What is anticholinergic syndrome?

Answer 1

http://en.wikipedia.org/wiki/Anticholinergic

Answer 2

Actually, swearing is an extremely rare (and debilitating) symptom in people who have Tourette syndrome. It's a type of tic called coprolalia. I have Tourette's and I've met a lot of people with Tourette's, but I've met very few who have coprolalia (maybe two out of a hundred people I've met) Tourette syndrome is much more than what you see on the outside. It's like a massive build up of tension all over your body. Your brain is making you do these things. For me, when I have vocal tics (the main one I have is just a noise - I don't say any words), it feels like there's a balloon in my chest and if I don't do it, I can barely breathe and it feels like the balloon is getting bigger and bigger. It doesn't stop until I do it. It's really uncomfortable and often painful, but a lot of the time I suppress the urge to do it because I don't want to be judged. The best way I could probably describe the swearing tic would be that the person has an extreme build up of energy and tension and the only possible way to get rid of it is to say/shout/do something that is considered "risky" or inappropriate. Sort of like, for example, if you stumped your toe or burned yourself, you need to release the tension. Some people cry, some jump around and some people scream or shout curse words. Now, it's much more complex than that but that's the way best way I could describe it to someone who doesn't have Tourette's. Also, I've never experienced coprolalia myself so this may not be how someone else with it would describe it, but that's my understanding of it to some extent. It's not the same for everyone. Anyway, I haven't answered your question yet. Basically, coprolalia isn't just about curse words, it's about saying something that would be inappropriate to say in a given situation. For example, in the news a few days ago, a man with Tourette syndrome was thrown off a plane for shouting the word "bomb". He has coprolalia even though "bomb" isn't a curse word. He was compelled to say the worst possible thing in that situation. Also, if a young child with Tourette's had coprolalia, they probably wouldn't know swear words, depending on their age, so they would shout words that they consider bad. I don't know if that makes sense to you or not because it's really difficult to explain. I've had TS my whole life and I still don't understand it!

Answer 3

Its in inhibiting or blocking the physiological action of acetlycholine at a receptor site: anticholinergic drugs

Answer 4

1

Answer 5

ACUTE ANTICHOLINERGIC SYNDROME

DEFINITION

Clinical syndrome resulting from antagonization of acetylcholine at
the muscarinic receptor.

TOXIC CAUSES

Antihistamines (especially Promethazine, Trimeprazine,
Dimenhydrinate)
Antiparkinsonian drugs (e.g., Benztropine, Biperiden, Orphenadrine,
Procyclidine)
Antispasmodic agents (e.g., Clidinium, Glycopyrrolate,
Propantheline)
Belladonna alkaloids (e.g., Belladonna extract, Atropine, Hyoscine,
L-Hyoscyamine sulphate, Scopolamine hydrobromide)
Cyclic Antidepressants
Ophthalmic cycloplegics (e.g., Cyclopentolate, Homatropine,
Tropicamide)
Phenothiazines
Plants containing anticholinergic alkaloids (e.g., Atropa
belladonna, Brugmansia spp, Cestrum spp, Datura spp, Hyoscyamus
niger, Solanum spp). The tropane derivatives (alkaloids of
solanaceous plants and related drugs) are of greatest practical
importance.

CLINICAL FEATURES

The clinical diagnosis is based on the appearance of the
anticholinergic toxidrome. This toxidrome has central and
peripheral components:

The central anticholinergic signs and symptoms include altered
mental status, disorientation, incoherent speech, delirium,
hallucinations, agitation, violent behaviour, somnolence, coma,
central respiratory failure, and, rarely, seizures.

The peripheral anticholinergic syndrome includes hyperthermia,
mydriasis, dry mucosa membranes, dry, hot and red skin, peripheral
vasodilatation, tachycardia, diminished bowel motility (even
paralytic ileus), and urinary retention.

Rhabdomyolysis, cardiogenic shock or cardiorespiratory arrest may
occur exceptionally. Patients with closed-angle glaucoma may
suffer an acute precipitation of the condition. Patients with
benign prostatic hyperplasia are particularly prone to develop
urinary retention.

DIFFERENTIAL DIAGNOSIS

Alcohol withdrawal
Organic delirium (usually secondary to sepsis)
Psychiatric illness
Psychedelic drugs
Sympathomimetic drugs

RELEVANT INVESTIGATIONS

Measurement of blood and urine levels of the anticholinergic agents
are of little or no practical value.
Other laboratory examinations may be needed as dictated by the
general condition of the patient.

TREATMENT

Treatment is primarily supportive. The patient must be protected
from self-inflicted injury. This may require physical and/or
pharmacological restraint. Respiratory failure may require
intubation and controlled respiration. In cases of ingestion,
decontamination may be considered.

Diazepam: Administer 5 to 10 mg intravenously over 1 to 3
minutes. Repeat this dose as necessary to a maximal total dose of
30 mg.

The paediatric dose of diazepam is 0.25 to 0.4 mg/kg up to
maximal total dose of 5 mg in children up to 5-years-old and 10mg
in children over 5-years-old.

Physostigmine is a specific antidote for anticholinergic
poisoning and may be used under the following conditions :

1. Severe agitation or psychotic behaviour unresponsive to
other treatments.
2. Clinical evidence of both peripheral and central
anticholinergic syndrome.
3. No history of seizures.
4. Normal ECG, especially QRS width.
5. No history of ingestion or co-ingestion of tricylic
antidepressants or other drugs that delay
intraventricular conduction.
6. Cardio-respiratory monitoring in place and resuscitation
facilities available.

The dose of physostigmine is 1 to 2 mg (0.5 mg in children) by
intravenous injection over 2 to 5 minutes. If necessary, this dose
can be repeated after 40 minutes.

