Antikolinergik: Perbedaan antara revisi
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'''Antikolinergik''' ('''agen antikolinergik''') adalah zat yang menghalangi kerja [[neurotransmiter]] [[asetilkolin]] (ACh) pada [[sinapsis]] di [[sistem saraf pusat]] dan [[sistem saraf tepi]].<ref name="Anticholinergic Agents 2012 p.">{{citation|title=Anticholinergic Agents|url=http://www.ncbi.nlm.nih.gov/books/NBK548287/|year=2012|chapter=Anticholinergics|location=Bethesda (MD)|publisher=National Institute of Diabetes and Digestive and Kidney Diseases|pmid=31643610|quote=Anticholinergics have antisecretory activities and decrease nasal and bronchial secretions, salivation, lacrimation, sweating and gastric acid production, and can be used to decrease secretions in allergic and inflammatory diseases. Anticholinergics relax smooth muscle in the gastrointestinal tract, bladder and lung and can be used for gastrointestinal, urological or respiratory conditions associated with spasm and dysmotility.|access-date=2020-03-23}}</ref><ref>Clinical Pharmacology [database online]. Tampa, FL: Gold Standard, Inc.; 2009. Drugs with Anticholinergic Activity. Prescriber's Letter 2011; 18 (12):271233.</ref>
Agen-agen ini menghambat [[sistem saraf parasimpatis]] dengan secara selektif memblokir pengikatan ACh ke reseptornya di [[sel saraf]]. [[Akson|Serabut saraf]] sistem parasimpatis bertanggung jawab atas pergerakan [[otot polos]] yang tidak disengaja di saluran pencernaan, [[Sistem
Secara luas, antikolinergik dibagi menjadi dua kategori sesuai dengan target spesifiknya di sistem saraf pusat dan perifer serta pada sambungan neuromuskular:<ref name="Migirov Datta 2020 p.">{{citation | last1=Migirov | first1=A | last2=Datta | first2=AR | title=Physiology, Anticholinergic Reaction | chapter=article-17683 | publisher=StatPearls Publishing | location=Treasure Island (FL) | year=2020 | pmid=31536197 | url=http://www.ncbi.nlm.nih.gov/books/NBK546589/ | access-date=2020-03-24 | others=This book is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, a link is provided to the Creative Commons license, and any changes made are indicated.}}</ref> agen antimuskarinik dan agen antinikotinik (penghambat ganglionik, penghambat neuromuskular).<ref>{{cite web|title=Urinary Incontinence|url=http://www2.kumc.edu/coa/Education/AMED900/UrinaryIncon.htm|publisher=Landon Center on Aging|author1=Sharee A. Wiggins|author2=Tomas Griebling|url-status=dead|archive-url=https://web.archive.org/web/20110927135227/http://www2.kumc.edu/coa/Education/AMED900/UrinaryIncon.htm|archive-date=2011-09-27|access-date=2011-07-09}}</ref>
Istilah "antikolinergik" biasanya digunakan untuk merujuk pada antimuskarinik yang secara kompetitif menghambat pengikatan ACh ke reseptor asetilkolin muskarinik; agen tersebut tidak memusuhi pengikatan reseptor asetilkolin nikotinat di
==Kegunaan dalam medis==
Obat antikolinergik digunakan untuk mengobati berbagai kondisi seperti:
*[[Pusing]] (termasuk gejala yang berhubungan dengan [[vertigo]] dan [[mabuk gerak]])
*Gejala ekstrapiramidal, potensi efek samping obat antipsikotik
*Gangguan gastrointestinal (misalnya [[tukak lambung]], diare, pilorospasme, [[divertikulitis]], [[kolitis ulseratif]], mual, dan muntah)
*Gangguan genitourinari (misalnya sistitis, uretritis, dan [[prostatitis]])
*Insomnia, meski biasanya hanya dalam jangka pendek
*Gangguan pernapasan (misalnya asma, bronkitis kronis, dan [[penyakit paru obstruktif kronik]] [PPOK])
*Sinus bradikardia karena [[saraf vagus]] yang hipersensitif
