My Wiki
  • Introduction
  • 01 Step 1
    • Antimicrobials
      • 01 Cell Wall And Membrane
      • 02 Protein Synthesis
      • 03 Others
      • 04 Antimicrobials
    • Behavior Science
      • Development
      • Public Health Copy
      • Public Health
    • Biochemistry
      • 01 DNA Structure
      • 02 Purine
      • 03 Pyrimidine
      • 04 Glucose
      • 05 Glycolysis
      • 06 Gluconeogenesis
      • 07 Glycogen
      • 08 HMP Shunt
      • 09 Fructose And Galactose
      • 10 Pyruvate Dehydrogenase
      • 11 TCA
      • 12 ETC
      • 13 FA
      • 14 Ketones
      • 15 Ethanol
      • 17 Inborn Errors
      • Ammonia
      • B Vitamins
      • Lysosomal Storage Diseases
      • Other Vitamins
    • Cardiology
      • 01 Cardiac Anatomy
      • 01 Cardiac Embryology
      • 02 Heart Physiology
      • 03 Congenital Heart Disease
      • 04 Cardiac Cycle
      • 06 PV Loop
      • 07 Wiggers And Venous
      • 09 Starling
      • 10 Cardiac Ischemia
      • 11 Stable Angina
      • 14 EKG Basics
      • 15 EKG Others
      • 15 High Yield EKG
      • 16 Cardiac AP
      • 17 BBB
      • 21 Antiarrhythmics
      • 22 Heart Murmurs
      • 23 Heart Sounds
      • 24 HF Basics
      • 25 Systolic Diastolic HF
      • 26 Restrictive Cardiomyopathy
      • 27 Acute HF
      • 28 Chronic HF
      • 30 Shunts
      • 31 Congenital Heart Disease
      • 32 Hypertension
      • 33 Antihypertensives
      • 34 Valvular Disease
      • 35 Shock
      • 36 Pericardial Disease
      • 37 Aortic Dissection
      • 38 Cardiac Tumors
      • 39 Hypertrophic Cardiomyopathy
      • 40 Endocarditis
      • Chest Pain
    • Cell
      • 01 DNA
      • 02 DNA Mutation
      • 03 DNA Repair
      • 04 Transcription
      • 05 Translation
      • 06 PCR
      • Cell Cycle
      • Cell Structure
      • CT
      • Cytoskeleton
    • Endocrinology
      • 01 Thyroid
      • 02 Thyroid Disorders
      • 03 Adrenal Gland
      • 04 Adrenal Disorders
      • 05 CAH
      • 06 Pituitary Anatomy
      • 07 Pituitary Secretions
      • 08 Pituitary Pathology
      • 10 Endocrine Pancreas
      • 11 Diabetes
      • 12 Diabetes Treatment
      • 13 Insulin
      • 14 Parathyroid
      • 15 MEN
    • Genetics
      • 01 Genetic Principles
      • 02 Gene Mapping
      • 03 Meiosis
      • 04 Hardy
      • 05 Pedigree
      • 06 Imprinting
      • 07 Down
      • 08 Trisomy
      • 09 AD
      • Deletion
      • Trinucleotide Disorders
    • GI
      • 01 Embryology
      • 02 GI Anatomy
      • 03 GI Blood
      • 04 GI Tract
      • 05 Liver Gallbladder Pancreas
      • 06 Salivary
      • 07 Hernia
      • 08 Bile
      • 09 Bilirubin
      • 10 GI Secretion
      • 11 GI Hormones
      • 12 Exocrine Pancreas
      • 13 Esophageal Disorders
      • 14 Liver Disease
      • 15 Cirrhosis
      • 16 Liver Tumors
      • [17 Wilson S](01 Step 1/GI/17 Wilson's.md)
      • 18 Gallstones
      • 19 Biliary Disorders
      • 20 Gastric
      • 21 Malabsorption
      • 22 Acute Pancreatitis
      • 23 Chronic Pancreatitis
      • 24 Intestinal Disorders
      • 25 IBD
      • 26 Colon Cancer
    • Heme
      • 01 Coagulation
      • 02 Platelets
      • 03 Hypercoagulable States
      • 04 Coagulopathies
      • 05 Platelet Disorders
      • 06 Antiplatelet
      • 08 Hemolysis Basics
      • 09 Extrinsic Hemolysis
      • 10 Intrinsic Hemolysis
      • 11 Microcytic Anemia
      • 12 Thalassemia
      • 13 Sickle Cell
      • 14 Other Anemias
      • 15 Blood Groups
      • 16 Acute Leukemia
      • 17 Chronic Leukemia
      • 18 Hodgkin Lymphoma
      • 19 Nonhodgkin Lymphoma
      • 20 Plasma Cell Disorders
      • 21 Amyloidosis
      • 22 Myeloproliferative
      • 23 Porphyrias
    • Immunology
      • 01 Innate Immunity
      • 02 T Cells
      • 03 B Cells
      • 04 Complement
      • 05 Spleen
      • Antibodies
      • Glucocorticoids
      • Hypersensitivity
      • Immune Deficiencies
