AUTONOMIC NS
)
The sympathetic NS:
Increases the heart rate
Makes the pupil dilate
Inhibits digestion
Inhibits nasal secretions
Inhibits saliva production
Prasympathetic : CHOLinergic system
Uses Ach pre-synaptically and post-
synaptically
Craniosacral depolarization
cGMP: 2nd messenger
Receptors
o Muscarinic: M1, M2, M3, M4, M5
o Nicotinic: located at NMJ and
autonomic ganglia
Cholinomimetic: You make them more
parasympathetic
M1: CNS/ENS (Brain is the most important part
of the body)
M2: Heart (Number 2 most important part of
the body)
M3: Everthing else
o Increases Exocrine gland secretion
(Sweat glands, airway, GI tract,
Lacrimal glands)-> Makes you wet
o Increases Gut motility -> Makes you go
to the bathroom more frequently
o Miosis via pupillary sphincter -> makes
your pupil maliit
o Accommodation via ciliary
o Bronchoconstriction
o Bladder constriction-> Makes you pee
DIRECT-ACTING
Cholinergics/Cholinomimetics/Muscarinic agonists
BethanaCHOL
Post op and neurogenic ileus and urinary
retention/ Bladder and bowel atony -> Px cant
pee : M3 makes u pee!!
Activates M1-3
SE: Diarrhea, Urinary urgency, Vasodilation,
Reflex tachycardia, Sweating
CarbaCHOL
Glaucoma, pupillary contraction, and relief of
IOP, also for post op urinary retention
MethaCHOLine
Induces bronchospasm (bronchoconstriction)
for asthma challenge test
Pilocarpine/ PiloCHOLpine
Cystic fibrosis sweat test (Makes you wet!
Activates M3 receptors
o In the ciliary muscle -> increases AH
outflow (tx for GLAUCOMA)
o Salivary glands: Increases salivation
(Makes you wet!)
o SE: Miosis Blurring of vision (due to
cyclospasm)
Muscarinic Toxicity
CNS stimulation
EYES: miosis, spasm of accommodation
LUNGS: bronchoconstriction
GIT/GUT: excessive GI and GU motility
Increased secretory activity (
Cholinomimetic: NICOTINIC
Nicotine
SimD: VARENICLINE
Activates nicotinic Ach receptors (Nn and Nm)
For smoking cessation
SE: Generalized ganglionic stimulation: HPN,
nausea, vomiting, diarrhea
Nicotinic Toxicity
Ganglionic stimulation
Blockade of neuromuscular end plate
depolarization
o Leading to fasciculation and paralysis
CNS stimulation (convulsions) followed by CNS
depression
INDIRECT-ACTING Cholinergics/ANTI-Cholinesterase
Bind to cholinesterase and undergo hydrolysis
(deactivation of AchE -> prevent Ach
degradation)
Result: Amplification of Acetylcholine effects
wherever Ach is released
Edrophonium
Dx: Myasthenia Gravis
NeoSTIGmine/ PyridoSTIGmine
Myasthenia Gravis