FINGER SWEAT PRINT TAPE BANDS

A simple inexpensive technique for obtaining finger sweat prints (FSPs) is described. Evidence for its validity is presented. The method proved approximately equal to a more elaborate procedure in sensitivity to an anticholinergic drug effect. FSP techniques, perhaps, have been technically refined without the compensating gains of increased reliability or validity.     

某些取代羟乙酸哌啶醇酯类化合物的合成及抗胆碱作用的研究

本文报道20个取代羟乙酸哌啶醇酯类化合物的合成及其中枢及外周抗胆碱作用。初步药理结果表明:其中一部份化合物具有较强的中枢及外周抗胆碱作用,尤以化合物Ⅲ的生理活性最强,其抗震颤素引起震颤的ED₅₀0.173 mg/kg,稍强或相当于著名的中枢抗M-胆碱作用的代表化合物——二苯羟乙酸-3-喹咛酯(QNB)的强度,值得进一步研究。     

Anticholinergic premedication in Finland 1988

In order to investigate the present use of anticholinergic drugs in premedication, a questionnaire was sent to Finnish anaesthesiologists. The results indicate that there is significant variation between different parts of the country regarding the usage of these drugs. A decrease in routine use has taken place over the past 5 years. Half of the anaesthesiologists now routinely use anticholinergic drugs in premedication, while 69% were using them 5 years ago. Glycopyrrolate has gained popularity and was the most used drug. Most anaesthesiologists gave the anticholinergic premedication intravenously, briefly before induction.     

Effects of intrahippocampal injections with methylscopolamine and neostigmine upon exploratory behaviour in two inbred mouse strains

After stereotaxically injecting male mice of the inbred strains C57BL/6 and DBA/2 with two doses of methylscopolamine or with two doses of neostigmine into the left dorsal hippocampus, the frequencies of the exploratory acts rearing, leaning, and sniffing carried out in a novel environment were recorded. At the lower dose-level, the anticholinergic drug tended to augment exploration in strain DBA and to reduce it in strain C57BL; the two doses of anticholinesterase diminished the scores in both genotypes. From these data it is concluded that the hippocampus contains a cholinergic mechanism which regulates exploratory behaviour and which is genetically controlled.     

新抗胆碱化合物TBBB的M-受体拮抗作用与丁基东莨菪碱HBB及阿托品的比较

The radioreceptor assay using ³H-QNB as a ligand on cardiac membrane preparation and determination of pA₂ and pA₁₀ on isolated atria and ileum of guinea-pig were performed for comparing the potency of M-receptor antagonism of a new cholinolytic compound TBBB with that of HBB and atropine. Taking the potency of atropine as 1, the inhibition action of TBBB and HBB on ³H-QNB bindings to cardiac membrane preparation corresponded to 1/77 and 1/59, respectively. The antagonistic action of both in this respect was almost the same. The antagonism of inhibition induced by Ach on contractility of guinea-pig atria, however, was 1/8.9 and 1/26.5 for TBBB and HBB, respectively. The cholinolytic effect of TBBB and HBB on isolated guinea-pig ileum was 1/11.2 and 1/21,9, respectively, showing that the former is more potent to relax the spasm of gastro-intestinal smooth muscle. The mode of antagonism was believed to be competitive based on the fact that the difference of PA₂ and PA₁₀ observed was about 0.95 which was the same for all the three compounds. TBBB, which is less expensive and easier to produce, is warranted for clinical applications.     

Scopolamine does not disrupt spatial working memory in rats

The importance of cholinergic systems for spatial working memory was examined by injecting scopolamine at varying times during a 5 hr-long retention interval imposed between the rat's fourth and fifth choices in an 8 arm maze. Regardless of whether or not the testing procedure required the rats to adopt a spatial solution for the task, scopolamine (1.0–5.0 mg/kg) did not impair retention in a manner that was suggestive of an effect on working memory. Modest deficits observed in some conditions appeared to result from drug effects on performance. Previous findings of impaired acquisition of accurate spatial behavior by scopolamine-treated rats evidently reflect an influence of the drug on physiological systems other than those necessary to maintain working memory for spatial information.     

