Presentation
Present in neuromuscular junction, N M Agonist: Phenyl Trimethyl Ammonium Antagonist: Tubocurarine b. Present in autonomic ganglia, adrenal medulla, N N Agonist: Dimethyl phenyl piperazinium Antagonist: Hexamethonium Classification A. [howmed.net]
Nicotinic receptors are present at the ganglia of both the sympathetic and parasympathetic arms of the ANS as well as on the adrenal medulla. [pharmacologyeducation.org]
[…] culminating in coma Musculoskeletal symptoms: fasciculations, weakness ;, spasms, paralysis → peripheral neuromuscular respiratory failure Cholinergic crisis ( cholinergic syndrome ) Cause: in most cases as a result of poisoning with organophosphates Clinical presentation [amboss.com]
A SEMINAR ON PARASYMPATHOMIMETIC AGENTS Presented By: Ms. Kirti Vadi 17MPHCT002 M.Pharm (pharmacolgy) Rpcp,changa Guided By: Dr. Jalpa Suthar Assistant Professor Dept. Of Pharmacology & Toxicology Rpcp,changa 2. [slideshare.net]
Entire Body System
- Pain
Overview Effects Effects of parasympathomimetics References: [1] Side effects Indirect parasympathomimetics Cardiovascular symptoms: bradycardia, hypotension Gastrointestinal symptoms: ↑ salivation, diarrhea, abdominal pain, uncontrolled urination Increased [amboss.com]
Anxiety, anal distention, bladder distention as a result of vigorous hydration during surgery, and reflex inhibition of the urinary bladder detrusor muscle secondary to pain have been postulated as contributing factors. [insights.ovid.com]
Possible side effects include: miosis, accommodative spasm causing ocular pain. It should not be used to treat uveitic glaucoma. [gpnotebook.co.uk]
[…] catecholamines epinephrine, norepinephrine, and dopamine, derived from tyrosamine neurohormones hormones found inportion of the nervous system such as the catecholamines analeptics drugs that stimulate the central nervous system analgesic medication with pain-relieving [quia.com]
- Inflammation
Parasympathomimetic agents Direct cholinergic agonist Pilocarpine HCL Isopto Carpine Pilocar 0.2%-5% 0.5-6% bid, qid bid, qid 15%-25% 15%-25% Increase trabecular outflow Miosis (decrease vision), brow ache, induced myopia and variable refractive error, exacerbate inflammation [eyewiki.aao.org]
Respiratoric
- Cough
Muscarinic effects are those of parasympathetic overactivity and include bradycardia, pinpoint pupils, sweating, blurred vision, excessive lacrimation, excessive bronchial secretions, wheezing, dyspnoea, coughing, vomiting, abdominal cramping, diarrhea [chemistry.elmhurst.edu]
[…] removing resins 40.17 Calcium removing resins 40.18 Potassium removing resins 40.20 Caloric agents 40.24 Sugar substitutes 40.24 Salt substitutes 40.28 Diuretics 40.36 Irrigating solutions 40.40 Uricosuric agents 44.00 Enzymes 48.00 Expectorants and cough [resourcecenter.ovid.com]
A positive reaction to methacholine challenge may produce symptoms of bronchospasm, such as chest tightness, cough or wheezing. [provocholine.com]
Therapeutic goods in Australia are regulated by the Therapeutic Goods Administration, there are 5 main categories, Normal Medicines - Cough, cold and fever medicines, antiseptics, vitamins and others. [wikivisually.com]
[…] teary eyes -Excessive unexplained runny nose -Increased salivation such as sudden unexplained excessive drooling -Chest tightness or difficulty breathing -Tremors throughout the body or muscular twitching -Nausea and/or vomiting -Unexplained wheezing or coughing [rxlist.com]
- Dyspnea
D efecation (Increased GI motility) ADR: Cramps and diarrhea U rination (Detrusor contraction and Sphincter relaxation) ADR: Urinary frequency M uscle (Skeletal) excitation ADR: Twitchings and fasciculations B ronchospasm ADR: Shortness of breathe (Dyspnea [medchrome.com]
