Pharm

Anticholinergic Medication

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Anticholinergic Medication, Anticholinergic Agent, Muscarinic Antagonist, Nicotinic Antagonist

  • Mechanism
  • Muscarinic Antagonists
  1. M1, M4, M5 Receptor Antagonist (CNS Effects)
    1. Altered Mental Status
  2. M2 Receptor Antagonist (Cardiac Effects)
    1. Increased AV Nodal Conduction (Tachycardia, arrhythmias)
  3. M3 Receptor Antagonist (Smooth Muscle and Exocrine Glands)
    1. Decreased gastrointestinal motility
    2. Decreased Salivation
    3. Decreased Bladder contractions and increased Urethral sphincter tone
    4. Bronchodilation and decreased Bronchial secretions
    5. Mydriasis
    6. Decreased sweating
  • Mechanism
  • Nicotinic Antagonists
  1. Ganglionic Blocking Agents (act at Autonomic Nervous System)
    1. Sympathetic effects
      1. Vasodilation
    2. Parasympathetic effects
      1. Mydriasis
      2. Decreased gastrointestinal motility and Constipation
      3. Tachycardia
      4. Urinary Retention
  2. Neuromuscular Blocking Agents (act at neuromuscular junction)
    1. Acetylcholine Competitive Receptor Antagonists (Vecuronium, Rocuronium)
      1. Inhibited muscle contraction (muscle relaxation, paralysis)
    2. Depolarizing Antagonists (Succinylcholine)
      1. Transient muscle fasciculations and contractions, followed by paralysis
  • Complications
  1. See Anticholinergic Toxicity
  2. Altered Level of Consciousness (esp. elderly)
    1. Delirium or confusion (may mimic Dementia)
    2. Memory Impairment
    3. Delirium
    4. Obtundation
  1. Atropine (100% of maximal Anticholinergic effect)
  2. Scopolamine
  3. Tolterodine
  4. Hyoscyamine
  5. Cholinergic Parkinsonism agents
    1. Trihexyphenidyl
    2. Benztropine
  6. Prednisone (55%)
  7. Diphenhydramine (Benadryl)
  8. Amitriptyline (Elavil)
  9. Digoxin
  10. Nifedipine
  11. Phenobarbital
  12. Oxybutynin (20%)
  13. Isosorbide Dinitrate
  14. Hydroxyzine
  15. Warfarin
  16. Dipyridamole
  17. Codeine
  18. Ranitidine (10%)
  19. Dyazide
  20. Furosemide (Lasix)
  21. Nortriptyline (3%)