Ch 19 1 Pharm

Affects synapses using acetylcholine as a neurotransmitter

• Cholinergic stimulants
• ----Increase activity at the Ach synapse
• Anticholinergic drugs
• ----Decrease activity at Ach synapse

• Muscarinic
• Nicotinic

• Located on peripheral tissue supplied by parasympathetic postganglionic neuron
• GI
• Urinary bladder
• Heart
• Eye
• Ach synapses in CNS

• Located in the autonomic ganglia (NN)
• skeletal neuromuscular junction (NM)

• Some drugs bind to specific receptors, others indiscriminately to all cholinergic receptors
• Specific are better bc less side effects

• Increase activity at acetylcholine synapses
• Direct acting
• Indirect acting

• Muscarinic stimulants primarily affect peripheral tissues
• Specific, More beneficial
• Nicotinic (in autonomic ganglia and skeletal neuromuscular junction)

• GI and urinary atony
• ----Increase contractions (especially after surgery)
• Glaucoma

• Allows more acetylcholine to remain at the synapse
• ----Prevents destruction of Ach in synaptic cleft
• ----Cholinesterase inhibitors
• ----Anticholinesterase agents
• Lack of specificity

• Myasthenia gravis
• Glaucoma
• Dementia
• Reversal of neuromuscular blocking agents

• Prevent Cholinergic neurons degradation
• ----Critical for memory, cognition
• Indirect cholinergic stimulants decrease symptoms
• ----Inhibit break down of Ach, prolonging effects of release
• Drugs
• ----donepezil (Aricept)
• Gastrointestinal and urinary bladder atony cholinergic drugs
• Cholinergic agonists stimulate smooth muscle contraction
• Direct acting vs Indirect acting
• ---- indirect acting used Most frequently

• Cholinergic stimulation via parasymp increases outflow of aqueous humor preventing excessive accumulation
• Direct or indirect stimulants

Allow endogenous Ach release from presynaptic terminal to remain in junction for longer prior of time allowing for adequate excitation of SM