      • Immunosuppressants
      • Lupus
      • Rheumatoid Arthritis
      • Scleroderma
      • Sjogren
      • Transplants
      • Vasculitis
    • Infectious Disease
      • 01 Bacteria
      • 02 Bacteria Culture
      • 03 Bacteria Virulence
      • 04 Virus Structure
      • 05 Bacterial Genetics
      • Malaria
      • Virus Sturcture
    • Microbes
      • 01 Gm Positive Cocci
      • 02 Gm Positive Bacilli
      • 03 Gm Negative Cocci
      • 04 Gm Negative Enteric Bacilli
      • 05 Gm Negative Respiratory Bacilli
      • 06 Gm Negative Zoonotic Bacilli
      • 07 Mycobacterium
      • 08 Spirochetes
      • 09 Gm Indeterminate
      • 10 Parasites
      • 11 Virus
      • Fungi
      • Herpes
      • Sketchy
      • Strep
    • MSK
      • 01 Bone Disorders
      • 01 Knee
      • 02 Shoulder
      • 03 Brachial
      • 04 Wrist
      • 05 Hand
      • 06 Lumbosacral
      • 07 Hip
      • 08 Bone Biology
      • 09 Skeletal Muscles
      • Dermatomes
    • Neurology
      • 01 CNS Cells
      • 02 Wallerian Degeneration
      • 03 BBB
      • 04 Neurotransmitters
      • 06 Cerebral Cortex
      • 07 Spinal Cord
      • 08 Spinal Cord Syndromes
      • 09 Brainstem
      • 10 Cranial Nerves
      • 11 Auditory System
      • 12 Vestibular System
      • 13 Thalamus
      • 14 Cerebellum
      • 15 Basal Ganglia
      • 16 Ventricles And Sinuses
      • 17 Cerebral And Lacunar Strokes
      • 18 Vertebrobasilar Stroke
      • 19 CNS Aneurysm
      • 20 Intracranial Bleeding
      • 21 Management Of Stroke
      • 25 Pupil
      • 26 Lens
      • 27 Retina
      • 30 Gaze Palsies
      • 31 Structural Eye Disorders
      • 32 Glaucoma
      • 36 Meningitis
      • 37 Seizures
      • 39 Dementia And Delirium
      • 40 Demyelinating Diseases
      • 41 Headaches
      • 42 Brain Tumors
      • 43 Movement Disorders
      • 44 CNS Infections
    • Pharm
      • 01 Autonomics
      • 02 Cardiorenal
      • 03 Blood
      • 04 Smooth Muscles
      • 05 GI
      • Analgesics
      • Antineoplastics
      • Cholinometics
      • CYP 450
      • Parkinson
      • Psych
      • Sedatives
    • Pharmacology
      • 01 Enzymes
      • 02 Inhibitors
      • 03 Dose
      • 04 Drug Elimination
      • 05 Pharmacokinetics
    • Pulmonary
      • 01 Pulmonary Anatomy
      • 02 Pulmonary Physiology
      • 03 Hemoglobin
      • 04 Pulmonary Circulation
      • 05 Hypoxia
      • 06 Ventilation
      • 07 CO 2
      • 08 Pulmonary Exam
      • 09 PFT
      • 10 Obstructive
      • 11 Restrictive
      • 12 COPD Treatment
      • 13 Pneumonia
      • 14 Pleural Disease
      • 15 Lung Cancer
      • 16 Sleep Apnea
      • 17 Cystic Fibrosis
      • 18 TB
      • 19 Sarcoidosis
      • 20 PE
      • 21 Xray
    • Renal
      • 01 Renal Embryology
      • 02 Renal Anatomy
      • 03 Renal Physiology 1
      • 04 Renal Physiology II
      • 05 Nephron Physiology
      • 06 Renal Endocrine
      • 07 Acid Excretion
      • 08 Acid Base Principles
      • 09 Respiratory Disorders
      • 10 Metabolic Disorders
      • 11 RTA
      • 12 Metabolic Acidosis
      • 13 Electrolytes
      • 14 Na And Water
      • 15 Na Disorders
      • 16 Glomerulonephritis Principles
      • 17 Nephritic Syndrome
      • 18 Nephrotic Syndrome
      • 19 MPGN
      • 20 Tubulointerstitial Disease
      • 21 Renal Failure
      • 22 UTI
      • 23 Cystic Kidney
      • 24 Diuretics
      • 25 Renal Stones
      • 26 Renal Tumors
      • 27 Rhabdomyolysis
      • 28 Pathogenesis
    • Reproductive
      • Breast Disorders
      • Breast
      • Candida Albicans
      • Chlamydia Trachomatis
      • Disorders Of Sexual Differentiation
      • Female Pathology
      • Female Reproductive Embryology And Anatomy
      • Gardnerella Vaginalis
      • HPV
      • Male Anatomy
      • Male Pathology
      • Neoplastic Ovarian Pathology
      • Ovarian Pathology
      • Pharyngeal Arches
