Cholinergics and anti cholinergics drugs, definition, indications and contraindications, complications, drugs brand name ,generic name , nursing consideration

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 CHOLINERGIC AND
 ANTICHOLINERGIC DRUGS
 Submitted to : Resp.Madam Samarna Sardar
 Subject : Pharmacology
 Class : Post RN BSc Nursing
 Semester /Batch : one 2021-2023
 Participants : Group 6
 Date of presentation : 06 April 2022
 College of Nursing
 Jinnah Post graduate Medical Center
Karachi.
Participants Topic /Slides
Ghulam Asghar Objectives
Introduction
Definition
Najeebullah Differences
Drugs names
Fazila khan Mode of Action
Indications ,
Contra Indications
Farzana Azam Risk factors
Salwa Khan Nursing management
Ghulam Asghar
Fazila Khan
Conclusion

3.  I would like to convey my heartfelt appreciation and gratitude to our
teacher Respected madam Samrna Sardar for providing us
opportunity to workOn this wonderful presentation on CHOLINERGIC
And ANTICHOLINERGIC DRUGS which helped us in a lot of article
reading and we came to know so many new things
 We are really thankful to all participants too for their assistance in
completing this presentation in such a short and hectic working
schedule as we All are nurses performing duties in different critical
units in day and night shifts
 Thank you very much group 6 participants.
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4.  OBJECTIVES
 At the end of presentation you will be able to Understand :
 Introduction Of Cholinergic and Anti cholinergic drugs
 Definition of cholinergic and Anti Cholinergic drugs
 Difference between Cholinergic and Anticholinergic drugs
 Drugs name ( Generic and brand )
 Mode of Action OF Cholinergic and Anti cholinergic drugs
 Indications of cholinergic and Anticholinergic drugs
 Contra Indication of Cholinergic and Anticholinergic drugs
 Risk Factors of Cholinergic and Anticholinergic drugs
 Nursing Management of Cholinergic and Anticholinergic drugs
 Conclusions
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5.  Introduction Cholinergic drugs :
 Cholinergic medications are a category of pharmaceutical
agents that act upon the neurotransmitter acetylcholine.
 The primary neurotransmitter within the parasympathetic
nervous system (PNS).
 There are two broad categories of cholinergic drugs:
 Direct-acting and indirect-acting.
 The direct-acting cholinergic agonists work by directly
binding to and activating the muscarinic receptors.
 Indirect-acting cholinergic agents increase the availability of
acetylcholine at the cholinergic receptors.
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6.  Introduction of Anti Cholinergic drugs :
 Anticholinergic drugs competitively inhibit binding of the
neurotransmitter, acetylcholine. They target either muscarinic
acetylcholine receptors or, less commonly, nicotinic acetylcholine
receptors.
 Muscarinic receptors are found on nerve endings to smooth muscles
cells, secretory glands and the eye. They are also found in the central
nervous system.
 Nicotinic acetylcholine receptors are located at the nerve endings of
neuromuscular junctions and are the target of muscle relaxing drugs
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7. Definition of Cholinergic drugs :
Cholinergic drug, any of various
drugs that inhibit, enhance, or
mimic the action of the neurotransmitter
acetylcholine, the primary transmitter
of nerve impulses within the
parasympathetic nervous system
that part of the autonomic nervous
system that contracts smooth
Muscles dilates blood vessels
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8. Anticholinergics are drugs that oppose the effects of acetylcholine. In
essence, they also lyse and block the effects of
parasympathetic nervous system (PNS) so they are also called
as parasympatholytics. Atropine is currently the only widely used
anticholinergic drug. Other common examples include meclizine,
scopolamine and ipratropium
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9. Difference between Cholinergic and Anticholinergic drugs
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Cholinergic drugs. Anticholinergic drugs
1. Cholinergic drugs are agent which produce
the action similar to those seen by the
stimulation of parasympathetic nervous
system
1.Drugs which block the action of
acetycholine.They are muscarinic receptors
2 .Enhance the action of acetylcholine at
neuromuscular junction
2.Block the ability of acetylcholine to
initiate involuntary muscle movement in the
lungs
3 .Enhance PNS activity 3.Enhance SNS acetylcholine
4 .Treatment of urinary retention 4.Over active bladder

10. Cholinergic drugs Anticholinergic drugs
5 ,Diagnosis of MG and treatment of long
term MG
5.Decrease mucous production in COPD
,Bronchospasm in asthma
6. Neuromuscular blockers 6.Treat Parkinson disease
7. Bethanecol ,Tensilon and Neostigmine. 7.Atropine .dicyclomine ,ipratropium
,congelon
8 .Side effects Bradycardia ,Hypotension
,Muscle weakness ,Dyspnea
8.Side effects : Dry mouth ,eyes
constipation ,urinary retension and
Tachycardia
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11. Drugs : 11