*Keracunan zat saraf berbasis organofosfat, seperti [[VX (racun saraf)|VX]], [[sarin]], tabun, dan soman ([[atropin]] lebih disukai jika digabungkan dengan oksim, biasanya pralidoksim)<ref>{{Cite web|title=NERVE AGENTS|url=https://fas.org/nuke/guide/usa/doctrine/army/mmcch/NervAgnt.htm#MEDICAL%20MANAGEMENT|access-date=2020-07-27|website=fas.org}}</ref><ref>{{Cite journal|last1=Nair|first1=V. Priya|last2=Hunter|first2=Jennifer M.|date=2004-10-01|title=Anticholinesterases and anticholinergic drugs|url=https://academic.oup.com/bjaed/article/4/5/164/291028|journal=Continuing Education in Anaesthesia, Critical Care & Pain|language=en|volume=4|issue=5|pages=164–168|doi=10.1093/bjaceaccp/mkh045|issn=1743-1816|doi-access=free}}</ref>
Antikolinergik umumnya memiliki efek antisialagogue (menurunkan produksi air liur), dan sebagian besar menghasilkan efek sedasi pada tingkat tertentu, keduanya bermanfaat dalam prosedur pembedahan.<ref>Page 592 in: {{cite book |author1=Cahalan, Michael D. |author2=Barash, Paul G. |author3=Cullen, Bruce F. |author4=Stoelting, Robert K. |title=Clinical Anesthesia |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2009 |isbn=978-0-7817-8763-5 }}</ref><ref>{{cite book|url=https://books.google.com/books?id=-YI9P2DLe9UC|title=Clinical Anesthesia|access-date=8 December 2014|url-status=live|archive-url=https://web.archive.org/web/20170220091947/https://books.google.com/books?id=-YI9P2DLe9UC|archive-date=20 February 2017|isbn=9780781787635|last1=Barash|first1=Paul G.|year=2009|publisher=Lippincott Williams & Wilkins }}</ref>
Hingga awal abad ke-20, obat antikolinergik banyak digunakan untuk mengobati gangguan kejiwaan.<ref>Bangen, Hans: ''Geschichte der medikamentösen Therapie der Schizophrenie''. Berlin 1992, {{ISBN|3-927408-82-4}}</ref>
==Contoh==
{{div col|colwidth=20em}}
* '''Agen Antimuskarinik'''
** [[Antidepresan trisiklik]]
** [[Antipsikotik]] ([[klozapin]], [[kuetiapin]])<ref name=TI113>{{cite web |title=[113] How well do you know your anticholinergic (antimuscarinic) drugs? {{!}} Therapeutics Initiative |url=https://www.ti.ubc.ca/2018/09/10/113-anticholinergic-antimuscarinic-drugs/ |website=Therapeutics Initiative |access-date=20 September 2018 |date=10 September 2018}}</ref>
** [[Atropin]]
** [[Benztropin]]
** [[Biperiden]]
** [[Klorfenamin]]
** [[Difenhidramin]]<ref name=TI113/>
** [[Dimenhidrinat]]<ref name=TI113/>
** Disiklomin ([[Disikloverin]])
** [[Doksepin]]
** [[Doksilamin]]
** [[Flavoksat]]
** [[Glikopironium|Glikopironium/-late]]
** [[Hiosiamin]]
** [[Ipratropium bromida]]
** [[Oksibutinin]]<ref name=TI113/>
** [[Oksitropium bromida|Oksitropium]]
** [[Orfenadrin]]
** [[Prometazin]]
** [[Propantelin bromida]]
** [[Hiosin hidrobromida|Skopolamin]]
** [[Solifenasin]]
** SSRI tertentu ([[Paroksetin]])<ref name=TI113/>
** [[Tolterodin]]
** [[Tiotropium]]
** [[Triheksifenidil]]
** [[Tropikamida]]<ref name="autogenerated1">{{Cite journal | doi = 10.1016/j.genhosppsych.2013.04.013| pmid = 23706777| title = Drops of madness? Recreational misuse of tropicamide collyrium; early warning alerts from Russia and Italy| journal = General Hospital Psychiatry| volume = 35| issue = 5| pages = 571–3| year = 2013| last1 = Bersani | first1 = F. S. | last2 = Corazza | first2 = O. | last3 = Simonato | first3 = P. | last4 = Mylokosta | first4 = A. | last5 = Levari | first5 = E. | last6 = Lovaste | first6 = R. | last7 = Schifano | first7 = F. }}</ref>
** [[Umeklidinium]]
* '''Agen Antinikotinat'''