      • Preeclampsia
      • Testicular Pathology
      • Treponema Pallidu
      • Trichomonas Vaginalis
    • Uworld
      • Uworld Notes 2
      • Uworld Notes 3
      • Uworld Notes
  • 02 Step 2
    • Family
      • A Complicated Pregnancy
      • A Healthy Pregnancy
      • AAFP Questions
      • Derm
      • Family Planning
      • Labor
      • Postpartum Complications
      • Reproductive Endocrinology
    • Internal
      • 01 Cardiology
      • 01 EKG
      • 02 Pulmonary
      • 02 Pulmonary 2
      • 03 Pediatric
      • 04 Dermatology
      • 05 Endocrine
      • 06 GI
      • 07 Heme
      • 07 Heme 2
      • 08 Infectious Disease
      • 09 Fluid
      • 09 Nephrology
      • 09 Nephrology 2
      • 10 Ortho
      • 11 Cardiac Arrest
      • Exam
      • Uworld 2
      • Uworld
    • Neuro
      • Alpha Synuclens
      • Anatomy
      • Back Pain
      • Brain
      • CNS Infections
      • Coma
      • Dementia And Movement
      • Dementia
      • Dizziness
      • Eye Problems
      • Headache
      • Localization
      • Malignancies
      • Neuro Exam
      • Neuromuscular
      • Neuropathy
      • Others
      • Overview
      • Seizures Notes
      • Seizures
      • Spinal Cord Syndromes
      • Stroke Meded
      • Stroke
      • Tremors
      • Uworld Neuro Notes
    • OB
      • 01 Abnormal Pap
      • 01 Cancer
      • OB Cases
      • OB Uworld
    • Pediatrics
      • 01 Newborn Management
      • 02 NICU
      • 03 Failure To Pass Meconium
      • 04 Emesis
      • 05 Neonatal Jaundice
      • 06 Congenital Defect
      • Well Child
      • Vaccines
      • 09 SIDS
      • 10 Trauma
      • 11 Child Abuse
      • 12 Rashes
      • 13 Peds ID
      • 14 Allergies
      • 15 ENT
      • 16 Upper Airway
      • 17 Lower Airway
      • 18 Seizures
      • 19 GI Bleed
      • 20 CT Surgery
      • 21 Orthopedics
      • 22 Ophthalmology
      • Pediatric Nephrology
      • Pediatric Sickle Cell
      • 25 Immunodeficiency
      • Ambulatory
      • Genetic Syndromes
      • Misc
      • Neonatal Rashes
      • Newborn Nursery
      • Pretest Adolescent
      • Pretest Cardiorespiratory
      • Pretest Endocrine
      • Pretest GI
      • Pretest Infectious Disease
      • Pretest Neuro
      • Pretest Newborn
      • Pretest
      • PTT Vs Anti Xa
      • Uworld
      • Wards
    • Psych
      • Anxiety Disorders
      • Childhood Psychiatry
      • Dementia Delirium
      • Dissociative Disorders
      • Eating Disorders
      • EEG
      • Factitious Disorders
      • Impuse Control
      • Legal Psychiatry
      • Mood Disorders
      • Nonpharm Treatment
      • Personality Disorders
      • Psychiatric Exams
      • Psychopharmacology
      • Psychosis Ddx
      • Psychotic Disorders
      • Sexual Disorders
      • Sleep Disorders
      • Substance Abuse
      • Uworld Psych
      • Week 2
    • Surgery
      • 01 Ethics
      • 01 Trauma
      • 02 Colorectal
      • 02 Pediatric
      • 03 Burns
      • 03 Gyn
      • 04 Postoperative
      • 05 Preoperative
      • 06 Trauma
      • 07 Burns
      • 08 Cardiology
      • 09 Colorectal
      • 10 Dermatology
      • 11 Endocrine
      • 12 ENT
      • 13 ER
      • 14 General Surgery
      • 15 GI
      • 17 Infectious Disease
      • 18 Nephrology
      • 19 Neuroendocrine Tumors
      • 20 Orthopedics
      • 21 Pulmonary
      • 22 Shock
      • 23 Transplant
      • 24 Urology
      • 25 Breasts
      • 25 Vascular
      • Fluids
      • GI Autonomics
      • Notes
      • Review
    • Uworld
      • Class Notes
      • Step 2 Uworld 1
      • Uworld 2
      • Uworld 3
      • Uworld 4
      • Uworld 5
  • 03 Residency
    • 01 Insulin
    • 02 ICU
    • 03 Electrolytes
    • 04 Sedation
    • 05 Wards
    • 06 Acid Base
    • Orientation Notes
    • Prescription Writing
Powered by GitBook
On this page
  • Cholinomimetics
  • Acetylcholinesterase Inhibitors
  • Antimuscarinics

