pns agon

uptake of choline into nerve terminal

choline acetyltransferase

acetylcholinesterase

m1 - cns
m2 - heart
m3 - sm m, glands

glaucoma
diagnostic
urinary retention or bladder atony
reverse GIT depression/paralytic ileus
xerostomia

bradycardia
hypotension
sweating
dizzy
headache
if poisoning, DUMBBELS/full cholinergic poisoning

has muscarinic/nicotinic action
musc at low dose

musc >> nico
relatively resistant to ACh-esterase, so last longer

tx: diagnostic for bronchial asthma; if pt has hyper reactive airway, will have bronchial sm m contr

sfx: bradycardia, hypotension

no nico action
completely resistant to AChE

tx: urinary retention, activation of AChM in bladder > sm m contr > urination
off label > tx xerostomia by stim salivate
oral or sc only! IM/IV=bradycardia

sfx: bradycardia, hypotension

contraind: asthma pt

musc > nico
complete resist to AChE

tx: topical use reduces intraocular pressure in wide angle glaucoma (sm m contr lining schlemm canals, more aq humor)

muscarinic receptor subtype selective
can dec adverse cardiac fx

tx: xerostomia

contraind: complete loss of gland func

muscarinic agonist: inc outflow (carbachol)
beta blocker: dec secretion (timolol)
prostaglandin

muscarine

xs stim of muscarinic receps

happens with mushrooms or OD

SLUDGE

salivation
lacrimation
urination
diarrhea
GI upset
emesis(vomit)

can also get Bronchoconstriction/Bronchorrea (↑mucus), bradycardia

physostigmine
neostigmine
donepezil

reversible AChE inhibitor
cross BBB > CNS activity
tx: WAglaucoma, anticholinergic poisoning

reversible AChE inhibitor
no CNS activity
tx: post op urinary retention, myasthenia gravis

reversible AChE inhibitor
CNS activity
tx: alzheimers

same as muscarine; tx with atropine

very toxic!

organophosphates insecticides
organophosphates nerve agents

sfx: DUMBBELS and hyper/hypotension, NMJ paralysis (nicotinic sfx too since ACh presence too much)

DFP, Isoflurophate, Malathion, Parathion, Nerve gases

atropine
mechanical ventilation if NMJ paralysis
2-PAM