Anticholinergic syndrome following an unintentional overdose of scopolamine

Perioperative considerations for patients exposed to hallucinogens

Hallucinogen exposure in patients in the perioperative period presents challenges for anesthesiologists and other anesthesia providers. Acute and chronic exposure to these substances can cause physiological impacts that can affect the function of anesthetic and analgesic medications used during perioperative care. The objective of this narrative review is to educate readers on the wide array of hallucinogens and psychedelics that may influence the perioperative management of patients exposed to these substances. A narrative review of the literature surrounding hallucinogens and psychedelics was completed. Hallucinogens and psychedelics are quite varied in their mechanisms of action and therefore present a variety of perioperative implications and perioperative considerations. Many of these substances increase serotonin levels or act directly at serotonergic receptors. However, there are other relevant actions that may include varied mechanisms from N-methyl-D-aspartate receptor antagonism to stimulation of muscarinic receptors. With hallucinogen exposure rates on the rise, understanding the effects of hallucinogens is important for optimizing management and reducing risks perioperatively for patients with acute or chronic exposure.

Animal models of Alzheimer's disease: An originof innovativetreatments and insight to the disease's etiology

Alzheimer's disease (AD) is a progressive neurodegenerative disorder. The main pathogenic features are the development and depositionof senile plaques and neurofibrillary tangles in brain. Recent developments in the knowledge of the pathophysiological mechanisms behind Alzheimer's disease and other cognitive disorders have suggested new approaches to treatment development. These advancements have been significantly aided by the use of animal models, which are also essential for the assessment of therapies. Various approaches as transgenic animal model, chemical models, brain injury are used. This review will presentAD pathophysiology and emphasize several Alzheimer like dementia causingchemical substances, transgenic animal model and stereotaxy in order to enhance our existing knowledge of their mechanism of AD induction, dose, and treatment duration.

Determination of Scopolamine Distribution in Plasma and Brain by LC-MS/MS in Rats

Scopolamine, as a tropane alkaloid found in plants such as belladonna and datura, is used clinically as a transdermal patch and is highly neurotoxic. This study aimed to develop a simple, sensitive, and selective LC-MS/MS method for the determination of the content and distribution of scopolamine in rat plasma and brain after drug administration. In our study, sample pretreatment consisted of protein precipitation with acetonitrile followed by nitrogen blow concentration. Gradient elution of scopolamine and internal standard was performed on a ZORBAX Eclipse Plus C18 (2.1 $\ast$ 100 mm, 3.5 μm) column with water containing 0.1% formic acid (v/v) and acetonitrile as a mobile phase. Those samples were quantified in ESI positive ion mode using an API 4000 triple quadrupole mass spectrometer. The results showed that scopolamine was linear in the calibration range of 2–2500 ng/mL, and the selectivity, accuracy, precision, matrix effect, stability, and recovery of the method were within acceptable limits. The method has been validated and has been successfully used for toxicokinetic studies of scopolamine. After intraperitoneal injection, the time to peak toxic concentrations of scopolamine in rats was 0.5 h. The concentrations of scopolamine in the hippocampus and cortex were much higher than those in the striatum, indicating that the likely targets of its neurotoxic damage were the hippocampus and cortex. Overall, this study provides the basis for the neurotoxicity of scopolamine and provides a reference for its toxicokinetic studies.

Dualplex lateral flow assay for simultaneous scopolamine and "cannibal drug" detection based on receptor-gated mesoporous nanoparticles

We report herein the design of a strip-based rapid test utilizing bio-inspired hybrid nanomaterials for the in situ and at site detection of the drug scopolamine (SCP) using a smartphone for readout, allowing SCP identification in diluted saliva down to 40 nM in less than 15 min. For this purpose, we prepared a nanosensor based on mesoporous silica nanoparticles loaded with a fluorescent reporter (rhodamine B) and functionalized with bethanechol, a potent agonist of recombinant human muscarinic acetylcholine receptor M₂ (M₂-AChR). M₂-AChR interaction with the anchored bethanechol derivative leads to capping of the pores. The sensing mechanism relies on binding of SCP to M₂-AChR resulting in pore opening and delivery of the entrapped rhodamine B reporter. Moreover, the material was incorporated into strips for lateral-flow assays coupled to smartphone readout, giving fast response time, good selectivity, and exceptional sensitivity. In an attempt to a mobile analytical test system for law enforcement services, we have also developed a dualplex lateral flow assay for SCP and 3,4-methylenedioxypyrovalerone (MDPV) also known as the so-called "cannibal drug".