Was this helpful?

  1. 01 Step 1
  2. Pharm

Cholinometics

PreviousAntineoplasticsNextCYP 450

Last updated 5 years ago

Was this helpful?

Cholinomimetics

  • mimic Ach of sympathetic nervous

  • Acetyl-Cola: acetylcholine receptor agonists

  • Mime drinking cola: cholinomimetics

Smoker: nicotinic acetylcholine receptor:

  • Ganglia-like transformers (wire to wire) near smoker: nicotinic acetylcholine receptors are found on autonomic ganglia

  • Outlet near smoker: nicotinic acetylcholine receptors are found on skeletal muscle motor end plates

  • Adrenal beanie on smoker: nicotinic acetylcholine receptors are found in the adrenal gland

Motorcycle parking spots: muscarinic acetylcholine receptors (M1, M2, M3) (smooth muscles):

  • Brain helmet: M1 receptors are found in nerves and the CNS

  • Top of heart with atria visible and with jewels: M2 receptors are found in the atria, the SA and AV node. Ventricle is innervated by sympathetic not para sympathetic

  • Glandular sponge: M3 receptors are found on glands

  • Smooth muscle stripes: smooth muscle contains M3 receptors

  • Ion Channel news behind smoker: nicotinic receptors act as ion channels

  • QIQ store: M1, M2, and M3 are coupled to Gq, Gi, and Gq, respectively

  • 3 "dags": M1 and M3 are coupled to Gq proteins which activate the IP3-DAG cascade, increase in Ca

  • Packed up camp tent: M2 is coupled to a Gi protein which decreases cAMP

  • Dilated nitric oxide exhaust: M3 receptor activation -> nitric oxide release in vascular smooth muscle cells-> increased cGMP and vasodilation

  • Constricted clogged pipe: atherosclerosis-> vascular epithelial damage-> direct muscarinic receptor activation-> vasoconstriction