** [[Bupropion]] – Penghambat ganglion<ref name="pmid24484978">{{cite book |vauthors=Carroll FI, Blough BE, Mascarella SW, Navarro HA, Lukas RJ, Damaj MI |chapter=Bupropion and Bupropion Analogs as Treatments for CNS Disorders |title=Emerging Targets & Therapeutics in the Treatment of Psychostimulant Abuse |volume=69 |pages=177–216 |year=2014 |pmid=24484978 |doi=10.1016/B978-0-12-420118-7.00005-6 |series=Advances in Pharmacology |isbn=9780124201187 }}</ref><ref name="Dwoskin2014">{{cite book | author = Dwoskin, Linda P. | title = Emerging Targets & Therapeutics in the Treatment of Psychostimulant Abuse | url = https://books.google.com/books?id=b3UpAgAAQBAJ&pg=PA177 | date = 29 January 2014 | publisher = Elsevier Science | isbn = 978-0-12-420177-4 | pages = 177–216 | url-status = live | archive-url = https://web.archive.org/web/20170320155042/https://books.google.com/books?id=b3UpAgAAQBAJ&pg=PA177 | archive-date = 20 March 2017 }}</ref><ref name="TasmanKay2011">{{cite book | author1 = Tasman, Allan | author2 = Kay, Jerald | author3 = Lieberman, Jeffrey A. | author4 = First, Michael B. | author5 = Maj, Mario | title = Psychiatry | url = https://books.google.com/books?id=vVG7zz7eaxcC&pg=RA9-PT2900 | date = 11 October 2011 | publisher = John Wiley & Sons | isbn = 978-1-119-96540-4 | url-status = live | archive-url = https://web.archive.org/web/20170320140656/https://books.google.com/books?id=vVG7zz7eaxcC&pg=RA9-PT2900 | archive-date = 20 March 2017 }}</ref>
** [[Dekstrometorfan]] - Penekan batuk dan penghambat ganglion<ref name="pmid15356218">{{cite journal |doi=10.1124/jpet.104.075093 |pmid=15356218 |title=Effect of Dextrometorphan and Dextrorphan on Nicotine and Neuronal Nicotinic Receptors: In Vitro and in Vivo Selectivity |journal=Journal of Pharmacology and Experimental Therapeutics |volume=312 |issue=2 |pages=780–5 |year=2004 |last1=Damaj |first1=M. I. |last2=Flood |first2=P |last3=Ho |first3=K. K. |last4=May |first4=E. L. |last5=Martin |first5=B. R. |s2cid=149958 }}</ref><ref name="pmid16563374">{{cite journal |doi=10.1016/j.ejphar.2006.02.034 |pmid=16563374 |title=Effects of dextrorotatory morphinans on α3β4 nicotinic acetylcholine receptors expressed in Xenopus oocytes |journal=European Journal of Pharmacology |volume=536 |issue=1–2 |pages=85–92 |year=2006 |last1=Lee |first1=Jun-Ho |last2=Shin |first2=Eun-Joo |last3=Jeong |first3=Sang Min |last4=Kim |first4=Jong-Hoon |last5=Lee |first5=Byung-Hwan |last6=Yoon |first6=In-Soo |last7=Lee |first7=Joon-Hee |last8=Choi |first8=Sun-Hye |last9=Lee |first9=Sang-Mok |last10=Lee |first10=Phil Ho |last11=Kim |first11=Hyoung-Chun |last12=Nah |first12=Seung-Yeol }}</ref><ref name="pmid10869398">{{cite journal |pmid=10869398 |url=http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=10869398 |year=2000 |last1=Hernandez |first1=S. C. |title=Dextromethorphan and Its Metabolite Dextrorphan Block α3β4 Neuronal Nicotinic Receptors |journal=The Journal of Pharmacology and Experimental Therapeutics |volume=293 |issue=3 |pages=962–7 |last2=Bertolino |first2=M |last3=Xiao |first3=Y |last4=Pringle |first4=K. E. |last5=Caruso |first5=F. S. |last6=Kellar |first6=K. J. }}</ref>
** [[Doksakurium]] – Relaksan otot rangka nondepolarisasi
** [[Heksametonium]] – Penghambat ganglion
** [[Mekamilamin]] – Penghambat ganglion dan bantuan [[penghentian merokok]] sesekali<ref>{{cite journal|last=Shytle|first=RD|author2=Penny, E |author3=Silver, AA |author4=Goldman, J |author5= Sanberg, PR |title=Mecamylamine (Inversine): an old antihypertensive with new research directions |journal=Journal of Human Hypertension|date=Jul 2002|volume=16|issue=7|pages=453–7|pmid=12080428 |doi=10.1038/sj.jhh.1001416|doi-access=free}}</ref>
** [[Tubokurarin]] - Relaksan otot rangka nondepolarisasi
{{div col end}}
===Antidot===
Fisostigmin adalah salah satu dari sedikit obat yang dapat digunakan sebagai penangkal keracunan antikolinergik. [[Nikotin]] juga melawan antikolinergik dengan mengaktifkan reseptor asetilkolin nikotinat. [[Kafeina]] (meskipun merupakan [[antagonis reseptor]] [[adenosina]]) dapat melawan gejala antikolinergik dengan mengurangi sedasi dan meningkatkan aktivitas asetilkolin, sehingga menyebabkan kewaspadaan dan gairah.
==Referensi==
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