Cholinomimetics

Question 1

Bethanechol

Answer 1

Direct agonist; activates bowel and bladder smooth muscle

Treats postop ileus, neurogenic ileus, and urinary retention

Question 2

Carbachol

Answer 2

Direct agonist; “carbon copy of ACh”

Treats glaucoma, pupillary constriction, relief of IOP

Question 3

Pilocarpine

Answer 3

Direct agonist; contracts ciliary muscle of eye and pupillary sphincter

Potent stimulator of sweat, tears, and saliva (“cry, drool, and sweat on your pilo-w”)

Treats open-angle and closed-angle glaucoma

Question 4

Methacholine

Answer 4

Direct agonist; stimulates muscarinic receptors in airway

Used in challenge test for diagnosis of asthma

Question 5

Neostigmine

Answer 5

AChE inhibitor; “No CNS penetration”

Treats post-op and neurogenic ileus, urinary retention, myasthenia graves, post-op reversal of NMJ blockade

Question 6

Pyridostigmine

Answer 6

AChE inhibitor; No CNS penetration

Long-acting treatment of myasthenia gravis

Question 7

Physostigmine

Answer 7

AChE inhibitor; Crosses BBB!

Treats atropine overdose

Question 8

Donepezil, rivastigmine, galantamine

Answer 8

AChE inhibitor

Treats Alzheimer disease

Question 9

Edrophonium

Answer 9

AChE inhibitor

Extremely short-acting; historically used to diagnose myasthenia gravis

Question 10

Organophosphate

Answer 10

Causes irreversible inhibition of AChE

“DUMBBELSS” Symptoms: Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation

Antidote: Atropine (reverses muscarinic effects) and pralidoxime (regenerates AChE to reverse muscarinic and nicotinic effects)