Nama Maba : Azatil Ismah Firdaus

Nama Amerta : Pharmacology

ANTICHOLINERGIC

Anticholinergics are esters of aromatic acids combined with organic bases.

The ester bond is essential in an effective bond between anticholinergics and
acetylcholine receptors. This drug binds in a competitive blockade with
acetylcholine and prevents receptor activation (1). Examples of anticholinergic
drugs are atropine, scopolamine, beladona extract, oxyphenonium bromide and so
on (2).

The dose of anticholinergic drugs varies depending on the type of drug

used and the type of disease treated. For example, the dose of atropine to treat
gastrointestinal abnormalities is 3 times 0.4 mg. Ipratropium is available in liquid
form for steam therapy in people with asthma. The dose of ipratropium is 500
micrograms repeated every 20 menin for three times. Diphenhidramine for
insomnia (difficulty sleeping) the dose is 50 mg taken 30 minutes before bed (3).

Anticholinergics can be used to treat certain diseases, such as acute

dystionia, parkinsonism syndrome, and akathisia. Giving intravenous or
intramuscular anticholinergics for the sufferers of acute dystonia is a rapid and
effective therapy. The effects of anticholinergic drugs eliminate dystonia after a
few hours of use. Meanwhile for Parkinsonism disease, the common therapy for
idiopathic Parkinson's disease is improving the balance of dopamine-acetylcholine
and increasing the availability of dopamine. Parkinsonism therapy more often
leads to decreased levels of acetylcholine and effectively weakens the side effects
of parkinsonism without the exacerbation of underlying psychotic disorders. In
akathisia, anticholinergics is more effective in acute akathisia associated with
parkinsonism. An antipsychotic dose should be reduced before the addition of
other therapies to deal with acute acathisia (4).

The main effects of anticholinesterase used in therapy are effects on

pupils, intestines, and nerve-muscle joints. When fisostigmin (Eserin) or DFP is
dripped on bulb conjunctiva, then miosis appear, there is loss of accommodation
power, and conjunctival hyperemia are present. The loss of accommodation power
and conjunctival hyperemia did not last long. It is usually disappearing long
before the disappearance of miosis. While in the human gastrointestinal tract,
prostigmins increase bowel peristalsis, gastric contractions, and gastric acid
secretion. At the nerve-muscle junction, anticholinesterase shows a nicotic effect
on skeletal muscle because acetylcholine is accumulated in the nerve-muscle joint.
This causes the skeletal muscle in a state of continuous arousal resulting in
tremor, muscle fibrillation, and in a state of poisoning, convulsions. Another
effect of anticholinesterase use is to increase the secretion of all exocrine glands
such as the glands in the bronchus, tear glands, sweat glands, salivary glands, and
gastrointestinal glands (5). Other side effects of anticholinergic drugs are dry
mouth, anhidrosis, blurred eyes, tachycardia, dysuria and acute urinary retention
(6).

References

1. Dewi, D.A.K. 2015. Cholinergic and Anticholinergic Drugs.

https://dokumen.tips/documents/obat-kolinergik-antikolinergik.html. Accessed
on 15th August 2017. At 19.46.
2. Ulfa, Maria. 2014. Drugs on the Autonomic Nervous System. http://upa-
fafa.blogspot.co.id/2014/05/obat-obat-pada-sistem-saraf-otonom.html.
Accessed on 15th August 2017. At 20.57.
3. Fredy, F.C. 2014. Anticholinergic.
http://www.buku.asikbelajar.com/2016/10/cara-merujuk-dan-menulis-daftar-
rujukan.html. Accessed on 15th August 2017. At 08.09.
4. Swayami, I G.A.V. 2014. Biological Aspects of Trihexifenidil in Psychiatry.
MEDICINA 45: 88-92. (Online)
(https://ojs.unud.ac.id/index.php/medicina/article/view/14264/9799, accessed
on 15th August 2017).
5. Gan Gunawan et al. Pharmacology and Therapy (5th edition). Jakarta: Medical
Faculty of UI.
6. Putrawan, F.S. 2016. Cholinergic and Anticholinergic.
http://sidfirman82.blogspot.co.id/2016/03/kolinergik-dan-antikolinergik.html.
Accessed on 15th August 2017. At 08.11.