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2. Choline esters

2.1. Ach, Mch, carbachol, bethanechol

2.1.1. Nicotinic actions Autonomic ganglia Nm Skeletal muscle Nn

2.1.2. CNS actions Complex behavioral and neurological changes

2.2. New Topic

2.2.1. Muscarinic actions Heart and blood vessels M2 Smooth muscles M3 Glands M3 Eye

3. Cholinergic agonists

4. Organophosphates

4.1. Dyflos

4.2. Echothiophate

4.2.1. Long acting miotic

5. Carbamates

5.1. Tertiary N

5.1.1. Physostigmine Eye drops Belladonna's posisoning

5.1.2. Rivastigmine Cerebroselective Used in Alzheimer's disease

5.2. Quaternary N

5.2.1. Neostigmine Used in:myasthenia gravis Postoperative paralytic ileus Postoperative decurarization Cobra bite (Neostigmine +atropine)

5.2.2. Used in Alzheimer's disease

6. Alkaloids

6.1. Pilocarpine

6.1.1. Actions Small doses-bradycardia and fall in BP High dose-tachycardia and rise in BP Miosis and reduction in IOT

6.1.2. Uses 3rd line drug in glaucoma Counteracts mydriatics Breaks iris-lens and iris-cornea adhesionzs

6.2. Muscarine

6.2.1. Mushroom poisoning Muscarine type Caused by Inocybe Produce characteristic Cholinergic symptoms Reversed by Atropine Hallucinogenic type Caused by A. muscaria and psilocybe (which produce muscimol and psilocybine respectively) Produce Hallucinations Atropine is contraindicated Phalloidin type A. phalloide and Galerina Inhibit RNA and protein synthesizing machinery Thioctic acud may have some antidotal effect

6.3. Arecoline

6.3.1. Areca catechu Both muscarinic and nicotinic actions Prominent CNS effects No therapeutic use

7. Non-carbamates

7.1. Edrophonium

7.1.1. Diagnosis of myasthenia gravis

7.2. Tacrine

7.2.1. Provide symptomatic relief in Alzheimer's disease

7.3. Donepezil

7.3.1. Used in Alzheimer's disease

7.4. Galantamine

7.4.1. Used in Alzheimer's disease

8. New Topic