Wearable Electronic Finger for Date Rape Drugs Screening: From "Do-It-Yourself" Fabrication to Self-Testing

In-house digital fabrication of low-cost sensors that can on-site and rapidly detect adulteration of alcoholic beverages with sedation drugs (known as date rape drugs, (DRDs)) and analgesics is of great importance for everyday consumers and supervisory authorities. DRDs and analgesics are administrated in spirits for "drug-facilitated sexual assault" crimes and for the reduction of the following day hangover caused by low-quality spirits, respectively. This work describes, a novel "do-it-yourself" wearable 3D printed electrochemical finger (e-finger), which enables direct, rapid, and multianalyte self-testing of the main DRDs (flunitrazepam, scopolamine, ketamine) and paracetamol via direct immersing into a spirit shot. The oxygen interference on flunitrazepam detection was alleviated by dissolving an effervescent tablet of vitamin C in the spirit shot, as ascorbic acid serves as a scavenger for dissolved oxygen. The e-finger can be printed in-house at any size by anyone with access to a low-cost domestic 3D printer using a simple, fast, and low-cost printing procedure. The e-finger is addressed by a smartphone-based miniature potentiostat and allows on-the-spot self-checking of the quality and safety of alcoholic spirits, via a single calibration-free voltammetric measurement, readily performed even by untrained end users. The e-finger is a new powerful screening tool in the hands of supervisory authorities to conduct on-site forensic investigations. More importantly, it paves the way toward in-house e-production of "ready-to-use" reliable self-testing devices.

Effect of buscopan, a compound that alleviates cramps, on the developing nervous system of the chick embryo

BACKGROUND

Buscopan is used to treat stomach cramps including those resulting from irritable bowel syndrome, bladder cramps, and pain related to menstruation. Its pregnancy category is determined as C. It has been shown in experimental animal studies that the drug has a negative effect on the embryo, but sufficient and well-controlled studies have not been conducted in humans. The aim of this study is to investigate effects of buscopan on the development of the neural tube (NT) in chick embryos.

METHODS

Sixty specific pathogen-free (SPF) fertilized eggs were used. SPF eggs were placed in an incubator and divided into six groups at 28 hr of incubation. Five different doses (low to high) of buscopan were injected sub-blastodermally. At the end of 48 hr, the embryos were evaluated morphologically and histopathologically. The argyrophilic nucleolar-organizing region (AgNOR) method was used in this study to determine the proliferation activity of cells in NT development in chick embryos. AgNOR number and total AgNOR area/nuclear area (TAA/NA) were detected for each embryo.

RESULTS

Depending on the dose, the embryo's crown-rump length and somite number decreased (p < .05). Significant differences were detected among all groups for mean AgNOR number (p < .05) and TAA/NA ratio (p < .05).

CONCLUSIONS

Considering the average count of AgNOR cells and TAA/NA ratio, it was found that there was a decrease in cell division depending on the dose. It was determined that buscopan treatment on chick embryos adversely affected early nervous system and NT development.

The computational pharmacology of oculomotion

Many physiological and pathological changes in brain function manifest in eye-movement control. As such, assessment of oculomotion is an invaluable part of a clinical examination and affords a non-invasive window on several key aspects of neuronal computation. While oculomotion is often used to detect deficits of the sort associated with vascular or neoplastic events; subtler (e.g. pharmacological) effects on neuronal processing also induce oculomotor changes. We have previously framed oculomotor control as part of active vision, namely, a process of inference comprising two distinct but related challenges. The first is inferring where to look, and the second is inferring how to implement the selected action. In this paper, we draw from recent theoretical work on the neuromodulatory control of active inference. This allows us to simulate the sort of changes we would expect in oculomotor behaviour, following pharmacological enhancement or suppression of key neuromodulators-in terms of deciding where to look and the ensuing trajectory of the eye movement itself. We focus upon the influence of cholinergic and GABAergic agents on the speed of saccades, and consider dopaminergic and noradrenergic effects on more complex, memory-guided, behaviour. In principle, a computational approach to understanding the relationship between pharmacology and oculomotor behaviour affords the opportunity to estimate the influence of a given pharmaceutical upon neuronal function, and to use this to optimise therapeutic interventions on an individual basis.

