Cholinergic

Question 1

Nicotine

Answer 1

Indications: Withdrawal symptoms of smoking cessation
MoA: Activation of neuronal nicotinic receptors
Adverse Effects:
Contraindications:
Misc:

Question 2

Succinylcholine

Answer 2

Indications: Neuromuscular block for electroconvulsive shock therapy or emergency intubation
MoA: Depolarizing block of nicotinic receptors
Adverse Effects: Paralysis
Contraindications:
Misc: Prevents propagation of AP by preventing fast NA channels from cycling

Question 3

Acetylcholine

Answer 3

Indications: None
MoA: Nicotinic and muscarinic agonist
Adverse Effects: 
Contraindications:
Misc:

Question 4

Methacholine

Answer 4

Indications: Diagnosis of subclinical asthma/test for severity of asthma
MoA: Muscarinic agonist
Adverse Effects: Bronchiole constriction
Contraindications: B-blockers
Misc: Must be done in a controlled setting

Question 5

Carbachol

Answer 5

Indications: Reduce pressure following ocular surgery
MoA: Muscarinic and nicotinic agonist
Adverse Effects: Excessive muscarinic activation (bronchoconstriction, reduced cardiac conduction)
Contraindications:
Misc: Topical agent, given post eye surgery to keep angle open/allow humor drainage

Question 6

Bethanechol

Answer 6

Indications: Urinary retention, bladder atony
MoA: Muscarinic agonist
Adverse Effects: Bradycardia, bronchoconstriction
Contraindications: Asthma, peptic ulcer, bradycardia
Misc: Resistant to hydrolysis by cholinesterases, less CV effects (less M2 affinity)

Question 7

Pilocarpine

Answer 7

Indications: Dry mouth from head/neck radiation or Sjorgren’s syndrome, narrow angle glaucoma
MoA: Muscarinic agonist
Adverse Effects: Excessive muscarinic activation (slowed AV conduction), hypotension, excessive salivation and bronchoconstriction
Contraindications:
Misc: Crosses BBB

Question 8

Neostigmine

Answer 8

Indications: Myasthenia gravis, reverse neuromuscular block
MoA: AchE inhibitor
Adverse Effects: Muscarinic and nicotinic excess (paralysis from too much Ach blocking APs)
Contraindications: Intestional obstruction
Misc: Direct stimulation of Nm receptors

Question 9

Edrophonium

Answer 9

Indications: Diagnosis of myasthenia gravis, reversal of neuromuscular block
MoA: AchE inhibitor
Adverse Effects: Bradycardia, cardiac standstill
Contraindications: Intestinal blockade or urinary obstruction
Misc: Short acting, doesn’t cross BBB, DDX of too little or too much AchE inhibitor in rx of myasthenia gravis

Question 10

Physostigmine

Answer 10

Indications: Delirium from anticholinergic drugs, glaucoma
MoA: Reversible AchE inhibitor
Adverse Effects: Convulsions, respiratory and CV depression
Contraindications: Asthma, CV disease, intestinal obstruction
Misc: Antidote for muscarinic antagonist poisoning

Question 11

Donepezil

Answer 11

Indications: Alzheimer's
MoA: Reversible AchE inhibitor
Adverse Effects: 
Contraindications:
Misc: Only inhibits acetylcholinesterase

Question 12

Pralidoxime

Answer 12

Indications: Respiratory muscle weakness in organophosphate poisoning
MoA: Peripheral AchE reactivator
Adverse Effects: 
Contraindications:
Misc: AKA 2-PAM

Question 13

Echothiphate

Answer 13

Indications: Open angle glaucoma
MoA: Irreversible AchE inhibitor
Adverse Effects: Blurry vision
Contraindications:
Misc: Commonly used in elderly patients (they don't care as much about the blurry vision)

Question 14

Atropine

Answer 14

Indications: Excess secretion during surgery, increased frequency and urgency from cystitis, hypertonic gut, organophosphate poisoning, bradycardia
MoA: Muscarinic antagonist
Adverse Effects: Nervousness, confusion, hallucinations, dry mouth, difficulty swallowing, thirst, dilated pupils, blurred vision, tachycardia, increased BP, respiratory collapse
Contraindications: Glaucoma, pyloric stenosis, prostatic hypertrophy
Misc: From nightshade family

Question 15

Scopolamine

Answer 15

Indications: Motion sickness, anti-sialagogue in surgery
MoA: Muscarinic antagonist
Adverse Effects: Nervousness, confusion, hallucinations, dry mouth, difficulty swallowing, thirst, dilated pupils, blurred vision, tachycardia, increased BP, respiratory collapse
Contraindications:
Misc:

Question 16

Glycopyrrolate

Answer 16

Indications: Protect against excessive muscarinic activation during reversal of neuromuscular blockade, anti-sialagogue
MoA: Muscarinic receptor antagonist
Adverse Effects: Heat stroke d/t inability to sweat
Contraindications:
Misc: