• racemic mixture of D and L hyoscyamine
• physiological effects caused by L
• induces mydriasis by blocking contraction of pupillary sphincter (but tropicamide and phenylephrine are better mydriatics)
• used to treat bradycardia (resuscitation [unless hypoxic]), increased secretions, and bronchoconstriction

atropine = antidote for OP poisoning

Salivation

Lacrimation

Urination

Diaphoresis

GI Motility

Emesis

A FLOP

bloody tears caused by cholinesterase inhibition

• too much atropine
• sweat glands are symp and parasymp, both use ACh
• mad as a hatter, red as a beet, dry as a bone, blind as a bat, hot as a hare
• micropsia

• child of atropine, but no CNS effects
• synthetic
• weaker muscarinic antagonist
• p.o. or i.v.

COPD/asthma

inhaled antimuscarinics

• ipratropium and oxitropium are short acting
• tiotropium is long acting

• muscarinic receptors are a family
• these are selective subtype blockers, but selectivity unimpressive/not useful
• M3 receptors are mediators of detrusor contractility, also involced in GI contraction, saliva production, iris sphincter, etc
• darifenacin, M3>M1>M2
• used to make you have to go less
• oxybutinin, semi-selective, M1=M3>M2
• may cause dry mouth --> increased thirst
• tolterodine is unselective

• used to treat Parkinson's
• two big players in motor control: ACh and D
• benzatropin, obv has CNS penetration

1st generation H1 antihistamine

with strong anticholinergic effect

antimuscarinic

antihistamine

NMDA antagonist

derivative of diphenhydramine

almost as potent as atropine

• most commonly used antimuscarinic for Parkinson's
• esp for iatrogenic pseudo-parkinson's
• IV formulation as well

• muscarine: not a drug, but substance of abuse, used to increase male potency pre-sildenafil, no BBB crossing (no CNS effects), causes bradycardia and bronchorrhea
• pilocarpine used in treatment of chronic open-angle glaucoma and acute angle-closure glaucoma
• cevimeline M3 agonist, used to increase salivation, treat dry mouth and eyes in Sjogren syndrome
• cyclosporine A also used for dry eyes which is also used for immunosuppression (look up immunosuppressants)