Understanding Central Nervous System Effects of Deliriant Hallucinogenic Drugs through Experimental Animal Models

Hallucinogenic drugs potently alter human behavior and have a millennia-long history of use for medicinal and religious purposes. Interest is rapidly growing in their potential as CNS modulators and therapeutic agents for brain conditions. Antimuscarinic cholinergic drugs, such as atropine and scopolamine, induce characteristic hyperactivity and dream-like hallucinations and form a separate group of hallucinogens known as "deliriants". Although atropine and scopolamine are relatively well-studied drugs in cholinergic physiology, deliriants represent the least-studied class of hallucinogens in terms of their behavioral and neurological phenotypes. As such, novel approaches and new model organisms are needed to investigate the CNS effects of these compounds. Here, we comprehensively evaluate the preclinical effects of deliriant hallucinogens in various animal models, their mechanisms of action, and potential interplay with other signaling pathways. We also parallel experimental and clinical findings on deliriant agents and outline future directions of translational research in this field.

Medications influencing central cholinergic pathways affect fixation stability, saccadic response time and associated eye movement dynamics during a temporally-cued visual reaction time task

RATIONALE

Anticholinergic medications largely exert their effects due to actions on the muscarinic receptor, which mediates the functions of acetylcholine in the peripheral and central nervous systems. In the central nervous system, acetylcholine plays an important role in the modulation of movement.

OBJECTIVE

This study investigated the effects of over-the-counter medications with varying degrees of central anticholinergic properties on fixation stability, saccadic response time and the dynamics associated with this eye movement during a temporally-cued visual reaction time task, in order to establish the significance of central cholinergic pathways in influencing eye movements during reaction time tasks.

METHODS

Twenty-two participants were recruited into the placebo-controlled, human double-blind, four-way crossover investigation. Eye tracking technology recorded eye movements while participants reacted to visual stimuli following temporally informative and uninformative cues. The task was performed pre-ingestion as well as 0.5 and 2 h post-ingestion of promethazine hydrochloride (strong centrally acting anticholinergic), hyoscine hydrobromide (moderate centrally acting anticholinergic), hyoscine butylbromide (anticholinergic devoid of central properties) and a placebo.

RESULTS

Promethazine decreased fixation stability during the reaction time task. In addition, promethazine was the only drug to increase saccadic response time during temporally informative and uninformative cued trials, whereby effects on response time were more pronounced following temporally informative cues. Promethazine also decreased saccadic amplitude and increased saccadic duration during the temporally-cued reaction time task.

CONCLUSION

Collectively, the results of the study highlight the significant role that central cholinergic pathways play in the control of eye movements during tasks that involve stimulus identification and motor responses following temporal cues.

Medications influencing central cholinergic neurotransmission affect saccadic and smooth pursuit eye movements in healthy young adults

RATIONALE

Acetylcholine is an important neuromodulator in the central nervous system, where it plays a significant role in central functions such as the regulation of movement.

OBJECTIVE

This study investigated the pharmacological effects of over-the-counter anticholinergic medications on saccadic and smooth pursuit eye movements, in order to establish the significance of central cholinergic pathways in the control of these centrally regulated oculomotor processes.

METHODS

Sixteen subjects (mean age 23 ± 3 years, 9 females) performed pro-saccadic, anti-saccadic and smooth pursuit eye movement tests, while an eye tracker collected eye movement data. Oculomotor assessments were performed pre-ingestion, 0.5 and 2 h post-ingestion of drugs with varying degrees of central anticholinergic properties. The drugs tested were promethazine, hyoscine hydrobromide, hyoscine butylbromide and placebo.

RESULTS

The drug intervention with stronger central anticholinergic properties, promethazine, decreased amplitude and increased velocity in the pro-saccadic task and increased duration in the anti-saccadic task. Promethazine, once again, was the only drug to decrease eye velocity in the smooth pursuit test.

CONCLUSION

The prominent effects of the stronger central anticholinergic promethazine, on saccadic and smooth pursuit eye movements, potentially conveys the significance of central cholinergic pathways in the control of these centrally regulated oculomotor processes.

