Cholinergic/Anti-cholinergic

Bethanechol

Direct-acting muscarinic

Bladder and bowel/urinary retention

Carbachol

Direct-acting muscarinic

Glaucoma- not used anymore

Methacholine

Direct-acting muscarinic

Bronchial airway hyper reactivity

Pilocarpine

Direct-acting muscarinic

Glaucoma and Sjögren’s syndrome

Cevimeline

Direct-acting muscarinic

Sjogren’s syndrome

Edrophonium

Indirect-acting

Myesthenia gravis & stopping post-surgical NMBs

Physostigmine

Indirect-acting

Glaucoma, atropine overdose, reverse NMBs

Neostigmine & Pyridostigmine

Indirect-acting

Myesthenia gravis, increase muscular contraction force, GI atony, urinary retention, reverse NMJ

*NOT for atropine

Donepezil, rivastigmine, and galantamine

Indirect-acting

Alzheimer’s treatment

Trick: Alzheimer’s DRaGs on

Organophosphates

Indirect-acting

Irreversible

Insecticide and nerve gas

Symptoms either appear as muscarinic(PANS-like) or nicotinic(SANS-like)

Give pralidoxime(reactivated AchE before its irreversible)

Varenicline(chantix)

Direct-acting nicotinic

Helps to stop smoking

Partial agonist that mediates reward center with mild dopamine, which reduces withdrawal

Atropine

Anti-muscarinic

Uncharged, lipophilic, targets CNS

Treats bradycardia, diarrhea, and overactive secretions

Cyclopentolate and tropicamide

Anti-muscarinic

Causes mydriasis and cycloplegia

Scopolamine

Treats motion sickness

Can cause short-term memory loss, sedation at low doses, and susceptible to abuse

Ipratropium, tiotropium, aclidinium

Asthma and COPD

I= short-acting

TA= long-acting

Glycopyrrolate

Treats excessive liquid secretion (hyperhydrosis, salivation, drooling)

Trihexyphenidyl, benztropine

Treats Parkinson’s

Trick: Tri and park the benz

Dicyclomine and hyoscyamine

Treate IBS

Oxybutynin, trospium, darifenacin, sooifenacin and tolterodine

Treats overactive bladder/incontinence

Trospium is best for dementia patients, it doesn’t cross the BBB

Trick: TOTS have an overactive bladDAR

Succinylcholine

Depolarizing N(M) agonist

Causes skeletal muscle paralysis

Mimic Ach, but more resistant, so it leads to muscle fatigue

Rocuronium, pancuronium, vecuronium

Non-depolarizing N(M) antagonist

Causes no muscle contraction