Cholinergic Drugs

• Cholinergic receptors:

  Muscarinic 1, 2, 3

  Niocotinic (Nn and Nm)
• Murscarinic receptors

  • 1 GIT
  • 2 heart
  • 3 Smooth muscle in the eyes and lungs
• Cholinergic Agonists: Direct Acting

  • Acetylchonine
  • Carbechol
  • Pilocarpine
  • Betanechol
• Drug of choice for Glaucoma

  • Pilocarpine - they decrease the intra-ocular pressure (constricting = draining of fluids)
• Betanechol

  Px suffering from urinary retention
• Indirect acting agonists ( target / inhibit enzymes Ache) : Reversible

  • Edrophonium
  • Physostigmine
  • Neostigmine
  • Pyridostigmine
• Edrophonium is used to diagnosed Myasthenia Gravis

  • Tensilon's test
• Antidote for Reversible Agonist toxicity is

  • Atropine
• Alzheimers

  • Tacrine
  • Galantamine
  • Donepezil
  • Rivastigmine
• Irreversible (prolonged effect) Military


  Sarin

  Tabun

  soman
• Irreversible : Insecticides 


  Parathion

  malathion
• Irreversible : caused

  DUMBELLS EFFECTS
• IRREVERSIBLE DRUG CAUSE MIOSIS

  ecothiophate
• Cholinergic Antagonist : Antimuscarinic Agents: Non selective


  Atropine = caused blurred vision

  Cyclopentolate

  Tropicamide

  Scopolamine = motion sickness
• Atropine caused

  ALICE in Wonderland effect

  From Atropa Belladona
• Cholinergic Antagonists : Non selective promote urinary retention

  • Tolterodine
  • Fesoterodin
  • Darifenacin
  • Solifenacin
  • Oxybutinin
  • Trospium
• Cholinergic Antagonists : Non selective Asthma and COPD

  • Ipatropium
  • Tiotropium
• Ganglionic Blockers

  Nicotine = increase in HR and BP but still leads to CNS depression
• Neuromuscular Blockers : Nondepolarizing

  Cisatracurium

  Pancuronium

  Rocuronium

  Vecuronium

  Atracuronium
• • Cisatracurium
  • Pancuronium


  90 minutes
• • Rocuronium
  • Vecuronium
  • Atracuronium

  40 minutes
• Neuromuscular Blocker : Depolarizing 


  Succinylcholine
• Phase 1:


  Binds to the nicotinic receptors that leads to entrance of sodium and release of calcium leading to muscle contraction.
• Phase 2

  • Resistant to Ache prolonged binding and leading to desensitization of the receptors