12. Cholinergic and Cholinergic drugs Generic and brand names :
Cholinergic drugs Anticholinergic drugs
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Generic name Brand name Generic Name Brand Name
1.Bethanecol Duvoid .urecholir Ipratropium Atrovent
2.Carbacol Miostat Meclizine Bonine .Antivert
3.Cevimeline Evoxac Methscopolamine Pamine
4.Pilocarpine salagen Scopolamine Transderm scope
5.Pyridostigmine Menstinon Tiotropium spiriva

13. PARASYMPATHETIC
NERVOUS SYSTEM
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salivation Lacrimation,
Urination Digestion,

14. Acetycholine
neurotransmiter
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• Acetylcholine is the chief neurotransmitter of the
parasympathetic nervous system
• the part of the autonomic nervous system (a branch of
the peripheral nervous system)
• contracts smooth muscles,
• dialates blood vessels,
 increases bodily secretions,
• slows heart rate.

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16. Cholinergic drugs effects:
Constrict pupil
Secrets saliva
Slow heart rate
Slow respiration
Constrict bronchi
Contract stomach
Stimulates peristalsis
Contract bladder
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17. Indications of cholinergic
drugs :
Glucoma
carbachol
Sjogrens
syndroms
Decreae slivation
decrease lacrimation
Alziemer’s
disease
Dementia in older
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19. Indications of cholinergics :
Belladonna
poisionoing
• Urinary
retention
• neostigmine
• (bathenachol)
Post operative
Paralytic ileus
 (bathenachol)
• neostigmine
Diagnosis of
bronchial
hyper
senstivity
Methacoline
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20. Myasthenia gravis
 Treatment (neostigmine ,pyridostigmine)
 Diagnosis (endophonium)
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22. Reversal of skeletal
muscle relaxant
cobra bite(neostigmine)
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24. BELLADONNA PLANT 24
The foliage and berries are extremely toxic
when ingested, containing tropane
alkaloids.
PHARMACEUTICAL USE:
These toxins include atropine,
scopolamine, and hyoscyamine, which
cause delirium and hallucinations, and are
also used as pharmaceutical
anticholinergics.

25. Indications of
anticholinergics
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26. Drug of choice for various
conditions 1.atropine
Pupil dialators
1.tropocamide(induce mydriasis)
2.cyclopentolate(induce mydriasis)iritis
Reduce GI motality (diarrehea,spasm)
Increases heart rate
Dry mouth
Reduce lacrimatione
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27. 2. Scopolamine : ( Hycosine )
 Prevention of motion sickness (
Oral injectible ,Transdermal 0.2 mg
given prophylaxis before surgery
 Patch behind pinnal 4-6 hours
 Decrease post operative Nausea
,Vomiting
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28. 3.Ipratropium and
tiotropium
 Copd
 Bronchodilators
 Ipratropium used as nasal spray
 (long action, once a day)
 Tiotropium is a short acting ,
(used 4times a day)
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29. Both use for over active
bladder
 1.tolterodine
 Solfenacine
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30. Parkinsons like disease
 Benztropine
 trihexyphenidyl
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31. Muscles relaxant during
surgery
 cisatracurium
 succinylcholine
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32. Botox (botulinum toxin)
 Treat local muscle spasm
 Becterial toxins
 Decreases acetycholine
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Botox is only injected in small, targeted
doses. When injected, Botox blocks signals
from your nerves to your muscles. This
prevents the targeted muscles from
contracting, which can ease certain
muscular conditions and improve the
appearance of fine lines and wrinkles.

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35. Contra Indications of Cholinergic drugs
:
• Pulmonary disease (COPD/bronchial
asthma)
• Peptic ulcer disease (may use with
caution)
• Arrhythmias (atrial fibrillation)
• Coronary vascular disease
• Angle-closure glaucoma
• Hyperthyroidism
• Intestinal resection or anastomosis
• Urinary obstruction
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36. Anticholinergic Contra
Indications
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 The following are contraindications and
 cautions for the use of anticholinergics:
 Allergy to any component of the drug
 prevent hypersensitivity reaction
 Glaucoma. Can be exacerbated by blockade of PNS.
 Intestinal atony, paralytic ileus, GI obstruction.
 Can be exacerbated with further slowing of GI activity.
 Pregnancy. Potential adverse effects on the fetus.