  • Beth with cola: bethanechol (a cholinomimetic)

  • Cement pouring from colon spout: muscarinic agonists (e.g. bethanechol) increase secretion and motor activity of the gut

  • "Do Not Obstruct": bethanechol is used to treat non-obstructive gastrointestinal dysmotility (e.g post-op ileus, neurogenic ileus)

  • Beth using bladder hose: bethanechol treats urinary retention

  • Pile o' carp: pilocarpine (a cholinomimetic)

  • Dripping carp mouths: pilocarpine increases salivation

  • Round glass: muscarinic agonists (e.g. pilocarpine) cause accommodation of the lens

  • Smooth muscle crane with net zonules: pilocarpine contracts the ciliary muscle, zonular fibers relax, lens become spherical shaped, reduce intraocular pressure, increasing aqueous humor outflow (useful to treat glaucoma).

  • Constricted hood: pilocarpine activates the sphincter pupillae muscle to cause pupillary constriction (useful in acute angle-closure glaucoma)

  • Carbon fumes from smoker: carbachol is both a muscarinic and nicotinic agonist

  • Constricted hood blocking carbon fumes: carbachol causes pupillary constriction (useful in acute angle-closure glaucoma)

  • Marathon: methacholine (a cholinomimetic)

  • Challenge: methacholine challenge instigates asthma for pulmonary testing

  • Wheezing man: cholinomimetics (e.g. methacholine) contract bronchial smooth muscle which may exacerbate asthma or COPD

  • 1-800-VERY-CLEAN: varenicline (a nicotinic receptor partial agonist) is used for smoking cessation

Acetylcholinesterase Inhibitors

  • Indirect view of Acetyl-cola mime: indirect cholinomimetics (inhibit acetylcholinesterase)

  • Dumpster of acetyl-cola bottles: acetylcholinesterase degrades acetylcholine (ACh)

  • Knocked over dumpster with acetyl-cola spilling out: acetylcholinesterase inhibitors increase synaptic concentrations of ACh

  • ANTI-ESTablishment: anti-cholinesterase, a.k.a. acetylcholinesterase inhibitor

  • STIGMA: "c-stigmine"d drug suffix of acetylcholinesterase inhibitors

  • Skeletal muscle brick wall: acetylcholinesterase inhibitors enhance effects of ACh at the NMJ (increase activity of NICOTINIC ACh receptors)

  • Electrical end plate: motor endplate (at the NMJ), increase contraction

  • GRAVIS graffiti: myasthenia gravis (MG)-> antibodies against nicotinic ACh receptors at motor endplate (skeletal muscle NMJ)

  • Graffiti covering electrical end plates: MG causes progressive proximal weakness, ptosis, diplopia (inactivated nicotinic ACh receptors at motor endplate)

  • Community PRIDE: PYRIDOstigmine (acetylcholinesterase inhibitor used as long-term treatment for MG)

  • Removing graffiti on end plates: acetylcholinesterase inhibitors increase ACh at NMJ endplate to outcompete MG antibodies

  • Neon sign STIGMA: neostigmine (acetylcholinesterase inhibitor used as treatment for MG)

  • Phone booth: edrophonium (acetylcholinesterase inhibitor that transiently reverses symptoms of MG)

  • Quarters only: pyridostigmine, neostigmine and edrophonium are quaternary amines and do not penetrate the CNS

  • Phone wire tension: tensilon test -> edrophonium reverses (positive) or fails to reverse (negative) muscle weakness

  • Phone in working order: edrophonium REVERSES muscle weakness in undertreated MG patients (POSITIVE tensilon test)

  • Phone out of order, with anti-esterase graffiti: edrophonium FAILS to reverse muscle weakness during cholinergic crisis (NEGATIVE tensilon test)

  • CURARE crayons stuck in end plate: nondepolarizing neuromuscular blocking agents (e.g. tubocurarine, pancuronium, cisatracurium) inhibit nicotinic ACh receptors at NMJ endplate (for inducing paralysis in surgery)

  • Neon sign store owner kicking out CURARE crayon kid: acetylcholinesterase inhibitors (e.g neostigmine) reverse nondepolarizing neuromuscular blockade

