Cholinergic and Anticholinergic Pharmacology Made Easy

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Today, we’ll be focusing our attention on anticholinergic bronchodilators.

In the simplest sense, you anticholinergic bronchodilators are your drugs that have the capacity to turn off the system in your body that causes the fight and flight reaction.

To explain further…

Sympathetic versus Parasympathetic

So, there are two systems involved – the sympathetic nervous system and the parasympathetic nervous system. How do you distinguish one from the other?

  • Sympathetic nervous system (SNS) – fight and flight
  • Parasympathetic nervous system (PNS) – rest and digest

When trying to differentiate one from the other, there are a couple of questions that you need to ask:

  1. Where is the blood going?
  2. Is it headed towards your fight and flight organs or towards your digest and rest organs?
  3. What are your fight and flight organs?
  4. What are your digest and rest organs?

Your fight and flight organs are:

  1. Heart
  2. Lungs
  3. Brain

Your digest and rest organs are:

  1. Gastrointestinal (GI) Tract
  2. Kidneys
  3. Muscles
  4. Other organs

The teeter-totter figure

To make your memorization easier, imagine a teeter-totter.

On the left side, is your sympathetic nervous system (SNS), and on the right side is your parasympathetic nervous system (PNS) or the parasympathomimetics nervous system. Below your SNS, write down the organs responsible for the fight and flight reaction which is your heart, lungs, and brain. Then below the PNS, write down the organs responsible for the digest and rest reaction.

Anticholinergic versus Cholinergic

After identifying what your SNS and PNS are, we now have to relate them to your cholinergic and anticholinergic drugs.

How does one distinguish anticholinergic from cholinergic drugs?

Sympathomimetic reactions (fight and flight) – Anticholinergic drugs

The mechanism of anticholinergic drugs is to direct blood to your heart, lungs, and brain by inhibiting the parasympathetic nervous system. When the signal going to the PNS is blocked or disrupted, the involuntary functions like mucus secretion, salivation, urination, and digestion is decreased significantly.

Examples: Atropine, Epinephrine

Parasympathetic nervous system (rest and digest) – Cholinergic drugs

On the other hand, cholinergic drugs are basically the opposite of the SNS. Because with cholinergic drugs, there is an increase in involuntary functions which basically means that there is saliva production, urination, and mucus secretion.

An instructor of Mike’s once shared a very useful tip when remembering cholinergic and anticholinergic drugs. Just remember the 3 S’s:

  • See
  • Spit
  • Shit (excrete)

Simply put it this way:

Anticholinergics – can’t see, can’t spit, can’t shit

Cholinergics – can see, can spit, can shit

Easy enough?

Cholinergic agents allow you to see due to the production of fluid that moisturizes the eyes and you can salivate because of the production of mucus. You can also urinate and defecate.

Anticholinergic agents decrease all the activities mentioned above. Instead, you will increase the client’s heart rate and perfusion to the lungs and brain.

So just remember…

Administering drugs with SNS and PNS effects will directly influence where the blood will be heavily distributed for the sake of treating a number of conditions. If you turn one off, the other is turned on. Don’t forget the teeter-totter figure.