Cholinomimetic agents Flashcards
What are the clinical applications of bethanechol?
Postoperative ileus, neurogenic ileus, urinary retention.
What is the site of action of bethanechol?
“Bethany, call me to activate your bowels and bladder!”. Activates bowel and bladder smooth muscle, resistance to AchE.
What are the clinical applications of carbachol?
Glaucoma.
What is the site of action of carbachol?
Constricts pupil and relieves intra-ocular pressure in glaucoma.
What is the clinical application for methacholine?
Challenge test for diagnosis of asthma.
What is the site of action of methacholine?
Stimulates Muscarinic receptors in airway when inhaled.
What is the clinical application for pilocarpine?
Potent stimulator of sweat, tears, saliva. Open-angle/closed angle glaucoma.
What is the site of action of pilocarpine?
“You cry, drool, and sweat on your PILOw.”
Stimulates exocrine glands, contracts ciliary muscle of eye (open-angle), pupillary sphincter of eye (closed-angle). Resistant to AchE.
What is the clinical application for donepezil/galantamine/rivastigmine?
Alzheimer’s.
What is the site of action of donepezil/galantamine/rivastigmine?
Increased ACh due to blocked acetylcholinesterase.
What is the clinical application for edrophonium?
Historically, dx of myasthenia gravis (very short acting). Now, MG is diagnosed by anti-Acetylcholine receptor antibody test).
What is the site of action of edrophonium?
Increased Ach due to blocked acetylcholinesterase.
What are the clinical applications for neostigmine?
1) Post-op/neurogenic ileus and urinary retention
2) Myasthenia gravis
3) Post-op reversal of neuromuscular junction blockade.
What is the site of action of neostigmine?
Increased Ach due to blocked acetylcholinesterase. No CNS penetration.
What is the clinical application for physostigmine?
Anticholinergic toxicity.
What is the site of action of physostigmine?
Increased Ach due to blocked acetylcholinesterase. PHYSostigmine PHYXES atropine overdose. Penetrates CNS!
What is the clinical application for pyridostigmine?
Myasthenia gravis (long-acting).
What is the site of action of pyridostigmine?
PyRIDostiGMine gets RID of MG. Increased Ach, increased muscle strength.
What are important risks of all cholinomimetic agents?
Exacerbation of COPD, Asthma, and peptic ulcers.
How do organophosphates cause cholinergic poisoning?
Irreversibly inhibit cholinesterase.
What are the symptoms of cholinergic poisoning?
DUMBBELSS.
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of Skeletal muscle and CNS, Lacrimation, Sweating, and Salivation.
