Chapter 7
Anticholinergic Drugs

My heart is racing!

Lesley J. Smith

Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, USA

1. Q. What are anticholinergics?
   
2. A. Anticholinergics are a class of drugs that work specifically to antagonize acetylcholine (Ach) at muscarinic receptors in the parasympathetic nervous system. Other common terms for these drugs are anti-muscarinics, vagolytics, and parasympatholytics. The two most commonly used anticholinergics in veterinary medicine are atropine and glycopyrrolate.
   
3. Q. What is the clinical effect of giving an anticholinergic?
   
4. A. The primary clinical effect of these drugs is to increase heart rate and to reduce salivation. All of the clinical effects of these drugs are related to their blockade of Ach at parasympathetic post-ganglionic sites in the body, therefore parasympathetic, or vagal tone, is reduced. Because these drugs do not discriminate between muscarinic Ach receptors, they have other effects in the body that may be undesirable. A list of their clinical effects includes:
   
   
   
   • increased heart rate/tachycardia;
     
   • decreased salivation;
     
   • decreased mucociliary transport/decrease airway clearance of debris and mucous;
     
   • bronchodilation;
     
   • pupillary dilation, decreased tear production (atropine only);
     
   • GI ileus, relaxation of gastro-esophageal sphincter → increased risk of GI reflux?
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