CLINICAL COURSE AND MONITORING

Complete recovery is expected over a period of hours to days.

In more severe cases of anticholinergic syndrome, cardiac rhythm
should be monitored and blood pressure frequently measured. Urine
output should be monitored so as not to overlook urinary retention.

LONG TERM COMPLICATIONS

Nil specific.

AUTHOR(S)/PEER REVIEW

Author: Dr J. Szajewski, Director, Warsaw Poison Control
Centre, Warsaw, Poland.

Peer Review: Berlin, October 1995: R. Dowsett, J. Pronczuk.

Answer 6

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ACUTE ANTICHOLINERGIC SYNDROME

DEFINITION

Clinical syndrome resulting from antagonization of acetylcholine at
the muscarinic receptor.

TOXIC CAUSES

Antihistamines (especially Promethazine, Trimeprazine,
Dimenhydrinate)
Antiparkinsonian drugs (e.g., Benztropine, Biperiden, Orphenadrine,
Procyclidine)
Antispasmodic agents (e.g., Clidinium, Glycopyrrolate,
Propantheline)
Belladonna alkaloids (e.g., Belladonna extract, Atropine, Hyoscine,
L-Hyoscyamine sulphate, Scopolamine hydrobromide)
Cyclic Antidepressants
Ophthalmic cycloplegics (e.g., Cyclopentolate, Homatropine,
Tropicamide)
Phenothiazines
Plants containing anticholinergic alkaloids (e.g., Atropa
belladonna, Brugmansia spp, Cestrum spp, Datura spp, Hyoscyamus
niger, Solanum spp). The tropane derivatives (alkaloids of
solanaceous plants and related drugs) are of greatest practical
importance.

CLINICAL FEATURES

The clinical diagnosis is based on the appearance of the
anticholinergic toxidrome. This toxidrome has central and
peripheral components:

The central anticholinergic signs and symptoms include altered
mental status, disorientation, incoherent speech, delirium,
hallucinations, agitation, violent behaviour, somnolence, coma,
central respiratory failure, and, rarely, seizures.

The peripheral anticholinergic syndrome includes hyperthermia,
mydriasis, dry mucosa membranes, dry, hot and red skin, peripheral
vasodilatation, tachycardia, diminished bowel motility (even
paralytic ileus), and urinary retention.

Rhabdomyolysis, cardiogenic shock or cardiorespiratory arrest may
occur exceptionally. Patients with closed-angle glaucoma may
suffer an acute precipitation of the condition. Patients with
benign prostatic hyperplasia are particularly prone to develop
urinary retention.

DIFFERENTIAL DIAGNOSIS

Alcohol withdrawal
Organic delirium (usually secondary to sepsis)
Psychiatric illness
Psychedelic drugs
Sympathomimetic drugs

RELEVANT INVESTIGATIONS

Measurement of blood and urine levels of the anticholinergic agents
are of little or no practical value.
Other laboratory examinations may be needed as dictated by the
general condition of the patient.

TREATMENT

Treatment is primarily supportive. The patient must be protected
from self-inflicted injury. This may require physical and/or
pharmacological restraint. Respiratory failure may require
intubation and controlled respiration. In cases of ingestion,
decontamination may be considered.

Diazepam: Administer 5 to 10 mg intravenously over 1 to 3
minutes. Repeat this dose as necessary to a maximal total dose of
30 mg.

The paediatric dose of diazepam is 0.25 to 0.4 mg/kg up to
maximal total dose of 5 mg in children up to 5-years-old and 10mg
in children over 5-years-old.

Physostigmine is a specific antidote for anticholinergic
poisoning and may be used under the following conditions :

1. Severe agitation or psychotic behaviour unresponsive to
other treatments.
2. Clinical evidence of both peripheral and central
anticholinergic syndrome.
3. No history of seizures.
4. Normal ECG, especially QRS width.
5. No history of ingestion or co-ingestion of tricylic
antidepressants or other drugs that delay
intraventricular conduction.
6. Cardio-respiratory monitoring in place and resuscitation
facilities available.

The dose of physostigmine is 1 to 2 mg (0.5 mg in children) by
intravenous injection over 2 to 5 minutes. If necessary, this dose
can be repeated after 40 minutes.

CLINICAL COURSE AND MONITORING

Complete recovery is expected over a period of hours to days.

In more severe cases of anticholinergic syndrome, cardiac rhythm
should be monitored and blood pressure frequently measured. Urine
output should be monitored so as not to overlook urinary retention.

LONG TERM COMPLICATIONS

Nil specific.

AUTHOR(S)/PEER REVIEW

Author: Dr J. Szajewski, Director, Warsaw Poison Control
Centre, Warsaw, Poland.

Peer Review: Berlin, October 1995: R. Dowsett, J. Pronczuk.

Answer 7

Adverse effects of TCAs include anticholingeric effects, cardiotoxicity, weight gain, hypertension in children, decreased seizure threshold, agitation and psychosis. TCAs can be lethal in overdose. Electrocardiogram (EKG) monitoring is important when taking a TCA and should be conducted at baseline, steady state, dosing changes and yearly thereafter. Withdrawal effects associated with the discontinuation of a TCA include dizziness, nausea, vomiting, headache, malaise, hyperthermia, irritability and sleep disturbances. Counseling patients and their family regarding the necessity of compliance with their medication regimen and complications of abrupt discontinuation is important.

Answer 8

1. Clinical syndrome resulting from antagonization of acetylcholine at the muscarinic receptor.

2. Inhibiting or blocking the physiological action of acetylcholine at a receptor site

Answer 9

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Answer 10

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