ANTICHOLINERGICS
PRESENTED BY
DR.SRIDEVI
DEPARTMENT OF PEDODONTICS
INTRODUCTION:Anticholinergic drugs are those which blocks actions
of Ach on autonomic effectors and in the CNS
excreated through muscarinic receptors.
Nicotinic antagonists which blocks actions of Ach are
generally referred as “ganglion blockers” and
“neuromuscular blockers”.
Atropine, the prototype drug of this class, is highly
selective for muscarinic receptors, but some of its
synthetic substitutes do possess significant nicotinic
blocking property in addition.
All anticholinergics are competitive antagonists
CLASSIFICATION:1)
2)
3)
NATURAL ALKALOIDS- Atropine,Hyoscine(Scopolamine)
SEMISYNTHETIC DERIVATIVES- Homatropine,Atropine
methonitrate,Hyoscine butyl bromide,Ipratopium bromide.
SYNTHETIC COMPOUNDSa)Mydriatics: Cyclopentolate,Tropicamide
b)Anti-secretary-Antispasmodics
i) Quaternary compounds: Propantheline,
Clidinium,Glycopyrrolate, Oxyphenonium
ii) Tertiary amines: Dicyclomine,Oxybutynin,
Flavoxate,Pirenzepine
c) Anti-parkinsonian:Trihexyphenidyl(benzhexol)
Procyclidine,Biperiden
The natural alkaloids are found in plants of
solanaceae family – atropine in atropa
belladonna and datura
stramonium,hyoscine in hyoscyamus niger.
The term belladonna comes from the italian
“beautiful woman” and is so named
because instillation of one of these drugs
ino the eyes was said makes woman more
attractive.
USES:Preanaesthetic medication- during GA antichoinergics
diminishes secretions in respiratory tract,thus lessening the
likleyhood of laryngospasm and help prevent reflex vagal
slowing of the heart.
Antispasmodic , Antiulcer therapy: functional GIT disorders
Anti sailogogues
To relieve urinary frequency and urgency in neurogenic
disorders
COPD: Ipratopium is used to preserve the ciliary motility and
prevents the formation of mucous plugs.
As mydriatic and cycloplegic for refraction testing and
fundoscopy : Tropicamide
parkinsonism: reduces tremors ang rigidity
Motion sickness: hyoscine
Mushroom poisoning : atropine
Antidote for anticholinesterase eg. Neostigmine
Heavy metal poisoning
ADVERSE EFFECTS:Belladonna poisoning :
manifestations include- dry mouth, difficulty in
swallowing and talking, dry flushed and hot
skin,difficulty in micturition psychotic behaviour,
dilated pupil, blurring of near vision, palpitation,
convulsion and coma occur in severe poisoning.
Treatment :- gastric lavage with tannic acid
- patient should be dark and quiet room.
- Physostigmine 1-3 mg SC/IV
antagonises both central and peripheral effects,
should be repeated 4-6 hrly
CONTRAINDICATIONS:Narrow angle glaucoma
Prostatic hypertrophy
PREPARATIONS AND ORAL
DOSAGES USED IN DENTISTRY:DRUG
DOSE
TIME OF
ADMINISTRATI
ON
Atropine
sulphate
0.4- 1mg
1-2 hrs
Belladonna
tincture
0.6 -1ml
2.5-3 hrs
Glycopyrrolate
1-2mg
30-45 mins
Propantheline
bromide
15-30mg
30-45 mins
Scopolamine
0.4-0.8 mg
30-60 mins
QUESTION ROUND:Why anticholinergics are preferred
preanaesthetically?
What problems does dentists usually
comes across with patients on
anticholinergics and how do they overcome
this?
What are contraindications?
Drug interactions of anticholinergics?
What is atropine flush? Prevention and
Treatment?
What is glaucoma? Why
anticholinergics are contraindicated
only in narrow angle glaucoma?
What is central anticholinergic
syndrome? prevention?
What are the uses in dentistry?
Side effects?
GLAUCOMA
Progressive form of optic nerve
damage associated with increased
iop
CENTRAL ANTICHOLINERGIC
SYNDROME
Produced by scopalamine
occasionally atropine
THANK YOU