/reference/drugs/anticholinergics

Anticholinergics

Atropine, glycopyrrolate, scopolamine

Glycopyrrolate

Quaternary ammonium muscarinic antagonist / antisialagogue

Competitive antagonist at peripheral muscarinic acetylcholine receptors. Quaternary structure → does NOT cross blood-brain barrier (unlike atropine, scopolamine) → no CNS effects. Primary anesthesia uses: (1) prevent muscarinic effects of anticholinesterases during NMB reversal; (2) reduce secretions before fiberoptic/awake intubation.

Atropine

AtroPen

Tertiary amine muscarinic antagonist

Competitive antagonist at muscarinic ACh receptors. Tertiary amine → CROSSES blood-brain barrier (in contrast to glycopyrrolate) → central anticholinergic effects possible. Faster onset than glycopyrrolate; useful for emergent bradycardia.

Scopolamine

Transderm-Scop

Tertiary-amine muscarinic antagonist (CNS-active)

Competitive muscarinic antagonist with high CNS penetration. Strong central antiemetic + amnestic effects via vestibular nuclei + chemoreceptor trigger zone. Weak peripheral effects compared with atropine.

Education only — not a substitute for current package inserts or clinical judgment. Always confirm doses.