Which drug class is commonly associated with anticholinergic effects such as dry eyes, dry mouth, mydriasis, tachycardia, and potentially high intraocular pressure?

• A. Phenothiazines (antipsychotics)
• B. Ritalin, Dexedrine (ADHD)
• C. 1st gen oral antihistamines (Benadryl)
• D. TCAs (Elavil, impramine)

Answer: (A)

Anticholinergic effects come from blocking muscarinic receptors, which reduces secretions and smooth muscle activity in various tissues. In the eye this shows up as mydriasis (pupil dilation) and decreased tearing, leading to dry eyes. In the mouth you get dry mouth, and systemically you can see tachycardia. When the pupil is dilated, aqueous humor drainage can be impeded, potentially raising intraocular pressure, especially in people with narrow-angle anatomy or glaucoma risk.

Phenothiazines, a class of antipsychotics, have notable antimuscarinic (anticholinergic) activity. That means they readily produce the dry eyes, dry mouth, mydriasis, and tachycardia described, and they can contribute to increased intraocular pressure in susceptible individuals. While other drug classes can also have some anticholinergic effects (for example, certain antihistamines and TCAs), phenothiazines are a classic group reliably associated with this constellation of ocular and systemic anticholinergic effects, making them the best fit for this scenario.