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1. 
Management of
◦ Myasthenia gravis and tensilon test
◦ Glaucoma
◦ Alzheimer's disease poisoning

2. 
The autonomic nervous system
(ANS or visceral nervous
system or involuntary nervous system ) is
the part of the peripheral nervous systemthat acts
as a control system, functioning largely below the
level of consciousness, and
controls visceral functions.

3. 
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Heart: Cardiac suppressant…Bradycardia, hypotension,
Eye: Miosis, cycloplegia, facilitates aqueous humour
drainage, lacrimation
Bronchospasm
Excess secretion from glands….salivary, bronchial,
lacrimal glands etc…..
GIT /bladder… smooth muscle contraction and
relaxation of sphincters…, increased motility, diarrhea,
vomiting , increased micturation (urinary urgency)

4. 
Often called parasympathomimetic drugs,
because their action mimics the action of the
PSNS commonly

Also called as Cholinergic drugs or
cholinomimetric
Cholinergic agonists are two types :
1. Direct
acting
2. Indirect
acting

5. They act by binding directly to cholinoceptors

Acetylcholine (Synthetic analogue of ACH)

Carbachol

Bethanechol

Pilocarpine (naturally occurring alkaloid)

6. They act through inhibition of Acetyl
cholinesterase enzyme….so increases
Acetylcholine level in the synapse
 Reversible:
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Neostigmine
Physostigmine
Pyridostigmine
Edrophonium
Tacrine
Danopezil
•Irreversible :
Ecothiophate
Malathion
Parathion
Sarin

8. 
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It is a quaternary ammonium compound so
Cannot penetrate the membrane
Does not have any therapeutic importance,
because of multiplicity of actions & rapid
inactivation by acetylcholinesterases
It has both Muscarinic & Nicotinic actions
Neurotransmitter for pre-ganglionic neuron

9. 
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Not hydrolyzed by acetylcholinesterases
It has strong Muscarinic action & no Nicotinic action
Actions
Directly stimulates M receptors causing increased intestinal
motility & tone
It stimulates detrusor muscle of the bladder while trigone &
sphincters are relaxed causing expulsion of urine
Therapeutic Uses:
Paralytic ileus-Ileus is a disruption of the normal propulsive
ability of the gastrointestinal tract.
Urinary retentions

10. An alkaloid, lipid soluble & is stable to hydrolysis by
cholinsterases It has Muscarinic activity only .
Actions-
When applied locally to cornea Produces rapid miosis
& contraction of ciliary muscle produces of spasm of
accommodation & vision is fixed at particular distance
making it impossible to focus for far situated objects
Miosis-excessive constriction of the pupil of the eye
Therapeutic Use : In Glaucoma
It opens trabecular meshwork around schlemm’s canal
∴ causes drainage of aqueous humor
∴ IOP immediately decreases.

11. 
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Cholinesterase inhibitors. Can be reversible or
irreversible.
Reversable:
◦ Neostigmine
◦
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◦

Physostigmine
Edrophonium
Tacrin
Danopezil
Irreversible
◦ Malathion and Parathion
◦ Sarin
◦ Ecothiopate
◦

12. 
Neostigmine in M.gravis
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Physostigmine in Glaucoma
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Ecothiopate in glaucoma
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Edrophonium in M.gravis to test
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Tacrin, Danopezil in Alzheimer's

13. 
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An autoimmune process causes production of antibodies that
decrease the number of functional nicotinic receptors on the
postjunctional end plates.
Frequent findings are
Double vision…. diplopia,
Drooping of eyelids…. ptosis,
Dysarthria ……Difficulty in speaking
Dysphagia …..difficulty swallowing,
Difficult in Daily routines
Day passes, limb weakness increases.
Difficulty in respiration Severe disease may affect all the
muscles, including those necessary for respiration.
Death

14. Immunosuppressant drugs
 Thymectomy
 Acetyl Cholinesterase inhibitors
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Neostigmine
Pyridostigmine
Ambenonium
Edrophonium
Other supportive measures

15. 
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Neostigmine Has a strong influence at the
neuromuscular junction
Pyridostigmine : Has a longer duration of action
than neostigmine
Ambenonium :Available only in oral form; cannot
be used if patient is unable to swallow tablets
Edrophonium: Diagnostic agent for myasthenia
gravis and to diffrentiate myasthenic and
cholinergic crisis (Tensilon test )