Agitation muscarinic

Sweating is stimulated by direct action of the increased endogenous acetylcholine on muscarinic receptors of sweat glands in the skin these glands are innervated by the sympathetic division of the autonomic nervous system. Agitation is produced by a central excitatory effect on cholinergic neurones in the brain, but in large doses anticholinesterases can cause depression of the respiratory centre in the medulla. 

Atropine is an antidotal treatment. It is used to reverse the muscarinic signs, but it will not reverse the nicotinic effects (muscular weakness, diaphragmatic weakness, etc.). Atropine blocks the effects of accumulated acetylcholine (ACh) at the synapse and should be continued until the nerve agent is metabohzed (Midthng et al, 1985). Over-atropinization can cause hyperthermia, tachycardia, agitation, mydriasis, and ileus, which can be life threatening in the horse (Meerstadt, 1982). 

CNS signs of disorientation, agitation, tremor, ataxia, stupor, coma, and seizures may occur from inhibition of central muscarinic receptors (Holstege, 2006 Ketchum and Sidell, 1997). It is unknown if animals hallucinate like people, but they do appear distressed. Rhabdomyolysis can be seen secondary to seizures and agitation. If severe, myoglobinuric renal failure could develop (Holstege, 2006). 

Muscarinic hyperstimulation leads to a clinical presentation of miosis, lacrimation, salivation, bradyarrhythmias, urinary incontinence, and intestinal hypermotility (Levy-Khademi et al, 2007). Nicotinic hyperstimulation leads to fasciculations, weakness, and paralysis of skeletal muscles. CNS effects include depression and agitation with coma and... 

Bupropion (100 mg p.o. b.i.d.) is indicated in the treatment of depression. It is reserved for patients who cannot tolerate or have not responded to other medications. Bupropion does not alter the uptake of serotonin, has an equivocal effect on the uptake of norepinephrine, but blocks the uptake of dopamine. Bupropion has no affinity for alpha-1 and alpha-2-adrenergic receptors, H,-histamine receptors, muscarinic cholinergic receptors, or D2-dopaminergic receptors. It does not cause sedation or orthostatic hypotension. However, because it is structurally related to amphetamine, it may cause insomnia, agitation, and anxiety shortly after initiation of therapy. Bupropion lowers the seizure threshold and hence is contraindicated in patients with a history of seizure disorder (see also Tables 5 through 7). 

CNS signs of disorientation, agitation, tremor, ataxia, stupor, coma, and seizures may occur from inhibihon of central muscarinic receptors (Ketchum and Sidell, 1997 ... 

---