] Adverse Effects: Sinus arrest ( transient episode of asystole lasting up to 6-12 seconds Flushing, sinus bradycardia, hypotension (transient symptoms) Dyspnea, chest discomfort Signs of Toxicity: (None due to short half-life) Contraindications: Pre-existing [shadwige.sites.truman.edu]
Jaw & Teeth
- Xerostomia
Notes: oral pilocarpine is used in the management of patients with xerostomia pilocarpine is a non-selective muscarinic agonist with a mild ß-adrenergic ability (2) this parasympathomimetic agent enhances saliva secretion, ameliorating the sensation of [gpnotebook.co.uk]
[…] leading to cholinergic crisis (muscle weakness and paralyasis of respiratory muscles) Therapeutic uses: Atonic bladder and Urinary retention and Postoperative Gastrointestinal atony (Bethanechol) Glaucoma and eye surgery (Pilocarpine and Carbachol) Xerostomia [medchrome.com]
It is a non-selective muscarinic receptor agonist in the parasympathetic nervous system, which acts therapeutically at the muscarinic acetylcholine receptor M3 due to its topical application, e.g., in glaucoma and xerostomia. [drugsupdate.com]
Pilocarpine treatment of salivary gland hypofunction and dry mouth (xerostomia). Arch Intern Med 1991; 151 : 1149–1152. PubMed Google Scholar 48. Schwarz GA. The orthostatic hypotension syndrome of Shy—Drager. Arch Neurol 1967; 16 : 123–139. [link.springer.com]
Eyes
- Lacrimation
Six tests demonstrated pupillary, lacrimal, salivary, urinary bladder, sexual and sudomotor dysfunction in the majority of patients. [ncbi.nlm.nih.gov]
H eart bradycardia and reduced contractility, conductivity ADR: Bradycardia A utonomic ganglia stimulation V ascular dilation (hypotenstion and erection) ADR: Hypotension E ye miosis and accomodation spasm ADR: Blurred vision S ecretions increase (lacrimation [medchrome.com]
Indirect parasympathomimetics Cardiovascular symptoms: bradycardia, hypotension Gastrointestinal symptoms: ↑ salivation, diarrhea, abdominal pain, uncontrolled urination Increased sweating, salivation, and gastric secretion Nausea Ocular symptoms: miosis, lacrimation [amboss.com]
Schirmer test of lacrimation. Arch Otolaryngol 1975; 101 : 293–295. PubMed Google Scholar 27. Paschides CA, Petroutsis G, Psilas K. Correlation of conjunctival impression cytology results with lacrimal function and age. [link.springer.com]
Findings: Symptoms and Signs (Mnemonic: SLUDgE + Killer Bs, or DUMBELLS) Sludge Saliva tion Lacrimation and Lethargy Urination Diarrhea (and Diaphoresis) and abdominal cramping Emesis ( Nausea and Vomiting ) Killer B's Bronchospasm Bronchorrhea Bradycardia [fpnotebook.com]
Skin
- Sweating
[…] of coronary arteries Stomach and Intestine ↑ motility and secretion Urinary bladder Relaxation of sphincters and contraction of bladder wall Respiratory system Constriction of bronchi increased bronchial secretions Exocriene glands Stimulate all e.g. sweating [slideshare.net]
salivation, GI secretions) ADR: Nausea, vomiting, increased sweating and salivation S timulation followed by depression in CNS ADR: Delirium Classification: 1. [medchrome.com]
However, the Systemic side effects incorporating nausea, vomiting, tenesmus, abdominal spasm, salivation, lacrimation, sweating, pulmonary edema, and bronchial spasm. [medicscenter.com]
Effects Effects of parasympathomimetics References: [1] Side effects Indirect parasympathomimetics Cardiovascular symptoms: bradycardia, hypotension Gastrointestinal symptoms: ↑ salivation, diarrhea, abdominal pain, uncontrolled urination Increased sweating [amboss.com]
- Increased Sweating
sweating, salivation, and gastric secretion Nausea Ocular symptoms: miosis, lacrimation CNS -related symptoms: restlessness, anxiety, ataxia, tremor possibly culminating in coma Musculoskeletal symptoms: fasciculations, weakness ;, spasms, paralysis [amboss.com]