A survey of current usage of anticholinergic drugs in paediatric anaesthesia in Finland

BACKGROUND: The aim of this survey was to obtain information about the current use of anticholinergic preanaesthetic medication in children. It was carried out as a follow-up study of the previous survey amongst Finnish anaesthesiologists in 1990. METHODS: A questionnaire was send to all members of the Finnish Society of Anaesthesiologists. Data from anaesthesiologists taking care of at least three paediatric anaesthesias/week (n= 183) were analyzed. RESULTS: In 1998 only one-third of the Finnish anaesthesiologists routinely used anticholinergics before paediatric anaesthesia. The main indications for routine anticholinergic premedication were ENT surgery (66%), eye surgery (71%) and endoscopic procedures (67%). Anticholinergic drugs were administered principally via the intravenous route (90%) briefly before induction of anaesthesia, and glycopyrrolate was the most frequently used (66%). CONCLUSION: During the last eight years in Finland the routine use of anticholinergic premedication has decreased. As in 1990 the anticholinergic prophylaxis is directed to ENT and eye surgery, endoscopic procedures and to children younger than 1 year. Use of glycopyrrolate has gained popularity at the expense of atropine and scopolamine.     

Prehospital Anticholinergic Burden Is Associated With Delirium but Not With Mortality in a Population of Acutely Ill Medical Patients

ObjectivesAnticholinergic drugs have several side effects, and they have been associated with adverse outcomes, particularly in older patients. The aim of this study was to analyze anticholinergic burden and its relationship to delirium and mortality in older acutely ill medical patients.DesignCohort study.Setting and ParticipantsPatients 65 years of age and older who were admitted to an Internal Medicine ward between August 1 and December 31, 2016.MethodsAnticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion Assessment Method (Short-CAM).ResultsOf the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51]. Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug use, ACB, or delirium.DiscussionIn the population studied, we found an association between anticholinergic burden as measured by the ACB and the presence of delirium, but not with mortality at 12 months. A very high 12-month mortality rate might have been an obstacle for association recognition.Conclusions and ImplicationsClinician awareness of possible drug side effects, especially in older populations, is crucial. As part of medication reconciliation at the time of hospitalization, ACB of prehospitalization medications should be routinely calculated by inpatient pharmacy services and made available to medical teams.     

Quinidine inhibition of the muscarine receptor-activated K+ channel current in atrial cells of guinea pig

Summary Postsynaptic mechanisms underlying the anticholinergic effects of quinidine were examined in single atrial cells, using the tight-seal whole-cell recording technique. The solution in the glass pipettes contained guanosine-5triphosphate (GTP) or guanosine-5-O-(3-thiotriphosphate) (GTP-S, a non-hydrolyzable GTP analogue). In both cases, acetylcholine (ACh), applied to the bath, induced a specific K⁺ current. In GTP-loaded cells, quinidine in the bath solution depressed the ACh-induced K⁺ current concentration-dependently. Atropine also blocked the K⁺ current. On the other hand, in GTP-S-loaded cells, the ACh-induced current was not blocked by atropine and persisted even when ACh was washed out from the bath, indicating that GTP-S causes uncoupling of the K⁺ channels from the muscarine receptors. Quinidine, however, did depress the increased K⁺ current concentration-dependently. The percent inhibition curves for quinidine to depress the K⁺ current were very similar between GTP-loaded and GTP-S-loaded cells. From these observations, we suggest that direct inhibition of the muscarine receptor-activated K⁺ channel current by quinidine, and not blockade of the muscarine receptor itself, is mainly responsible for the anticholinergic effects of the drug in atrial myocytes. Send offprint requests to Y. Kurachi at the above address     

Safety issues associated with using medication to treat overactive bladder

Introduction: The mainstay of overactive bladder treatment is the use of anticholinergic medication with its common side effects well known. This review focused on three less well-known safety issues when treating OAB.

Areas covered: Patients with increased anticholinergic load are at risk of cognitive decline, dementia or even death. The elderly are particularly at risk due to polypharmacy. Botulinum toxin carries the risk of high urinary residuals, urinary tract infection and need to self catheterise. The use of vaginal oestrogens may improve OAB symptoms, but there is concern in those with a history of breast cancer. Studies have shown that the systemic absorption is negligible and does not increase the risk of recurrence.

Expert Opinion: Improvement in assessing anticholinergic load is needed with the development of a universal drug scale. To avoid increasing load, Mirabegron or botulinum toxin can be used instead. There is no consensus of the use of prophylactic antibiotics when injecting botulinum toxin and at what residual to initiate self catheterisation. Despite evidence showing that the use of vaginal oestrogens is safe in those with a history of cancer, it is not fully supported by any health body. Further work is needed in those using aromatase inhibitors.