Anticholinergic activity in the nervous system: Consequences for visuomotor function

Acetylcholine is present in the peripheral and central nervous system, where it is involved in a number of fundamental physiological and biochemical processes. In particular, interaction with muscarinic receptors can cause adverse effects such as dry mouth, drowsiness, mydriasis and cognitive dysfunction. Despite the knowledge that exists regarding these common side-effects, little is known about how anticholinergic medications influence central motor processes and fine motor control in healthy individuals. This paper reviews critical visuomotor processes that operate in healthy individuals, and how controlling these motor processes are influenced by medications that interfere with central cholinergic neurotransmission. An overview of receptor function and neurotransmitter interaction following the ingestion or administration of anticholinergics is provided, before exploring how visuomotor performance is affected by anticholinergic medications. In particular, this review will focus on the effects that anticholinergic medications have on fixation stability, saccadic eye movements, smooth pursuit eye movements, and general pupil dynamics.

The pharmacology of medieval sedatives: the "Great Rest" of the Antidotarium Nicolai

ETHNOPHARMACOLOGICAL RELEVANCE

Past practices of compound drugs from different plant ingredients enjoyed remarkable longevity over centuries yet are largely dismissed by modern science as subtherapeutic, lethal or fanciful.

AIM OF THE STUDY

To examine the phytochemical content of a popular medieval opiate drug called the "Great Rest" and gauge the bioavailability and combined effects of its alkaloid compounds (morphine, codeine, hyoscyamine, scopolamine) on the human body according to modern pharmacokinetic and pharmacodynamic parameters established for these compounds.

CALCULATIONS AND THEORY

We reviewed the most recent studies on the pharmacodynamics of morphine, codeine, hyoscyamine and scopolamine to ascertain plasma concentrations required for different physiological effects and applied these findings to dosage of the Great Rest.

RESULTS

Given the proportional quantities of the alkaloid rich plants, we calculate the optimal dose of Great Rest to be 3.1±0.1-5.3±0.76 g and reveal that the lethal dose of Great Rest is double the therapeutic concentration where all three alkaloid compounds are biologically active.

CONCLUSION

This study helps establish the effective dose (ED50), toxic dose (TD50) and lethal dose (LD50) rates for the ingestion of raw opium, henbane and mandrake, and describes their probable combined effects, which may be applied to similar types of pre-modern pharmaceuticals to reveal the empirical logic behind past practices.

A Case Report of Probable Neuroleptic Malignant Syndrome

Objective: To report a case of probable neuroleptic malignant syndrome (NMS) of unknown origin. Case Summary: A 32-year-old Caucasian man was found unconscious by emergency services. On presentation to the emergency department, he had a temperature of 107.5°F (41.9°C) and a Glasgow Coma Scale rating of 3 (range = 3-15). Fluids were administered and cooling blankets applied. He was admitted to the intensive care unit. Supportive measures decreased his temperature to 101.7°F (38.7°C). Arterial blood gas, comprehensive metabolic panel, complete blood count, and cardiac risk panel results were within normal limits; urinalysis and urine and serum drug screens were negative. He had been discharged on the following medications: benztropine, citalopram, chlorpromazine, divalproex, haloperidol, and hydroxyzine. Based on the medication discharge list and clinical presentation, the Naranjo Adverse Drug Reaction Probability Scale was applied. The criteria scoring indicated a probable relationship (8 of 12) between the medications prescribed and symptoms consistent with NMS. Discussion: NMS has been reported with antipsychotics (APs) and other medications with dopaminergic activity. The etiology is poorly understood. Risk factors (ie, recent initiation or dose increase of an AP, dehydration, or genetic susceptibility) may increase the potential. The differentiation between the diagnosis of NMS and other factors, such as serotonin syndrome or hyperthermia, includes laboratory and clinical presentation characteristics. The potential contributions of anticholinergic agents, psychiatric comorbidities, and other risk factors were identified for this patient. Conclusions: We report the case of a patient found unresponsive and comatose. A variety of assessment measures were used to identify potential causes. Based on evaluations, clinical presentation, the medication list, and criteria for an adverse drug event, a diagnosis of NMS was given. Health care providers may not be fully aware of the potential severity for this medication-related effect in patients with multiple risk factors.