(lacrimation, sweating, salivation, GI secretions) ADR: Nausea, vomiting, increased sweating and salivation S timulation followed by depression in CNS ADR: Delirium Classification: 1. [medchrome.com]
Systemic side-effects noted are: bradycardia, increased sweating, diarrhoea, excessive salivation and anxiety. [ikeyes.blogspot.com]
Neurologic
- Headache
These include problems due to miosis itself (e.g. reduced visual acuity in the presence of polar cataracts, impairment of night vision and generalized contraction of visual fields), spasm of accommodation which may cause myopia and frontal headache, retinal [ikeyes.blogspot.com]
[…] substances from moving out of the blood stream and entering the meninges in the brain or cerebral spinal fluid aura neurological visual phenomenon (e.g., light flashes, blank areas in the field of vision) that may precede epileptic seizures and migraine headaches [quia.com]
Severe headache due to intense pupillary and ciliary muscle contraction. Management of OPC poisoning— Supportive treatment— 1. Decontamination to prevent further absorption 2. Start oxygen after clearing the airway 3. [cology4u.blogspot.com]
Systemic effects: Central Nervous System – Headache, Dizziness Respiratory System – Respiratory Distress Cardiovascular System – Bradycardia Contraindications: Phenylephrine should not be used in patients with severe hypertension or tachycardia(fast heart [pharmacologydopt.blogspot.com]
Ocular side effects composes meiosis, frontal headaches, twitching lids, conjunctival injection, cataractous alternates, allergic chemical reactions, iris cysts, retinal separation, increased permeability of the blood-aqueous barrier, anterior chamber [medicscenter.com]
- Irritability
Seite 540 - Caution — This product contains ingredients which may cause skin irritation on certain individuals and a preliminary test according to accompanying directions should first be made. [books.google.de]
Pilocarpine Indications / Pilocarpine Uses Information Not Available Pilocarpine Adverse Reactions / Pilocarpine Side Effects Ocular Pain and irritation, blurred vision, lachrymation, browache, conjunctival vascular congestion, superficial keratitis, [drugsupdate.com]
Poisoning may be – Occupational, accidental, Suicidal Symptoms: Fall in BP, bradycardia or tachycardia, cardiac arrhythmia and vascular collapse Irritation of Eye, lacrimation, salivation, involuntary defection, breathlessness, blurring of vision [slideshare.net]
Neurologic abnormalities consisted of irritability, agitation, confusion, lethargy, and ataxia. [rxlist.com]
[…] adrenergic Agonists Selective Apraclonidine HCL Iopidine 0.5%, 1.0% bid, tid 20-30% Decrease aqueous production; decrease episcleral venous pressure Systemic: dry mouth, decrease blood pressure, bradycardia Ocular: follicular conjunctivitis, ocular irritation [eyewiki.aao.org]
- Agitation
Findings: Symptoms and Signs: Other (not covered by mnemonic) Anxiety or Agitation Seizure s Coma Muscle fasciculations Flaccid Paralysis (including respiratory muscles) [fpnotebook.com]
Ingestion of these antagonists can cause a range of peripheral (flushing, dry mouth, blurred vision, dilated pupils, tachycardia, urinary retention, constipation and hyperthermia) and central (confusion, hallucinations agitation, coma and convulsions) [pharmacologyeducation.org]
Neurologic abnormalities consisted of irritability, agitation, confusion, lethargy, and ataxia. [rxlist.com]
It does cause central nervous system stimulation- which can result in insomnia, nervousness, nausea, agitation 2. Pharmacokinetics a. Ephedrine- absorbed when taken orally b. resistant to COMT and MAO, therefore long lasting. 3. Therapeutic uses a. [angelfire.com]
