Anticholinergics By: Angela Tipton

How do you define Anticholinergic ( an-ti-koh-luh-nur-jik):1 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.

Ipratropium bromide Atrovent Oxitropium bromide Oxiven There are different types of Anticholinergic’s there are short acting and long acting some of the short acting anticholinergics are: GENERIC NAME TRADE NAME Ipratropium bromide Atrovent Oxitropium bromide 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 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 Antiarrythmics Antidiarrheals Antihistamines Skeletal muscle relaxants Antiulcer drugs Antidepressants Antipsychotics Herbals Anticholinergics Antiemetics/antivertigo Anti-Parkinson’s Antispasmodics(GI) Antispasmodics(URO) Antimigraine Bronchodilators Preanesthetics Mydriatcs

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.