Drugs which directly stimulate muscarinic receptors resulting in cholinergic effects that mimic parasympathetic responses (parasympathomimetic or cholinomimetic effects)

Muscarinic Rcptr Agonists

Acetylcholine (Miochol-E)
Bethanechol (Urecholine)
Carbachol (Isopto Carbachol and Miostat)
Cevimeline (Evoxac)
Methacholine (Provocholine)

(muscarinic receptor agonist)
Intraocular solution: indicated to obtain miosis (pupil constriction) after delivery of the prosthetic lens in cataract surgery, as well as in penetrating keratoplasty, iridectomy, and other anterior eye chamber surgery where rapid miosis may be required

(M rcptr agonist)
Tablets: indicated for the treatment of acute postoperative and postpartum non-obstructive (functional) urinary retention & for neurogenic atony of the urinary bladder with retention; off-label use for gastroesophageal reflux disease

(M rcptr agonist)
Ophthalmic solution: indicated for lowering IOP in glaucoma & intraocular solution for inducing mitosis during ophthalmic surgery (not as susceptible to Atropine)

(M rcptr agonist)
Capsules: indicated for the treatment of dry mouth (xerostomia) in patients with Sjorgren's syndrome (an autoimmune disorder assoc. with salivary & lacrimal gland injury leading to severe dry mouth & dry eyes - may be paired with lupus or RA)

(M rcptr agonist)
Inhalation sol'n: indicated for the diagnosis of bronchial airway hperreactivity (BBW: methacholine is a diagnostic tool and is not to be used as a therapeutic agent)

M Rcptr Agonists

Arecoline
Muscarine
Pilocarpine

(M rcptr agonist)
(naturally occurring parasympathomimetic (cholinomimetic) alkaloid

-Alkeloid from the areca nut commonly referred to as betel nut-

M rcptr agonist
Naturally occurring parasympathomimetic (cholinomimetic) alkaloid

-alkaloid from the mushrooms Amanita muscaria and Inocybe-

M rcptr agonist
Naturally occurring parasympathomimetic (cholinomimetic) alkaloid

-alkaloid from the leaves of the South American Pilocarpus plant-

(M rctpr agonist)
Opthalmic solution & gel: open-angle glaucoma; Tabs: dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head & neck, as well as dry mouth assoc. w/Sjogren's syndrome; off-label: dry eye syndrome & relief of dry mouth in pts w/graft vs host disease

Major alkaloid of areca (betel) nuts. Red staining, commonly consumed as a euphoric by the native pple of the Indian subcontinent, East Indies, & Southeast Asia. Masticatory mxtr known as a betel quid (paan), which is composed of the areca nut & slaked lime wrapped in leaves of Piper betle, a species of pepper

Contributes in part to the toxic effects resulting from the consumption of Amanita and Inocybemushroom species. Sx of toxicity include salivation, lacrimation, nausea, vomiting, h/a, visual dist., abdom. cramping, diarrhea, bronchospasm, bradycardia, & poss. hypotension & shock.

The major alkaloid obtained from the leaves of South American shrubs of the genus Pilocarpus. SA natives have chewed the leaves to promote salivation. The alkaloid was isolated in the late 1800s followed by elucidation of the actions of pilocarpine on the pupil (mitosis) and on the sweat and salivary glands (stimulation)

Acetlcholine, methacholine, carbachol, and bethanechol are (absorbed / poorly absobed) from the GI tract.

Arecoline and pilocarpine (are / are not) readily absorbed into the GI tract

T or F

Although muscarine is a quaternary amine, it is capable of producing systemic effects, including CNS effects, upon oral ingestion

Alkaloids and Choline esters are (Direct acting or indirect acting) drugs

Direct-acting drugs are drugs that are