Cholinergic Agonists
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| cholinergic agonists also known as | parasympathomimetics or muscarinic agonists; promote or mimic the action of acetylcholine
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| 3 categories in this class: | 1. muscarinic agonists
2. cholinesterase inhibitors
3. ganglionic stimulants
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| MUSCARINIC AGONISTS: | 1. acetylcholine[Miochol] 2. carbachol[Isopto Carbachol] 3. pilocarpine[Isopto Carpine] 4. bethanechol[Urecholine] 5. methacholine[Provocholine]
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| muscarinic receptors[acetylcholine] are located in: | eye, heart, blood vessels, lung, GI tract, urinary bladder, sweat glands
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| MAs are used clinically to tx | glaucoma and to improve GI and urinary bladder tone
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| ACh is destroyed rapidly by | cholinesterase and Miochol has too short of a half-life so its use is restricted to pupil constriction for procedures
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| methacholine is only used for | dx of bronchiol airway hyper-reactivity by specialists
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| carbachol and pilocarpine are used to tx | glaucoma
pilocarpine comes in an oral form that can also be used to tx xerostomia by increasing salivary gland secretion
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| bethanechol[Urecholine] increases the tone of the | detrusor urinae muscle and produces contraction strong enough to initiate micturition and empty the bladder
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| bethanechol also stimulates | gastric motility
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| bethanechol is not destroyed by cholinesterase as quickly as acetycholine | so its effects are more prolonged
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| bethanechol is contraindicated in: | PUD[can cause excessive secretion of gastric acid that could lead to perforation], intestinal obstruction[d/t increased peristalsis],
urinary obstruction or weak bladder wall[d/t increase urinary tract pressure]
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| also contraindicated in: | bronchospastic disease[stimulation of muscarinic receptors in lungs resulting in bronchoconstriction]
preexisting hypotension, bradycardia, CVD
hyperthyroidism
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| other adverse rxns | increased tearing, miosis of pupils, facial flushing
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| Muscarinic poisoning can occur from overdosage and also from certain poisonous mushrooms. Sx are abdominal cramps, salivation, flushing, n/v. Antidote: | Atropine subq
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| drug interactions include nicotine which could create | a critical fall in BP
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| drugs that have antimuscarinic activity and decrease the effects of muscarinic agonists are: | H1 blockers, pheonothiazines, quinidine, procainamide
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| clinical indications: | neurogenic atony of the bladder with retention
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