Muscarinic effects

Respiratory Effects. Pulmonary edema was reported in humans dying from acute methyl parathion (Wofatox) intoxication (Fazekas 1971). Edema was found in a man who died 2 hours after intoxication, and, in other cases, edema was found in others who died as long as 9 days after exposure. Broncho-constriction and hypersecretion of bronchial glands (bronchorrhea) are primary muscarinic effects of methyl parathion. The broncoconstriction, bronchorrhea, and bradycardia caused by methyl parathion are strongly conducive to pulmonary edema. 

Chapter 1 which showed that since muscarine mimicked some of the actions of ACh (but not all) while nicotine mimicked the other actions of ACh, then ACh probably acted on two distinct types of receptors. The fact that atropine antagonised the muscarinic effects of ACh but not the nicotinic effects, while tubocurarine blocked the nicotinic effects provided firm evidence for this concept. These simple qualitative observations by Langley and others at the beginning of the twentieth century led to the development of more quantitative pharmacological methods that were subsequently used to identify and classify receptors. These methods were based on the use of both (1) agonist and (2) antagonist drugs ... 

Some agonists, such as methacholine, carbachol and bethanecol are structurally very similar to ACh (Fig. 6.6). They are all more resistant to attack by cholinesterase than ACh and so longer acting, especially the non-acetylated carbamyl derivatives carbachol and bethanecol. Carbachol retains both nicotinic and muscarinic effects but the presence of a methyl (CH3) group on the p carbon of choline, as in methacholine and bethanecol, restricts activity to muscarinic receptors. Being charged lipophobic compounds they do not enter the CNS but produce powerful peripheral parasympathetic effects which are occasionally used clinically, i.e. to stimulate the gut or bladder. 

Few drugs, apart from nicotine itself, act specifically on nicotine receptors. One is methylcarbachol, which lacks the muscarinic effects of carbachol and another is dimethylphenylpiperazinium (DMPP), which appears to have some selectivity for the neuronal nicotinic receptor. Neither of them can cross the blood-brain barrier. 

The answer is a. (Hardman, p 436J The most common side effects associated with tricyclic antidepressants are their anti muscarinic effects, which may be evident in over 50% of patients. Clinically, the anti muscarinic effects may manifest as dry mouth, blurred vision, constipation, tachycardia, dizziness, and urinary retention. At therapeutic plasma concentrations, these drugs usually do not cause changes in the EKG Direct cardiac effects of the tricyclic antidepressants are important in over dosage. 

Muscarinic and dopaminergic pathways in the CNS interact in control of numerous pathways implicated in diseases, especially those controlling involuntary motor systems. Muscarinic effects on dopamine release are mediated in several ways via different mAChR subtypes. Thus mAChR facilitation of DA release appears to involve M4 receptors on GABA projection neurons to the striatum, while M3 receptors on striatal DA neurons are predicted to inhibit striatal DA release [12],... 

Exposure to disulfoton can result in inhibition of acetylcholinesterase activity, with consequent accumulation of acetylcholine at nerve synapses and ganglia leading to central nervous system, nicotinic, and muscarinic effects (see Section 2.2.1.4 for more extensive discussion). 

While atropine blocks the muscarinic effects, 2-PAM regenerates cholinesterase enzymes in sympathetic, parasympathetic, and central nervous system sites. 

The N-methyl carbamate esters cause reversible carbamylation of the acetylcholinesterase enzyme, allowing accumulation of acetylcholine, the neuromediator substance, at parasympathetic neuroeffector junctions (muscarinic effects), at... 

Pharmacology Direct-acting miotics are parasympathomimetic (cholinergic) drugs which duplicate the muscarinic effects of acetylcholine. When applied topically, these drugs produce pupillary constriction, stimulate ciliary muscles, and increase aqueous humor outflow facility. With the increase in outflow facility, there is a decrease in lOP. Topical ophthalmic instillation of acetylcholine causes no discernible P.1248... 

Mechanism of Action An acetylcholine antagonist that inhibits the action of acetylcholine by competing with acetylcholine for common binding sites on muscarinic receptors, which are located on exocrine glands, cardiac and smooth-muscle ganglia, and intramural neurons. This action blocks all muscarinic effects. Therapeutic Effect Decreases GI motility and secretory activity, and GU muscle tone (ureter, bladder) produces ophthalmiccycloplegia, and mydriasis. 

Muscarinic effects (diarrhea, diaphoresis, increased salivation, nausea, vomiting, abdominal cramps or pain)... 

Muscarinic effects (urinary urgency or frequency, increased bronchial secretions, miosis, lacrimation)... 

Muscarinic Receptor Interactions. Excitatory muscarinic effects, such as temporary stimulation of salivation and stimulation of intestinal peristalsis, were seen with 2-PAM. Atropine-like actions were seen at high concentrations (15-20 mg/kg or more), and, when injected rapidly, 2-PAM caused temporary diplopia (nicotinic block) and loss of accommodation in the eye.Both TMB-4 and 2-PAM blocked bradycardia induced by vagal stimulation. At low concentrations, neither compound affected normal intestinal peristalsis, but they did block peristalsis caused by increased vagal stimulation. TMB-4, 2-PAM, and toxogonin antagonized the effect of acetylcholine, acetyl- -methyl-choline, and other agonists on Isolated guinea pig ileum.62... 

Bethanechol (4.8) also has a prolonged effect, and finds application in stimulation of the gastrointestinal tract and urinary bladder (both muscarinic effects) to relieve postoperative atony. 

Neostigmine preceded by atropine to block muscarinic effects rapidly reverses muscle paralysis induced by competitive neuromuscular blockers (decurarization). 

The alkaloids namely atropine, hyoscyamine and scopolamine are obtained from Atropa belladonna. Atropine is dl-hyoscyamine, and, 1-isomer is more potent than d-form both peripherally and centrally. Atropine blocks the muscarinic effects of acetylcholine, the antagonism between acetylcholine and atropine is of competitive... 

If muscarinic effects of such therapy are prominent, they can be controlled by the administration of antimuscarinic drugs such as atropine. Frequently, tolerance to the muscarinic effects of the cholinesterase inhibitors develops, so atropine treatment is not required. 

Both the nicotinic and the muscarinic effects of the cholinesterase inhibitors can be life-threatening. Unfortunately, there is no effective method for directly blocking the nicotinic effects of cholinesterase inhibition, because nicotinic agonists and antagonists cause blockade of transmission (see Chapter 27). To reverse the muscarinic effects, a tertiary (not quaternary) amine drug must be used (preferably... 

The miotic effects of carbachol and bethanechol are greater than those of acetylcholine. Atropine is able to antagonize all cholinergic (muscarinic) effects produced by acetylcholine, methacholine, carbachol, and bethanechol. However, this antagonism is least evident with carbachol. 

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