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Related Concept Videos

Cholinergic Antagonists: Therapeutic Uses01:26

Cholinergic Antagonists: Therapeutic Uses

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Antimuscarinic drugs have various therapeutic applications by inhibiting parasympathetic stimulation in different systems. Here are the key therapeutic uses of antimuscarinics:    
Respiratory Tract: Ipratropium, aclidinium, and tiotropium treat asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). They protect against bronchoconstriction caused by irritants like cigarette smoke, sulfur dioxide, and ozone. They also help reduce nasopharyngeal...
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Cholinergic Antagonists: Pharmacological Actions01:28

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Antimuscarinic drugs block muscarinic receptors in multiple systems, including the gut, eye, smooth muscles, respiratory tract, cardiovascular, and central nervous systems. They produce similar effects with varying selectivity depending on the specific agent and tissue. Here are the key pharmacological actions of antimuscarinics:
Gastrointestinal Effects: Antimuscarinics reduce gut contractions, increase gastric emptying, and slow intestinal transit. They partly inhibit gastric acid secretion...
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Cholinergic Antagonists: Pharmacokinetics01:24

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Cholinergic antagonists—such as antimuscarinics—are available in oral, topical, ocular, parenteral, and inhalational formulations. Most antimuscarinics are oral formulations,  while scopolamine is available as a topical patch, and ipratropium and tiotropium are available as inhalation aerosols or powders. Atropine, tropicamide, and cyclopentolate are topically instilled in the eye. Most antimuscarinics are lipid-soluble and readily absorbed from the gastrointestinal tract and...
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Indirect-Acting Cholinergic Agonists: Pharmacological Actions01:30

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Indirect-acting cholinergic agonists, also known as anticholinesterases, exert their pharmacological effects by enhancing cholinergic transmission in various body parts, including the neuromuscular junction, autonomic cholinergic synapses, and the brain.
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
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Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Direct-Acting Cholinergic Agonists: Therapeutic Uses01:11

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Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren...
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Meta-Analysis of the Effectiveness and Safety of Shugan Jieyu Capsules for the Treatment of Insomnia
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Anticholinergic Medication Burden Scales: A Systematic Review.

Orla Vennard1,2, Carrie Stewart2, Mansi Tolia1,3

  • 1School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.

Journal of the American Geriatrics Society
|February 23, 2026
PubMed
Summary
This summary is machine-generated.

No single anticholinergic burden scale is universally accepted. This review highlights the need for a standardized system to accurately assess anticholinergic medication risks and improve patient safety.

Keywords:
anticholinergic burdenolder adultspolypharmacyscales

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A Computerized Test Battery to Study Pharmacodynamic Effects on the Central Nervous System of Cholinergic Drugs in Early Phase Drug Development
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Area of Science:

  • Pharmacology
  • Geriatrics
  • Clinical Pharmacy

Background:

  • Anticholinergic burden (ACB) is the cumulative effect of medications with anticholinergic properties.
  • ACB scales aid in identifying patients at risk of adverse effects and guiding prescribing practices.
  • Existing ACB scales show significant variability, lacking a recognized gold standard, which can lead to inconsistent risk assessment and suboptimal patient care.

Purpose of the Study:

  • To systematically review anticholinergic burden scales, examining their medication lists, development, and scoring methodologies.
  • To summarize the clinical outcomes associated with different anticholinergic burden scales.

Main Methods:

  • A systematic literature search was conducted up to January 2025, including studies proposing novel or updated ACB scales.
  • Independent review and data extraction by two reviewers using a custom tool based on expert consensus.
  • Narrative synthesis of findings from 21 included studies.

Main Results:

  • Significant variability exists in the number of medications included (27-217) and the scoring of high-potency drugs (74% inconsistent).
  • Scale development often relied on literature review and expert opinion, with geographical origin and methodology influencing variability.
  • Inconsistent consideration of factors like dosage across scales impacted clinical relevance, as reflected in outcome studies.

Conclusions:

  • No definitive gold standard anticholinergic burden scale was identified in the review.
  • Scales with comprehensive drug coverage and consideration for individual variability appear more clinically relevant.
  • A need exists for a universal, clinically accessible scoring system to mitigate risks of anticholinergic polypharmacy.