Anticholinergics抗膽鹼性藥物

主條目:藥物影響膽能素

Anticholinergics(抗膽鹼性藥物 may refer to antinicotinics or Antimuscarinics; however, when we use the word we often mean Antimuscarinics.

分類

natural tertiary amine alkaloid ester of tropic acid: nonselective muscarinic antagonist with little interactions with other receptors (N_N or histamine receptors)

• l(-)-hyoscylamine→atropine((±)-hyoscylamine)(dl-hyoscylamine):中樞興奮
• hyoscine(scopolamine)少量時中樞抑制，大量時也是中樞興奮

synthetic antimuscarinics: muscarinic antagonist moderately selective for one or another subgroups of muscarinic receptor with interactions with other receptors (N_N or histamine receptors)

spasmolytics(解痙藥)-解腸胃痙痛劑

• atropine: from Tyler
• scopolamine: from Tyler
• bucopan
• clidinium
• dicyclomine
• diphemanil
• glycopyrrolate
• homatropine methylbromide
• isopropamide
• mepenzolate
• methantheline
• oxyphencyclimine
• papaverine
• propantheline
• tridihexethyl

spasmolytics(解痙藥)-drugs for bladder spasm after urologic surgery

oxybutynin

incontinence in institutionalized elderly patients

• TCA:imipramine
• propiverine

骨架

• ethylenediamine
• ethanolamine

用途

• antiparkinson
• sedative-hypnotics
  • sedation
  • hypnotion
  • anxiolytics
• 麻醉手術前投與以減少分泌 PS scopolamine尚可有術後失憶的效果(同術前投與的sedative-hypnotics)
• 暈車藥、止吐藥
• 解腸胃痙痛劑、止瀉劑(少用)
• 解毒劑:cholineasterase inhibitor中毒的解毒劑

參考資料

• basic

Anticholinergic burden

• 有的藥有抗膽鹼作用，多重用藥要注意這類藥的累積效應
• 有的SSRI
• 有的抗組織胺
• 有的急迫性尿失禁用藥，用beta3 agonist-Mirabegron(商品名:Betmiga)替代
  • 過動性膀胱（Overactive bladder，簡稱OAB），又稱為膀胱過動症（Overactive bladder syndrome），急迫性尿失禁；欲望性尿失禁（Urge incontinence）

延伸學習

• 膽鹼性藥物
• 抗膽鹼性藥物
• 解腸胃痙痛劑
• analgesics
• spasmolytics