Anticholinesterases

Acetylcholine is used in entire parasympathetic nervous system (parasympathetic ganglions and effector cells), parts of the sympathetic nervous system (sympathetic ganglions, adrenal medulla, and sweat glands), some neurons in the central nervous system, and somatic nerves innervating skeletal muscle

- anticholinesterases increase muscarinic stimulation, which is to be minimized by giving glycopyrrolate or atropine. Muscarinic stimulation causes SLUDGE syndrome to brady, bronchospasm, GI output

- Neostigmine onset 5 min, peak 10 min, lasts 70 min. Glycopyrrolate has similar onset compared to atropine which has faster onset. However, neostigmine crosses the placenta to cause fetal bradycardia so theoretical benefit in using atropine in preggers

- Edrophonium onset ins 1-2 min but shorter duration. Full dose should be given each time so that duration will be long enough. Use with atropine.


Anticholinergic drugs such as glycopyrrolate, atropine, scopolamine causes tachycardia, inhibits secretions, reduces GI secretions (but not enough to reduce aspiration), causes mydrasis and cycloplegia (inability to accomodate near vision), urinary retention.

Scopolamine causes reduction in motoin sickness (n/v), potent sialagogue (better than atropine), and drowsiness. Lipid solubility means it can be given via patch. Avoid in closed-angle glaucoma

Anticholinergic syndrome (alice in wonderland)