Anticholinergics Drugs Pharmacology Cheat Sheet

Anticholinergics( below table) are drugs that oppose the effects of acetylcholine at receptor sites in the substantia nigra and the corpus striatum, thus helping to restore chemical balance in the area.

Anticholinergics used to treat Parkinson disease include benztropine (Cogentin), biperiden (Akineton), diphenhydramine (Benadryl), and trihexyphenidyl (Artane).

Here are some common applications and aspects of anticholinergics:

  1. Medical Uses:
    • Respiratory Conditions: Anticholinergics like ipratropium bromide are used to treat chronic obstructive pulmonary disease (COPD) and asthma. They help relax the airway muscles and reduce bronchoconstriction, making it easier to breathe.
    • Gastrointestinal Disorders: Anticholinergic drugs like hyoscyamine can relieve symptoms of irritable bowel syndrome (IBS) and other gastrointestinal conditions by reducing muscle spasms and cramps.
    • Parkinson’s Disease: Some anticholinergic medications are used in combination with other drugs to manage the symptoms of Parkinson’s disease by reducing tremors and muscle stiffness.
  2. Side Effects: Anticholinergics can cause a range of side effects, which may include dry mouth, blurred vision, constipation, urinary retention, confusion, and cognitive impairment. These side effects can be more pronounced in older adults and may contribute to falls and cognitive decline.
  3. Anticholinergic Toxicity: Excessive use of anticholinergic drugs or exposure to high doses can lead to anticholinergic toxicity, also known as anticholinergic syndrome. Symptoms may include delirium, hallucinations, high fever, rapid heart rate, and even seizures. This condition can be serious and requires medical attention.
  4. Over-the-Counter (OTC) Medications: Some common OTC medications, such as certain allergy medications, sleep aids, and motion sickness drugs, contain anticholinergic ingredients. Prolonged or excessive use of these products can lead to side effects and potential health issues.
  5. Risk Factors: Older adults are more susceptible to the side effects of anticholinergic drugs, as their bodies may metabolize these drugs more slowly. Individuals with certain medical conditions, such as glaucoma, enlarged prostate, or urinary retention, should use anticholinergic drugs with caution.
  6. Prescription and Non-Prescription Forms: Anticholinergics are available in both prescription and non-prescription forms. It’s important to use these medications as directed by a healthcare professional and to be aware of potential interactions with other drugs you may be taking.
  7. Alternative Treatments: In some cases, alternative treatments or lifestyle changes may be considered to reduce the need for anticholinergic medications. For example, in the case of urinary incontinence, behavioral therapies and pelvic floor exercises may be recommended before or in conjunction with anticholinergic drugs.


Adverse Effects

The use of anticholinergics for Parkinson disease and parkinsonism is associated with CNS effects that relate to the blocking of central acetylcholine receptors, such as disorientation, confusion, and memory loss. Agitation, nervousness, delirium, dizziness, light-headedness, and weakness may also occur.

Anticipated peripheral anticholinergic effects include dry mouth, nausea, vomiting, paralytic ileus, and constipation related to decreased GI secretions and motility. In addition, other adverse effects may occur, including the tachycardia, palpitations, and hypotension related to the blocking of the suppressive cardiac effects of the parasympathetic nervous system; urinary retention and hesitancy related to a blocking of bladder muscle activity and sphincter relaxation; blurred vision and photophobia related to pupil dilation and blocking of lens accommodation; and flushing and reduced sweating related to a blocking of the cholinergic sites that stimulate sweating and blood vessel dilation in the skin.


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