RT Book, Section
A1 Butterworth IV, John F.
A1 Mackey, David C.
A1 Wasnick, John D.
SR Print(0)
ID 1190604546
T1 Anticholinergic Drugs
T2 Morgan & Mikhail’s Clinical Anesthesiology, 7e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781260473797
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1190604546
RD 2024/04/24
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.