Medical Pharmacology Chapter 6: Autonomic Pharmacology: Cholinergic Drugs
Gastrointestinal and Genitourinary
GI smooth muscle stimulant
Postoperative abdominal distention
Esophageal reflux; promotes increased esophageal motility (other drugs are more effective, e.g. dopamine antagonist (metoclopramide) or serotonin agonists (cisapride)
Urinary bladder stimulant
Post-operative; post-partum urinary retention
Alternative to pilocarpine to treat diminished salivation secondary, for example. to radiation
Carbachol not used due to more prominent nicotinic receptor activation
Methacholine used for diagnostic purposes.
Testing for bronchial hyperreactivity and asthma
Acetylcholine and Carbachol may be used for intraocular use as a miotic in surgery
Carbachol may be used also in treatment of glaucoma.
Pilocarpine is used in management of glaucoma and has become the standard initial drug for treating the open-angle form.
Sequential adminstration of atropine (mydriatic) and pilocarpine (miotic) is used to break iris-lens adhesions.
Major contraindication to the use of muscarinic agonists
Asthma: Choline esters (muscarinic agonists) can produce bronchoconstriction. In the predisposed patient, an asthmatic attack may be induced.
Hyperthyroidism: Choline esters (muscarinic agonists) can induce atrial fibrillation in hyperthyroid patients.
Peptic ulcer: Choline esters (muscarinic agonists), by increasing gastric acid secretion, may exacerbate ulcer symptoms.
Coronary vascular disease: Choline esters (muscarinic agonists), as a result of their hypotensive effects, can further compromise coronary blood flow.
Adverse Effects: Muscarinic Agonists
Loss of visual accommodation
Brown, J.H. and Taylor, P. Muscarinic Receptor Agonists and Antagonists, In, Goodman and Gillman's The Pharmacological Basis of Therapeutics, (Hardman, J.G, Limbird, L.E, Molinoff, P.B., Ruddon, R.W, and Gilman, A.G.,eds) The McGraw-Hill Companies, Inc.,1996, pp.149-150.
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