The Massachusetts General Hospital Handbook of Neurology
Authors: Flaherty, Alice W.; Rost, Natalia S.
Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition
Copyright 2007 Lippincott Williams & Wilkins
> Table of Contents > Drugs > Cholinergic Drugs
Cholinergic Drugs
A. Location of receptors
Preganglionic sympathetic nervous system (SNS) + parasympathetic nervous system (PSNS), postganglionic PSNS, postganglionic SNS for sweating and vasodilation.
B. Acetylcholinesterase inhibitors
Inhibit acetylcholine breakdown. E.g., neostigmine (does not penetrate CNS well), physostigmine (does).
C. Muscarinic receptors
Postganglionic. Cause small pupils, high heart rate, secretions, bronchospasm, and bladder tone. Agonists include bethanechol, glycopyrrolate. Antagonists include benztropine, trihexyphenidyl, scopolamine, atropine.
D. Nicotinic receptors
Found in preganglionic ANS (where hexamethonium is an antagonist) and at the NMJ (where curare is an antagonist).
Anticholinergic toxicity mnemonic: Mad as a hatter (delirium). Plugged as a pig (stool and urinary retention). Dry as a bone (dry mouth, anhidrosis). Blind as a bat (blurred vision). Hot as a hare (fever). Fast as a fibrillation (tachycardia).