37. Cholinergic Risk factors :
 Cholinergic crisis can be precipitated by exposure to drugs that inhibit
AChE, for example :
 Nerve gas and organophosphate compounds used in pesticides
 Insecticides, and herbicides. Exposure might be via inhalation of vapors,
ingestion, or direct
 contact of the chemical with the skin or mucous membrane
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38. Anticholinergic drugs
Risk factors :
Chronic obstructive pulmonary disease ( COPD )
Over active bladder incontinence
Gastrointestinal disorders ,such as :Diaorrhoea ,Asthma
Dizziness and motion sickness
Poisoning cause by toxin such as :organophosphates or
muscarine,which may be found in
some insecticides and poisonous mushrooms
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39. Nursing Intervention (Cholinergic drugs )
 These are vital nursing interventions done in patients who are taking cholinergic
agonists:
 Administer oral drug on empty stomach to decrease nausea and vomiting.
 If drug is given intravenously, administer slowly to avoid severe cholinergic effects.
 Assess for contraindications or cautions (e.g. history of allergy to drug, GI
obstruction, pregnancy or lactation status, etc.) to avoid adverse effects.
 Establish baseline physical assessment to monitor for any potential adverse effects.
 Assess orientation, affect, reflexes to monitor CNS drug effects.
 Assess vital signs, especially pulse and blood pressure to monitor for possible
excess stimulation of the cardiac system.
 Assess abdomen, auscultating for bowel sounds and palpating for distention.
 Monitor intake and output, noting any complaints of urinary urgency to monitor for
drug effects on the urinary system
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40. Cont …
> Assess vital signs, especially pulse
and blood pressure to monitor for
possible excess stimulation of the
cardiac system.
> Assess abdomen, auscultating
for bowel sounds and palpating
for distention.
 Monitor intake and output, noting
any complaints of urinary urgency
to monitor for drug effects on the
urinary system
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41. NURSING MANAGEMENT OF ANTICHOLINERGIC DRUGS
 These are vital nursing interventions done in patients who are
taking anticholinergics:
 Ensure proper administration of the drug to ensure effective
use and decrease the risk of adverse effects.
 Monitor patient response (e.g., blood pressure, ECG, urine
output) for changes that may indicate need to adjust dose.
 Provide comfort measures (e.g., sugarless lozenges, lighting
control, small and frequent meals) to help patient cope with
drug effects.
 Provide patient education about drug effects and warning signs
to report to enhance knowledge about drug therapy and
promote
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43. Conclusion :
Cholinergic drugs a group of medication that effect the function of
nervous system
The Nervous system is made up of two main parts Sympathetic and
Para sympathetic nervous system
Sympathetic nervous system regulates action in stress ful situation
allowing the human body to react and respond quickly.
The parasympathetic nervous system manages normal day to day
body functions like smooth muscle Contractions , a regular heart rate
and diagestive system
Cholinergic drugs impact the parasympathetic nervous system ,This
means that they are used to treat conditions that interupt digestion
muscle contraction ,weakness and can even help manage some
cardiac issues
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44. Conclusion Anticholinergic drugs :
Anticholinergic are drugs that block the action of acetycholine
Acetycholine is a neurotransmitter or a chemical messenger
It transfer signals between certain cells to effect how your body
functions
These agents inhibits the parasympathetic nervous sytem by
selectively
Blocking the bindings of Ach to its receptors in nerve cells
The nerve fibers of parasympathetic system are responsible for
the in voluntary
Movement of smooth muscles present in the gastrointestinal
tract ,Urinary tract
Lungs ,sweet glands and many other parts of the body.
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45. References
 References
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 2.Jeyaratnam J. Acute pesticide poisoning: a major global health problem. World Health Stat Q. 1990;43(3):139-
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 3.Litovitz TL, Smilkstein M, Felberg L, Klein-Schwartz W, Berlin R, Morgan JL. 1996 annual report of the American
Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 1997 Sep;15(5):447-
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 4.Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev. 2003;22(3):165-
90. [PubMed]
 5.Tuovinen K. Organophosphate-induced convulsions and prevention of neuropathological damages. Toxicology. 2004 Mar
01;196(1-2):31-9. [PubMed]
 6.Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide
poisoning. Lancet. 2008 Feb 16;371(9612):597-607. [PMC free article] [PubMed]
 7.Lutovac M, Popova OV, Jovanovic Z, Berisa H, Kristina R, Ketin S, Bojic M. Management, Diagnostic and Prognostic
Significance of Acetylcholinesterase as a Biomarker of the Toxic Effects of Pesticides in People Occupationally
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