Treatment
These studies have used placebo [ 9, 11 - 15, 17 ], no treatment [ 8, 10 ] or other active treatments [ 16 ] as control, and involved 19–1796 patients. There was considerable heterogeneity in treatment methods ( Table 1 ). [onlinelibrary.wiley.com]
Treatments with some immunosuppressives take weeks to months before effects are noticed. [authorstream.com]
The use of an anxiolytic agent was not effective in the treatment of postoperative urinary retention. Bladder distention may increase the incidence of urinary retention. [ncbi.nlm.nih.gov]
TREATMENT - TREATMENT IS BY MEDICATION /SURGERY. - MEDICATION CONSISTS- CHOLINESTERASE INHIBITOR TO MUSCLE FUNCTION IMMUNOSUPPRESSANT DRUGS TO REDUCE AUTOIMMUNE PROCESS - THYMECTOMY IS A SURGICAL METHOD TO TREAT MG. - FOR EMERGENCY TREATMENT, PLASMAPHERESIS [slideshare.net]
Prognosis
PMID: 7914443 Prognosis Schmetterer L, Strenn K, Findl O, Breiteneder H, Graselli U, Agneter E, Eichler HG, Wolzt M Clin Pharmacol Ther 1997 May;61(5):583-95. doi: 10.1016/S0009-9236(97)90138-7. [ncbi.nlm.nih.gov]
Prognosis Most patients with glaucoma retain useful vision for most of their lives if caught early and treatment is initiated. Incidence of unilateral blindness has been reported to be 27% and bilateral blindness 9% at 20 years following diagnosis. [eyewiki.aao.org]
Etiology
[from MeSH ] Etiology Clin Auton Res 1994 Apr;4(1-2):5-13. PMID: 7914443 Gottesman L, Milsom JW, Mazier WP Dis Colon Rectum 1989 Oct;32(10):867-70. [ncbi.nlm.nih.gov]
Atropine may also lessen the degree of partial heart block when vagal activity is an etiologic factor. In some individuals with complete heart block, the idioventricular rate may be accelerated by atropine; in others, the rate is stabilized. [rxlist.com]
Epidemiology
Synthesizes a classical approach to the glaucomas-based on seven earlier editions spanning over 40 years-with the most up-to-date evidence-based and epidemiologically-derived classifications and outcomes.Coherently correlates with authoritative consensus [books.google.de]
Pathophysiology
Multiple system atrophy: clinical aspects, pathophysiology, and treatment. Neurol Clin 1984; 2 : 487–498. PubMed Google Scholar 10. Cohen J, Low P, Feaket R, Sheps J, Jiang N-S. [link.springer.com]
Other possible risk factors include: perfusion pressure, coronary artery disease, diabetes, myopia Pathophysiology Not entirely understood. [eyewiki.aao.org]
Pathophysiologic changes in the optic nerves of eyes with primary open angle and pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci. 2005 Nov. 46(11):4170-81. [Medline]. Kanthan GL, Mitchell P, Burlutsky G, Rochtchina E, Wang JJ. [emedicine.medscape.com]
Prevention
DISCUSSION Taken together the currently available data show little if any beneficial effect of parasympathomimetic agents in preventing or treating UUB. [onlinelibrary.wiley.com]
Drug Names bethanechol, edrophonium, Prostigmin / neostigmine, Eserine / physostigmine, Mestinon / pyridostigmine Common uses myasthenia gravis, nondepolarizing neuromuscular blockade, postoperative bladder distention, postoperative ileus Pharmacology prevent [everything2.com]
Encyclopedia Natural or synthetic Anti-glaucoma Agents relieve or prevent glaucoma, a condition characterized by increased intraocular pressure, excavation, and optic nerve damage. [tititudorancea.com]
Therapeutic uses 1) Treatment of hypertension 2) Prevention of angina pectoris (heart doesn't work so hard) 3) Prevention of ventricular arrhythmias 4) Long term prevention of sudden death in patients with myocardial infarction 5) Prevention of migraine [angelfire.com]