Drug Affecting the PSNS: direct muscarinic and indirect cholinomimetics

Question 1

which drugs are direct muscarinics

Answer 1

pilocarpine, bethanechol, methacholine

Question 2

which direct muscarinic has good CNS penetration

Answer 2

pilocarpine (pilocar)

Question 3

which direct muscarinic does not reach CNS

Answer 3

bethanechol, methacholine

Question 4

what are the AChE inhibitors

Answer 4

1. donepezil
2. physostigmine
3. edrophonium
4. neostigmine
5. pyridostigmine

Question 5

which AChE inhibitors cross in CNS

Answer 5

1. donepezil

2. physostigmine

Question 6

which AChE inhibitors have poor CNS penetration

Answer 6

1. edrophonium
2. neostigmine
3. pyridostigmine

Question 7

what AChE inhibitors are organophosphates?

Answer 7

1. malathion (is a topical for ectoparasites)

2. sarin, tabun (nerve gas)

Question 8

what is accommodation

Answer 8

reflex action controlled by CNII (afferent limb) interneurons, and CNIII (efferent limb); lens of eye changes shape to focus on nearby objects via contraction of ciliary muscle, regulates flow of aqueous humor into canal of schlemm

Question 9

what regulates accommodation

Answer 9

M3 receptor, Gq coupled

Question 10

what regulates miosis

Answer 10

M3 receptor, Gq coupled

Question 11

what is miosis

Answer 11

constriction of pupil, from pretectal nucleus of midbrain

neurons activate Edinger Westphal nucleus to activate M receptors to cause contraction of iris sphincter muscle

Question 12

what regulates salivation

Answer 12

M3

Question 13

what is sialorrhea

Answer 13

excessive salivation

Question 14

what occurs when administer muscarinic agonist

Answer 14

1. salivation, lacrimation, miosis, nearsightedness
2. decreased BP and HR
3. bronchorrhea/spasm
4. increased motility, diarrhea, fecal incontinence
5. urination/incontinence
6. sweating

Question 15

how to treat muscarinic agonist

Answer 15

block muscarinic receptors with atropine

Question 16

what occurs when administer AChE inhibitor

Answer 16

increases ACh everywhere it is

1. salivation, lacrimation, miosis, nearsightedness
2. increased BP and decreased HR (because increasing Nn at both SNS and PSNS which makes alpha 1 constrict BV)
3. bronchorrhea, bronchospasm, diaphragm paralysis )(because ACh desensitizes)
4. urination, incontinence
5. fasciculation followed by paralysis (activate Nm, Na/K, then desensitizes)
6. hyperkalemia (from skeletal muscle fasciculation)

Question 17

how to treat AChE inhibitor

Answer 17

atropine, pralidoxime for organophosphates to prevent aging, seizure control