TY - CHAP M1 - Book, Section TI - Anticholinergic Drugs A1 - Butterworth IV, John F. A1 - Mackey, David C. A1 - Wasnick, John D. Y1 - 2022 N1 - T2 - Morgan & Mikhail’s Clinical Anesthesiology, 7e AB - KEY CONCEPTS The ester linkage is essential for effective binding of anticholinergics to acetylcholine receptors. This binding competitively blocks binding by acetylcholine and prevents receptor activation. The cellular effects of acetylcholine, which are mediated through second messengers, are inhibited. Anticholinergics relax the bronchial smooth musculature, which reduces airway resistance and increases anatomic dead space. Atropine has particularly potent effects on the heart and bronchial smooth muscle and is the most efficacious anticholinergic for treating bradyarrhythmia. Ipratropium solution (0.5 mg in 2.5 mL) seems to be particularly effective in the treatment of acute chronic obstructive pulmonary disease when combined with a β-agonist drug (eg, albuterol). Scopolamine is a more potent antisialagogue than atropine and causes greater central nervous system effects. Because of its quaternary structure, glycopyrrolate cannot cross the blood–brain barrier and is almost devoid of central nervous system and ophthalmic activity. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1190604546 ER -