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Anticholinergics
By: Angela Tipton
How do you define Anticholinergic ( an-ti-koh-luh-nur-jik):1.
Of or pertaining to a substance that opposes the effects of
acetylcholine; interfering with the passage of
parasympathetic nerve impulses. 2. A drug or agent that
blocks these nerve impulses, used to control intestinal
spasm, increase the heart rate, dilate the pupils for
examination of the eyes, dry secretions in anesthesia, and in
some forms to treat Alzheimer’s disease.
Anticholinergics originated between the 1940’s and the
1945’s.
Anticholinergics are a
type of
bronchodilators they
affect the muscles
around the bronchi.
Anticholinergics work
by stopping the
muscles from
tightening.
There are different types of Anticholinergic’s there
are short acting and long acting some of the short
acting anticholinergics are:
GENERIC NAME
Ipratropium bromide
Oxitropium bromide
TRADE NAME
Atrovent
Oxiven
These types tend to work within 15 minutes and last
for about 6-8 hours.
There is currently only one long lasting
anticholinergic drug called: tiotropium (Spiriva)
which takes about 20 minutes to work and will
usually last for 24 hours.
Possible Side Effects of
Anticholinergic’s
Some possible side effects that you many
experience from using anticholinergic drugs can
be: Dry mouth, Blurred Vision (if eyes come in
contact with spray.), worsening glaucoma and dry
cough. Men who have prostate problems may
have more difficulty urinating.
Anticholinergics are associated with Beta- agonists
which affect the bronchioles. There are also two
types of beta-agonists which are short acting and
long acting. Some short acting beta-agonists last for
about 4-5 hours some examples of these are :Airolin,
Inspiryl, Salbulin, albuterol, bambuterol, bambes,
alupent, metaprel, prometa, brethine, bitolerol just
to name a few.
Long lasting beta-agonists last for about 12 hours.
Some examples of these types are: Foradil, Oxis,
Serevent.
Foradil - is a long-acting bronchodilator that
relaxes muscles in the airways to improve
breathing. It is used to prevent bronchospasm in
people with reversible obstructive airways disease,
including symptoms of night-time asthma.
Side effects of Beta-Agonists
Some side effects that you may experience
from using beta-agonists drugs can be: a
fast heart beat, shakiness and cramping of
hands, legs and feet.
Anticholinergic Drugs and Drugs with Anticholinergic side
effects used in the Elderly

Anticholinergics
 Drugs with anticholinergic side
effects

Antiemetics/antivertigo

Anti-Parkinson’s

Antispasmodics(GI)

Antispasmodics(URO)
 Skeletal muscle relaxants

Antimigraine
 Antiulcer drugs

Bronchodilators
 Antidepressants

Preanesthetics
 Antipsychotics

Mydriatcs
 Antiarrythmics
 Antidiarrheals
 Antihistamines
 Herbals
Anticholinergic drugs are used to treat a variety of
disorders like gastrointestinal cramps, Urinary
bladder spasms, motion sickness, muscular spasms.
It can also be used as an aid to anesthesia.
Anticholinergic drugs help to balance out the
production of Dopamine and Acetylcholine. They
can cause drowsiness and are also well known for
causing acute cognitive impairment in individuals
with dementia.
Just some more definitions
Cholinergic – an agent that stimulates sites where
acetylcholine is the neurotransmitter.
Anticholinergic – an agent which blocks sites where
acetylcholine is the neurotransmitter.
Adrenergic- Stimulates sites where norepinephrine or
epinephrine is the neurotransmitter.
Antiadrengeric- Blocks sites where norepinephrine or
epinephrine is the neurotransmitter.
Beta-agonists – mainly affect the muscles around the
airways.
Autonomic Nervous System
There are two divisions
to the ANS there is the
sympathetic division
and the
parasympathetic
division. There is also
autonomic
neurotransmitters.
Sympathetic Division
A. Location of Preganglionic neurons: T1 - L2 in the lateral horns of the gray
matter of the spinal cord.
B. Preganglionic neurons send fibers out the ventral root. They leave the
spinal nerves through the white rami (myelin) and enter the sympathetic
trunk.
C. Ganglionic neurons are located within the sympathetic chain ganglia or
in collateral ganglia outside of the sympathetic trunk.
D. Postganglionic fibers leave the sympathetic trunk through the gray rami
and pass through the spinal nerve again before terminating on the effector
organ.
E. Preganglionic fibers are short and myelinated.
F. Postganglionic fibers are long and unmyelinated.
H. Preganglionic fibers may:
Continued….
1. Synapse with one or more neurons in the sympathetic trunk
directly across from them;
2. Ascend or descend in the trunk before synapsing;
3. Pass through the sympathetic trunk and synapse with a
collateral ganglion outside the sympathetic trunk; or
4. Directly stimulate the release of epinephrine and
norepinephrine from the adrenal medulla.
I. The sympathetic division is responsible for vasomotor
(sympathetic) tone:
Parasympathetic Division
A. Location of preganglionic neurons: Brain stem and S2, S3, and
S4.
B. Preganglionic fibers travel through cranial nerves III, VII, IX, and
X, and spinal nerves S2-S4, and synapse with peripheral ganglia
located very near or directly on the effector organ.
C. Ganglionic neurons are located within peripheral ganglia.
D. Preganglionic fibers are long and myelinated.
E. Postganglionic fibers are short and not myelinated.
F. Parasympathetic fibers do not control the diameter of the
systemic arterioles but ARE responsible for peristalsis.
Autonomic Neurotransmitters
A. Cholinergic fibers - release ACh
All preganglionic fibers release ACh (both parasympathetic &
sympathetic)
Parasympathetic postganglionic fibers also release ACh
B. Adrenergic fibers - release NE
Sympathetic postganglionic fibers release NE except those that
innervate sweat glands and some blood vessels in the skin and
skeletal muscles (which cause vasodilation rather than
vasoconstriction)
C. Actions of Autonomic NT's
D. Receptors of Effectors
Continued….
1. Types of Cholinergic Receptors (bind Ach):
2. Types of Adrenergic Receptors (bind NE):
a. Alpha
B. Beta
Beta-blockers for heart patients
Adrenergic Drugs
Adrenergic drugs -are drugs that stimulate the sympathetic
nervous system. They are used to increase the output of the
heart, to raise blood pressure, and to increase urine flow as part
of the treatment of shock. Adrenergic’s are also used as heart
stimulants. They may be given to a patient to reverse the drop in
blood pressure that is sometimes caused by general anesthesia.