
anticholinergic is dicyclomine. Anticholinergics are administered to reduce the
effects mediated by acetylcholine on acetylcholine receptors in neurons through
competitive inhibition. Therefore, their effects are reversible.
Contents
[hide]
• 1 Pharmacology
• 2 Effects
• 3 Plant sources
• 4 Use as a deterrent
• 5 References
[edit] Pharmacology
Anticholinergics are classified according to the receptors that are affected:
• Antimuscarinic agents operate on the muscarinic acetylcholine receptors.
The majority of anticholinergic drugs are antimuscarinics.
• Antinicotinic agents operate on the nicotinic acetylcholine receptors. The
majority of these are non-depolarising skeletal muscle relaxants for surgical
use, along with a few of the depolarising agents and drugs of other
categories structurally related to curare.
Examples of anticholinergics • ipratropium bromide (Atrovent) • oxitropium
bromide (Oxivent) • tiotropium (Spiriva)
Physostigmine is one of a few drugs which are used as antidotes for anticholinergic
poisoning, and nicotine also counteracts antichlolinergics.
[edit] Effects
Anticholinergic drugs are used in treating a variety of conditions:
• Gastrointestinal disorders (e.g., gastritis, pylorospasm, diverticulitis,
ulcerative colitis)
• Genitourinary disorders (e.g., cystitis, urethritis, prostatitis)
• Respiratory disorders (e.g., asthma, chronic bronchitis)
• Parkinson’s disease and Parkinson-like adverse medication effects
 • Sinus bradycardia - Hypersensitive vagus nerve
When a significant amount of an anticholinergic is taken into the body, a toxic
reaction known as acute anticholinergic syndrome may result. This may happen
accidentally or intentionally as a consequence of recreational drug use.
Anticholinergic drugs are usually considered the least enjoyable by experienced
recreational drug users, possibly due to the lack of euphoria caused by them. (For
some of the recreational effects, see the article on deliriants.) Because most users
do not enjoy the experience, they do not use it again, or do so very rarely. The risk
of addiction is low in the anticholinergic class. The effects are usually more
pronounced in the elderly, due to natural reduction of acetylcholine production
associated with age.
Exceptions to the above include scopolamine, orphenadrine,
dicycloverine/dicyclomine and first-generation antihistamines with central nervous
system penetration.
Possible effects of anticholinergics include:
• Ataxia; loss of coordination
• Decreased mucus production in the nose and throat; consequent dry, sore
throat
• Xerostomia or dry-mouth with possible acceleration of caries
• Cessation of perspiration; consequent decreased epidermal thermal
dissipation leading to warm, blotchy, or red skin
• Increased body temperature
• Pupil dilation (mydriasis); consequent sensitivity to bright light
(photophobia)
• Loss of accommodation (loss of focusing ability, blurred vision —
cycloplegia)
• Double-vision (diplopia)
• Increased heart rate (tachycardia)

• Tendency to be easily startled

• Urinary retention
• Diminished bowel movement, sometimes ileus - (decreases motility via the
vagus nerve)
• Increased intraocular pressure; dangerous for people with narrow-angle
glaucoma
• Shaking
Possible effects in the central nervous system resemble those associated with
delirium, and may include:
• Confusion
• Disorientation
• Agitation
• Euphoria or dysphoria
• Respiratory depression
• Memory problems [1]
• Inability to concentrate
• Wandering thoughts; inability to sustain a train of thought
• Incoherent speech
• Wakeful myoclonic jerking
• Unusual sensitivity to sudden sounds
• Illogical thinking
• Photophobia
• Visual disturbances
○ Periodic flashes of light
○ Periodic changes in visual field
○ Visual snow
○ Restricted or "tunnel vision"
• Visual, auditory, or other sensory hallucinations[1]
○ Warping or waving of surfaces and edges
○ Textured surfaces
○ "Dancing" lines; "spiders", insects
○ Lifelike objects indistinguishable from reality
○ Hallucinated presence of people not actually there
• Rarely: seizures, coma, and death
Acute anticholinergic syndrome is completely reversible and subsides once all of
the toxin has been excreted. In ordinary circumstances, no specific treatment is
indicated. However, in extreme cases, especially those that involve severe
distortions of mental state, a reversible cholinergic agent such as physostigmine
may be used.
[edit] Plant sources
The most common plants containing anticholinergic alkaloids are:
• Atropa belladonna (Deadly Nightshade)
• Brugmansia species (Brugmansia)
• Datura species (Datura)
• Hyoscamus niger (Henbane)
• Mandragora officinarum (Mandrake).
[edit] Use as a deterrent
Certain preparations of some drugs, such as Hydrocodone, are mixed with an
anticholinergic agent to deter intentional overdose