Tertiary amine parasympathomimetic

Q57 Pilocarpine is a tertiary amine parasympathomimetic agent that is mainly used in the treatment of glaucoma. Pilocarpine is commonly administered with timolol eye drops. 

Pilocarpine is classified as a tertiary amine that has parasympathomimetic activity. When administered as eye drops, it causes pupillary constriction or miosis and is therefore indicated in the treatment of glaucoma. In glaucoma, multiple-drug therapy may be necessary to achieve the desired intraocular control. Pilocarpine may be used in combination with topical beta-blockers such as timolol. 

The choline ester, carbachol, activates M-cholinoceptors, but is not hydrolyzed by AChE. Carbachol can thus be effectively employed for local application to the eye (glaucoma) and systemic administration (bowel atonia, bladder ato-nia). The alkaloids, pilocarpine (from Pilocarpus jaborandi) and arecoline (from Areca catechu betel nut) also act as direct parasympathomimetics. As tertiary amines, they moreover exert central effects. The central effect of muscarinelike substances consists of an enlivening, mild stimulation that is probably the effect desired in betel chewing, a widespread habit in South Asia. Of this group, only pilocarpine enjoys therapeutic use, which is limited to local application to the eye in glaucoma... 

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