

Management of

◦ Myasthenia gravis and tensilon test
◦ Glaucoma
◦ Alzheimer's disease poisoning


The autonomic nervous system  
(ANS or visceral nervous
system or involuntary nervous system ) is
the part of the perip...








Heart: Cardiac suppressant…Bradycardia, hypotension,
Eye: Miosis, cycloplegia, facilitates aqueous humour
dra...


Often called parasympathomimetic drugs,
because their action mimics the action of the
PSNS commonly



Also called as ...
They act by binding directly to cholinoceptors


Acetylcholine (Synthetic analogue of ACH)



Carbachol



Bethanechol
...
They act through inhibition of Acetyl
cholinesterase enzyme….so increases
Acetylcholine level in the synapse
 Reversible:...







It is a quaternary ammonium compound so
Cannot penetrate the membrane
Does not have any therapeutic importance,...












Not hydrolyzed by acetylcholinesterases
It has strong Muscarinic action & no Nicotinic action
Actions
...
An alkaloid, lipid soluble & is stable to hydrolysis by
cholinsterases It has Muscarinic activity only .

Actions-

When a...




Cholinesterase inhibitors. Can be reversible or
irreversible.
Reversable:
◦ Neostigmine

◦
◦
◦
◦


Physostigmine
Ed...


Neostigmine in M.gravis



Physostigmine in Glaucoma



Ecothiopate in glaucoma



Edrophonium in M.gravis to test

...













An autoimmune process causes production of antibodies that
decrease the number of functional nicoti...
Immunosuppressant drugs
 Thymectomy
 Acetyl Cholinesterase inhibitors


◦
◦
◦
◦


Neostigmine
Pyridostigmine
Ambenoniu...








Neostigmine Has a strong influence at the
neuromuscular junction
Pyridostigmine : Has a longer duration of act...
Cholinergics
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Cholinergics

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Cholinergics

  1. 1.  Management of ◦ Myasthenia gravis and tensilon test ◦ Glaucoma ◦ Alzheimer's disease poisoning
  2. 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. 3.      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. 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. 5. They act by binding directly to cholinoceptors  Acetylcholine (Synthetic analogue of ACH)  Carbachol  Bethanechol  Pilocarpine (naturally occurring alkaloid)
  6. 6. They act through inhibition of Acetyl cholinesterase enzyme….so increases Acetylcholine level in the synapse  Reversible:  ◦ ◦ ◦ ◦ ◦ ◦ Neostigmine Physostigmine Pyridostigmine Edrophonium Tacrine Danopezil •Irreversible : Ecothiophate Malathion Parathion Sarin
  7. 7.     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
  8. 8.         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
  9. 9. 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.
  10. 10.   Cholinesterase inhibitors. Can be reversible or irreversible. Reversable: ◦ Neostigmine ◦ ◦ ◦ ◦  Physostigmine Edrophonium Tacrin Danopezil Irreversible ◦ Malathion and Parathion ◦ Sarin ◦ Ecothiopate ◦
  11. 11.  Neostigmine in M.gravis  Physostigmine in Glaucoma  Ecothiopate in glaucoma  Edrophonium in M.gravis to test  Tacrin, Danopezil in Alzheimer's
  12. 12.           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
  13. 13. Immunosuppressant drugs  Thymectomy  Acetyl Cholinesterase inhibitors  ◦ ◦ ◦ ◦  Neostigmine Pyridostigmine Ambenonium Edrophonium Other supportive measures
  14. 14.     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 )

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