Anticholinergic Side Effects
Basic, Clinical Sciences: Anesthesia Procedures, Methods, and Techniques
Anticholinergic or antimuscarinic medications such as atropine, scopolamine, and glycopyrrolate are competitive antagonists of acetylcholine. Cardiovascular side effects of anticholinergic agents includes tachycardia by blockade of muscarinic receptors in the sinoatrial node. They decrease secretions of the respiratory tract mucosa and cause relaxation of the bronchial smooth musculature. There can be various effects of anticholinergic agents on the central nervous system, including excitation resulting in restlessness and hallucinations. CNS depression can also occur, with manifestations of sedation and amnesia. These effects on the CNS can be reversed with physostigmine, a cholinesterase inhibitor, which is able to cross the blood brain barrier. Salivary, and to a lesser degree, gastric secretions are decreased. There is a reduction in lower esophageal sphincter pressure and intestinal motility. From an ophthalmic standpoint, mydriasis and cycloplegia can occur. Effects on the genitourinary system include decreased ureter and bladder tone, which can lead to urinary retention. Anticholinergics can potentially raise body temperature (atropine fever) by its inhibition of sweat glands.