Cholinomimetics: Indirect Agonists (AChE-i)

Question 1

Neostigmine

Answer 1

Clinic: Postop and neurogenic ileus and urinary retention, myasthenia gravis (not long-term), reversal of NMJ blockade

Increases endogenous ACh, no CNS penetration

Question 2

Pyridostigmine

Answer 2

Clinic: Myasthenia gravis (long-term tx), no CNS penetration

Increases endogenous ACh; increases strength

Question 3

Physostigmine

Answer 3

Clinic: Anticholinergic toxicity (crosses BBB)

Increases endogenous ACh.

PHYSostigmine PHYxes atropine OD.

Question 4

Donepezil, rivastigmine, galantamine

Answer 4

Clinic: ALZ

Increases endogenous ACh.

Question 5

Edrophonium

Answer 5

Clinic: Historically used to treat MG. Extremely short acting.

Increases endogenous ACh.