Cholinomimetic Agents

Question 1

Direct agonists?

Answer 1

1) Bethanechol
2) Carbachol
3) Pilocarpine
4) Methacholine

Question 2

Indirect agonists (AChEIs)?

Answer 2

1) Neostigmine
2) Pyridostigmine
3) Edrophonium
4) Physostigmine
5) Donepezil

Question 3

Uses for bethanechol?

Answer 3

1) Postop ileus
2) Neurogenic ileus (DM)
3) Urinary retention

Question 4

Uses for carbachol?

Answer 4

Glaucoma, pupillary contraction, relief of intraocular pressure

Question 5

Uses for pilocarpine?

Answer 5

Open/closed angle glaucoma, potent stimulator of sweat, tears, and saliva

Question 6

MOA of pilocarpine?

Answer 6

1) Contract ciliary muscle (open angle)

2) Contracts pupillary sphincter (closed angle)

Question 7

Which drug is resistant to AChE?

Answer 7

Pilocarpine

Question 8

Uses for methacoline?

Answer 8

Challenge asthma test (stimulates muscarinic receptors in airway)

Question 9

Uses for neostigmine?

Answer 9

1) Postop/neurogenic ileus and urinary retention
2) Myasthenia gravis
3) Reversal of NMJ blockade (postop)

Question 10

Uses for pyridostigmine?

Answer 10

Myasthenia gravis (long acting)

Question 11

Which 2 AChEIs do NOT penetrate the CNS?

Answer 11

1) Neostigmine

2) Pyridostigmine

Question 12

What is used to dx myasthenia gravis?

Answer 12

Edrophonium (extremely short acting)

Question 13

Uses for physostigmine?

Answer 13

Anticholinergic toxicity (atropine overdose) since it can cross the BBB

Question 14

Uses for donepezil?

Answer 14

Alzheimer’s

Question 15

What must you watch out for when giving a cholinomimetic?

Answer 15

Exacerbation of COPD, asthma, and peptic ulcers

Question 16

Tx for AChEI overdose?

Answer 16

Atropine (reverses of muscarinic effects) + pralidoxime (dephosphrylates AChE to regenerate it–reverses both muscarinic and nicotinic effects)