Cholinomimetics: Indirect agonists (anticholinesterases)

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Cholinomimetics: Indirect agonists (anticholinesterases)

Cardiology

Cardiology

Acute coronary syndrome: Clinical sciences

Advanced cardiac life support (ACLS): Clinical (To be retired)

Supraventricular arrhythmias: Pathology review

Ventricular arrhythmias: Pathology review

Heart blocks: Pathology review

Coronary artery disease: Clinical (To be retired)

Heart failure: Clinical (To be retired)

Syncope: Clinical (To be retired)

Pericardial disease: Clinical (To be retired)

Infective endocarditis: Clinical (To be retired)

Valvular heart disease: Clinical (To be retired)

Cardiomyopathies: Clinical (To be retired)

Hypertension: Clinical (To be retired)

Hypercholesterolemia: Clinical (To be retired)

Pharmacology

Cholinomimetics: Direct agonists

Cholinomimetics: Indirect agonists (anticholinesterases)

Sympathomimetics: Direct agonists

Muscarinic antagonists

Sympatholytics: Alpha-2 agonists

Adrenergic antagonists: Presynaptic

Adrenergic antagonists: Alpha blockers

Adrenergic antagonists: Beta blockers

ACE inhibitors, ARBs and direct renin inhibitors

Thiazide and thiazide-like diuretics

Calcium channel blockers

Adrenergic antagonists: Beta blockers

cGMP mediated smooth muscle vasodilators

Calcium channel blockers

Adrenergic antagonists: Beta blockers

Class I antiarrhythmics: Sodium channel blockers

Class II antiarrhythmics: Beta blockers

Class III antiarrhythmics: Potassium channel blockers

Class IV antiarrhythmics: Calcium channel blockers and others

Lipid-lowering medications: Statins

Lipid-lowering medications: Fibrates

Miscellaneous lipid-lowering medications

Positive inotropic medications

Loop diuretics

Antiplatelet medications

Assessments

Cholinomimetics: Indirect agonists (anticholinesterases)

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Cholinomimetics: Indirect agonists (anticholinesterases)

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Acetylcholine (ACh)

anticholinesterase effect on p. 241

Acetylcholinesterase (AChE)

cholinesterase inhibitor poisoning p. 241

Anticholinesterase drugs p. 241

Atropine p. 242

cholinesterase inhibitor poisoning p. 241

Bradycardia

cholinesterase inhibitor poisoning p. 241

Cholinesterase inhibitors

diarrhea with p. 250

poisoning from p. 241

Diarrhea

cholinesterase inhibitor poisoning p. 241

Miosis

cholinesterase inhibitor poisoning p. 241

Physostigmine

anticholinesterase p. 241

Transcript

Content Reviewers

Yifan Xiao, MD

Contributors

Ursula Florjanczyk, MScBMC

Sam Gillespie, BSc

Justin Ling, MD, MS

Evan Debevec-McKenney

The nervous system is divided into the central nervous system, that is the brain and spinal cord, and the peripheral nervous system, which includes all the nerves that connect the central nervous system to the muscles and organs.

The peripheral nervous system can be divided into the somatic nervous system, which controls voluntary movement of our skeletal muscles; and the autonomic nervous system, which controls the involuntary activity of the smooth muscles and glands of our organs, and is further divided into the sympathetic and parasympathetic nervous systems.

Parasympathetic neurons in the central nervous system project preganglionic fibers towards parasympathetic ganglia, which are collections of neurons near the organ they are supposed to affect.

From there, postganglionic fibers project towards the target cell.

Both the preganglionic and postganglionic neurons release the neurotransmitter acetylcholine.

Acetylcholine released from preganglionic fibers acts on nicotinic receptors on the postganglionic neurons.

And acetylcholine released from postganglionic neurons acts on muscarinic and nicotinic receptors on target organs.

Nicotinic receptors are coupled to ion channels that let sodium in and potassium out, causing depolarization.

Muscarinic receptors are G-protein coupled receptors, which means they trigger secondary messenger proteins that activating a cascade of enzymes inside the cell.

The physiologic effects of the muscarinic and nicotinic stimulation can be remembered with the mnemonic: DUMB HAVES, so defecation; urination; muscle excitation; bronchospasm; heart bradycardia; autonomic ganglia stimulation; vasodilation; eye miosis, which is constriction of the pupil, and eye accommodation, which is contraction of the ciliary muscles of the iris to facilitate looking at near objects; and secretions from the lacrimal, salivary, and sweat glands, as well as the glands in the GI tract.

Sources

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