Medicine & USMLE

Anticholinergic Syndrome

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Neuro Drugs
  1. Anticholinergic Syndrome
  2. Cholinergic Crisis
  3. Benztropine / Trihexyphenidyl
  4. Pyridostigmine, Neostigmine, Edrophonium
  5. Donepezil
  6. Memantine
  7. Scopolamine
  8. Levodopa, Carbidopa
  9. Selegiline / Rasagiline
  10. Entacapone / Tolcapone
  11. Propofol
  12. Halothane / Flurane
  13. Opioids
  14. Succinylcholine
  15. Lidocaine
  16. Ergotamine
  17. Triptans
  18. Pregabalin
  19. Gabapentin
  20. Ramelteon

Summary

Anticholinergic syndrome is a clinical condition caused by excessively low levels of acetylcholine signaling, most often caused by anticholinergic medications. Clinically, anticholinergic syndrome manifests as urinary retention, dry mouth, pupil dilation, constipation, tachycardia, and altered mental status. The best antidote to treat anticholinergic syndrome is physostigmine.

Key Points

  • Anticholinergic Syndrome
    • Cause
      • Decreased acetylcholine
        • Usually caused by drugs with anticholinergic properties (atropine, antipsychotics, TCAs, etc.)
    • Symptoms
      • Think reduced “rest and digest”
      • Tachycardia
      • Dry mouth
        • Caused by decreased secretions (e.g. saliva)
      • Constipation
      • Urinary retention
      • Blurry vision / Mydriasis (pupil dilation)
        • Caused by pupil dilation and cycloplegia (inhibited lens focusing)
      • Altered mental status (confusion)
        • Delirium/hallucinations and confusion may be seen in elderly patients due to reduced acetylcholine signaling in the central nervous system
        • This is the rationale for using Beer’s criteria to avoid medications in at-risk patients
    • Treatment
      • Physostigmine