Donepezil 

A carbamate AChase inhibitor 

Tx for Alzeheimer's DZ

Carbachol, Bethanechol, Methacholine

Choline Esters: Agonist at ACh receptors

Can't Be Metabolized by AChesterase

*inhibitors of AChase only potentiate effect of ACh

Methacholine

DX of what? 

diagnoses asthma: 

causes: flushing, sweating, salivation, GI, cramping, and bronchoconstriction. 

Acetylcholine and Carbachol

what receptors? 

both nicotinic and muscarinic

Methacholine and Bethanechol 

what receptors? 

ONLY muscarinic effects

Indications of Bethanecol 

• Parkinson pts tx w/ benztropine
• Psychotic pts tx w/ typical anti-psych dx
• Pts tx w/ TCA

Decreased BP via Nitric Oxide (NO released from vascular endothelial cells)

*Atropine can block this decreased in BP 

MOA of Pilocarpine 

Causes miosis and cycloplegia via contraction of ciliary muscle: decreases IOP via increased outflow of aqueous humor. 

S/Es: bronchoconstriction, salivation

↑SNS with ↑HR,BP, & vasoconstriction

↑ respiration, and ↑GI motility

large doses: muscle fasciculations

CNS: convulsions w/ overdose 

Nicotine 

Physostigmine, Neostigmine, Edrophonium

AChase inhibitors 

(Carbamates) 

Edrophonium 

• dx of Myastenia Gravis (MG)
• to diff btw. myasthenic and cholinergic crisis in pts tx w/ neostigmine

Used w/ atropine in reversal of of NMB caused by non-depolarizing drugs (d-tc, pancuronium) 

Edrophonium 

Tx of MG 

Neostigmine

*always used w/ atropine to prevent indirect muscarinic S/Es

3° Carbamates

Cross BBB, eye, placenta, & breast milk barrier 

Example: Physostigmine

4°Carbamates 

(+) charges at all pHs

Ex: neostigmine, edrophonium 

Malathion, Parathion, Isofluophate 

Irreversible inhibit AChesterase: are lipid soluble --> something about ACHesterase in brain & plasma

bradycardia, lacrimation, salivation, diaphoresis, miosis, blurred vision, dyspnea, pulmonary edema, bowel cramping, involuntary urination, skeletal muscle fasciculations (N2) 

Organophosphate Poisoning 

Tx of organophosphate poisoning 

Atropine + Pralidoxime 

Scopolamine, Dimenhydrinate, Meclizine

Prevention of Motion Sickness 

Trihexyphenidyl, Benztropine, Diphenhydramine

tx for Parkinson's Disease

Solifenancin, Tolterodine 

Tx for Urge Incontinence 

Meclizine 

Tx for Meniere's Disease

Promethazine 

Tx for N/V, poison ivy and oak 

Tropicamide

DOC for fundoscopic exam 

*overcoming pupillary light reflex

Cyclopentolate 

DOC for determination of refractive error 

Atropine + Scopolamine 

DOC for tx of pain in anterior uveitis, keratitis, and choroiditid

↓ formation of Aqueous humor

Timolol, dorzolamide, apraclonidine

↑Outflow of aqueous humor

Latanoprost, Epinephrine, Pilocarpine, Isofluophate

Trimethapan, Hexamethonium 

Block SNS and PSNS 

*Block ↑in plasma Epi induced by hypoglycemia 

*Used in emergency and acute situations 

Succinylcholine, Decamethonium 

NMJ blocking drugs 

Depolarizing (non-competitive) 

D-tubocurarine (curare)

Pancuronium 

NM blocking agents

Non-depolarizing (competitive) 

phase 1: MEP depolarize

phase 2: repolarized, but still refractory

causes fasciculations --> flaccid paralysis

Succinylcholine

Decamethonium 

MEP never polarized

no fasciculations prior to flaccid paralysis 

NM blockade 

D-tubocurarine 

Pancuronium (-curiums & -roniums)

Increased overflow of NE 

Ang II, β2 stimulation, α2 block, cocaine, TCAs

Decreased overflow of NE 

muscarinic (ACh) & α2 stimulation (clonidine), PGEs 

Drugs at sympathetic Nerve Jxn

α1, α2, β1, β2, uptake 1, MAO-A, MAO-B, storage granule, NE release mechanism, NE synthesis 

NE ___ HR via reflex baroreceptor

↓ *via reflex baroreceptor mediated vagal bradycardia

**effect blocked by atropine

DA ___ RBF/mesenteric BF, ______dP/dT (β1), and higher doses _____ DBP (α1)

Increases, increases, increases

Which one is used to maintain dp/dt post-MI ?

DA, NE, Epi

DA bc ↑ RBF, whereas NE or Epi ↓ RBF

Epi ____ skeletal muscle BF, _____ skin, renal and GI BF, ___ Hr, dp/dt, CO, SBP, PP & ____ DBP w/ physiological doses

increases, decreases, decreases

Epi reversal w/ an α blocker, such as

Epi + Phentolamine = only β =

↑ HR and RBF, 

↓TPR, BP, & ERP in heart

Epi + β blockers = only α effects = 

Increased BP 

Epi + local anesthetic causes: 

Local vasoconstriction, prevents systemic absorption, and ↑nerve blockade & provides hemostatis 

Phenylephrine (PE)

a1 agonist= mydriasis w/out cyclopegia 

Ritodrine (β2 agonist) 

 decreases uterine contraction in premature labor

Isoproterenol (non-selective β1 and β2 agonist)

Bronchodilation w/ ↑HR

Albuterol and Terbutaline (selective β2 agonists) 

Bronchodilation w/ less ↑ in HR

Clonidine 

pre and post-synaptic α2 agonist