Muscarinic Receptor Agonists

Question 1

Quaternary amine

-Primary effect on G.I./G.U. tracts

Answer 1

Bethanechol (Duvoid® / Urecholine®)

Question 2

When do we use Bethanechol?

Answer 2

orally or subcutaneous injection for urinary retention in the absence of obstruction (post-op urinary retention, urinary retention with diabetic neuropathy, bladder disorders)

Question 3

Bethanechol; type of organic chemistry

Answer 3

choline esters

Question 4

Tertiary amine (lipophilic) with predominantly muscarinic effects

Answer 4

Pilocarpine

Question 5

Where is Pilocarpine active?

Answer 5

-available orally

Question 6

orally to treat xerostomia

Answer 6

Pilocarpine

Question 7

miotic agent used ophthalmically to treat wide-angle glaucoma as well as
emergency treatment for narrow angle glaucoma

Answer 7

Pilocarpine

Question 8

Are muscarinic receptor agonists: pilocarpine/bethanechol/acetycholine delivered orally or by IV?

Answer 8

Orally or subcutaneous

Question 9

Why do muscarinic receptor agonists need to be delivered orally or subcutaenously?

Answer 9

Not administered intravenously because will cause hypotension due to activation of muscarinic receptors on vascular endothelium

Question 10

pilocarpine delivered:

Answer 10

Orally

Question 11

bethanechol delievered

Answer 11

orally or subcutaneous

Question 12

pilocarpine & acetylcholine applicaion:

Answer 12

Ophthalmic application

Question 13

Side Effects (with systemic exposure) of muscarinic receptor agonists
affect on heart
vision

Answer 13

• SLUDGE: salivation, lacrimation, urination, defecation, gastrointestinal upset, emesis
• also: hypotension, bradycardia, difficulty with visual accommodation (i.e., blurred
  vision)
• Toxicity

Question 14

Muscarinic receptor agonists are blocked by

Answer 14

atropine

Question 15

Muscarinic receptor agonists use with caution in patients with :
- Asthma & COPD because

Answer 15

muscarinic activation can cause bronchoconstriction

Question 16

Muscarinic receptor agonists use with caution in patients with -
Urinary or GI obstruction and peptic ulcer because

Answer 16

(enhances acid secretion)

Question 17

Muscarinic receptor agonists use with caution in patients with - Cardiovascular disease involving bradycardia, hypotension, hyperthyroidism because

Answer 17

(may precipitate atrial fibrillation)