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Anticholinergic / Antimuscarininic Drugs, 4. Use - Atropine -…
Anticholinergic / Antimuscarininic Drugs
Classification
Mydriatics
–
Homatropine, Cyclopentolate, Tropicamide
Anti-Parkinsonian
–
Benztropine, Trihexyphenidyl, Biperiden
Bronchodilators
–
Ipratropium bromide, Tiotropium bromide, Acledinium, Umeclidinium, Revefenacin, Glycopyrrolate
Uroselective
–
Flavoxate, Oxybutynin, Tolterodine, Fesoterodine, Darifenacin, Solifenacin, Propiverine, Trospium
Peptic Ulcer
–
Pirenzepine, Telenzepine
Natural alkaloids
–
Atropine, Hyoscine
(Scopolamine)
Antisecretory
– Quaternary -
Glycopyrrolate
Antispasmodic
- Tertiary-
Dicyclomine, Valethemate
Pharmacological Actions
CNS
🧠- Atropine - depression followed by excitation
Hyoscine -
twilight sleep
Uses
Trihexyphenidyl, Procyclidine, Biperiden, Benztropine
Parkinson's disease, Drug Induced Dystonia
Hyoscine
- truth serum
CVS
🫀- tachycardia
Uses
Use
Atropine
- used for bradyacrdia, AV block, during CPR
Smooth Muscle Relaxation
- constipation, urinary retention, bronchodilation 🫁
Use
Ipratropium
- Bronchodilators preferred for COPD & patients with tachycardia
Use
Dicyclomine, Valethamate, Hyoscine
- Dysmenorrhea, g.i. spasm (irritable bowel, travelers diarrhea) morning sickness, motion sickness
Atropine
- Combined with opioid antidiarrheal in low dose to discourage abuse
Uses
Use
Uroselective drugs (
Oxybutynin, Trospium, Tolterodine, Darifenacin, Solifenacin
) - used for urge incontinence, nocturnal enuresis, overactive bladder
Flavoxate
- dysuria
Dries Secretions
- sweat, saliva, lacrimal, tracheobronchial, stomach
Uses
Atropine, Glycopyrrolate
- (i) Pre-anesthetic medication
(ii) Along with neostigmine for reversal of skeletal muscle relaxation
(Glycopyrrolate preferred in patients with tachycardia. Has no central effects)
Pirenzepine
- peptic ulcer
Oxybutynin
- hyperhydrosis
Eye
👁 - mydriasis, loss of light reflex, cycloplegia
Uses
Use
Atropine, Homatropine, Tropicamide, Cyclopentolate
-Refraction testing, breaking synechia in uveitis
Atropine - preferred in children
C/I - narrow iridocorneal angle
Hyperthermia 🌡
Children more susceptible – “Atropine fever”
Depresses vestibular excitation
Uses
Hyoscine
(post-auricular patch),
Dicyclomine
- motion sickness
ADRs
Dryness of mouth, difficulty in swallowing
Dryness of eye, photophobia, blurred vision, dilated pupil
Dry, flushed, hot skin
Urinary retention, constipation
Tachycardia, palpitation, hypotension
Ataxia, delirium, hallucinations, convulsions
Atropine Poisoning - Treatment
Check for Airway-Breathing-Circulation
Control convulsions/ arrhythmia if present
Gastric lavage
Activated charcoal – to adsorb poison
External cooling – for hyperpyrexia
Antidote –
Physostigmine
– corrects both peripheral & central actions (Use sparingly, only when symptomatic treatment is not sufficient)
4. Use
-
Atropine
- organophosphorus poisoning, mushroom poisoning
