Antimuscarinics anticholinergics

AChE, acetylcholinesterase CNS, central nervous system COPD, chronic obstructive pulmonary disease. PREPARATIONS AVAILABLE Antimuscarinic Anticholinergic Drugs ... 

Physostigmine Suggested for antimuscarinic anticholinergic agents not for tricyclic antidepressants Adult dose is 0.5-1 mg IV slowly. The effects are transient (30-60 minutes), and the lowest effective dose may be repeated when symptoms return. May cause bradycardia, increased bronchial secretions, seizures. Have atropine ready to reverse excess effects. Do not use for tricyclic antidepressant overdose. 

Source and Mechanism of Action of Antimuscarinic Anticholinergic Drugs... 

The prototypical antimuscarinic anticholinergic drug is atropine (Fig. 19-2). Atropine is a naturally occurring substance that can be obtained from the extract of plants such as belladonna and jimsonweed. Other natural, semisynthetic, and synthetic antimuscarinic anticholinergic agents have been developed that are similar in structure or function to atropine. 

The primary clinical applications of antimuscarinic anticholinergic drugs include the treatment of certain gastrointestinal disorders. These drugs may also be helpful in managing Parkinson disease. In addition, they have been used to treat a variety clinical disorders involving other physiologic systems.5 The clinical ap-... 

The adverse effects of tolterodine and other antimuscarinic anticholinergic drugs have been reviewed in patients with incontinence and bladder overactivity (3-6). 

Antimuscarinic/anticholinergic medications control an overactive bladder urinary analgesic medications do not. Pyridium does help control urinary frequency associated with a urinary tract infection. 

In contrast, drugs with antimuscarinic (anticholinergic) effects (see Table 18.2 , (p.674)), which block the actions of acetylcholine, would be expected to oppose the actions of the anticholinesterases. 

Carbamazepine alone is not associated with NMS. It was suggested that carbamazepine may have reduced levels of the antimuscarinic (anticholinergic) antipsychotics (levomepromazine and sultopride), resulting in cholinergic rebound, and inducing NMS." The general applicability of... 

Areca contains arecoline, an alkaloid with cholinergic activity, which could therefore oppose the antimuscarinic (anticholinergic) actions of procyclidine. As the procyclidine was being used to control the extrapyrami-dal adverse effects of the two antipsychotics, opposing its action allowed the adverse effects to re-emerge and worsen. 

Antimuscarinics (Anticholinergics) Inhaled Ipratropium bromide, Oxitropium, Tiotropium... 

In praetical terms this means that the antimuscarinic (anticholinergic) effects of the tolterodine are only moderately increased, and it seems unlikely that any tolterodine dosage changes are likely to be needed. Consider also Antimuscarinics + Antimuscarinics , p.674. 

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