Drug absorption can occur after ingestion, smoking, or ocular use. The rate of absorption varies depending on the drug and the route of exposure. Because cholinergic blockade delays gastric emptying and decreases intestinal motility, absorption and peak clinical effects are often delayed. 2
The signs and symptoms of anticholinergic toxicity are a result of both central and peripheral cholinergic blockade. Muscarinic acetylcholine receptors predominate in the brain, while nicotinic receptors predominate in the spinal cord. Depending on the drug involved, antagonism of muscarinic, nicotinic, or both receptors may occur. 2 The central effects of cholinergic blockade include agitation, amnesia, anxiety, ataxia, coma, confusion, delirium, disorientation, dysarthria, hallucinations, hyperactivity, lethargy, somnolence, seizures, circulatory collapse, mydriasis, and respiratory failure. The peripheral effects include dysrhythmias, tachycardia, decreased bronchial secretions, dysphagia, decreased gastrointestinal motility, hyperthermia, hypo- or hypertension, decreased salivation, decreased sweating, urinary retention, and vasodilation.134
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