  • SUCKS: succinylcholine is a depolarizing neuromuscular blocking agent (nicotinic ACh receptor AGONIST)

  • PHASE-1 cleanup crew getting shocked: initial PHASE-1 of depolarizing blockade is IRREVERSIBLE (acetylcholinesterase inhibitors potentiate blockade). Continuous depolarize: unresponsive muscles

  • Bladder hose: acetylcholinesterase inhibitors can be used to treat urinary retention (muscarinic activation of detrusor)

  • PHYS ED center: PHYSostigmine (acetylcholinesterase inhibitor with CENTRAL effects) Cross BBB

  • Atropine in Wonderland: atropine overdose -> "mad as a hatter, hot as a hare, blind as a bat" (reversed by physostigmine)

  • Deadly nightshade: belladonna flower is a naturally occurring form of atropine (overdose reversed by physostigmine) (work in a garden then present with symptoms)

  • GYM weeds: Jimson weed is a naturally occurring form of atropine (overdose reversed by physostigmine)

  • PHYS ED teacher reprimanding atropine "cartist"d: physostigmine reverses atropine overdose (peripheral and CENTRAL effects)

  • "Your brain on drugs": physostigmine (and organophosphates) enters CNS to reverse atropine and cause central cholinergic effects

  • DUMBBELS: acetylcholinesterase inhibitor toxicity (Diarrhea, Urination, Miosis, Bronchospasm Bradycardia, Lacrimation, Salivation)

  • Weak nicotine kid: acetylcholinesterase inhibitor toxicity includes flaccid paralysis (NMJ nicotinic ACh receptor over-activation)

  • THIOL spray: thiosulfate insecticides (parathion, malathion, echothiophate) are organophosphates, a type of acetylcholinesterase inhibitor (also includes nerve agents and herbicides)

  • Green fumes: organophosphates are a major cause of acute cholinergic toxicity (DUMBBELS)

  • Closing LID on TOXIC spray: praLIDoxime reverses organophosphate toxicity (DUMBBELS)

  • New toxic waste dumpsters: pralidoxime regenerates acetylcholinesterase at muscarinic and NICOTINIC receptors (reverses cholinergic toxicity INCLUDING FLACCID PARALYSIS)

  • Atropine Alice is in your head: atropine reverses both peripheral and CENTRAL muscarinic toxicity from organophosphate poisoning (pralidoxime is peripheral only) (atropine only M, but not reverse paralysis; pralidoxime reverses )

  • Old pest-control man: "caging" of the organophosphate-cholinesterase complex leads to irreversible binding

  • Corroded dumpster: pralidoxime is ineffective once aging of organophosphate- cholinesterase complex has occurred

  • Alzheimer's GALA: galantamine (acetylcholinesterase inhibitor used to treat Alzheimer's disease)

  • REVERSE the STIGMA: rivastigmine (acetylcholinesterase inhibitor used to treat Alzheimer's disease)

  • Done with brain puzzle: donepezil (acetylcholinesterase inhibitor used to treat Alzheimer's disease)

  • Brain puzzle: galantamine, rivastigmine, and donepezil penetrate the CNS

Antimuscarinics

  • Motorcycle parking spots: muscarinic acetylcholine receptors (M1, M2, M3)

  • Reversing into motorcycle parking spot: muscarinic antagonists reversibly block muscarinic receptors

  • Blocked tweedleDUMBBELS: antimuscarinics block the muscarinic effects of diarrhea, urination, miosis, bronchospasm, bradycardia, lacrimation, salivation

  • Blocked acetyl-cola bottle: antimuscarinics block the action of acetylcholine at M receptors

  • Alice: atropine (antimuscarinic)

  • Belladonna flower - a natural antimuscarinic alkaloid

  • Jimson weed - a natural antimuscarinic alkaloid

  • TeleSCOPE: scopolamine (antimuscarinic)

  • Seasick sailor outfit: scopolamine is used to treat motion sickness (vestibular nausea)

  • Eyepatch: scopolamine transdermal patch is used to treat motion sickness

  • CNS hat: antimuscarinics (e.g. scopolamine) cross the blood-brain barrier and inhibits central M1 receptors

  • Heart with jewel nodes: antimuscarinics block parasympathetic activation of M2 receptors on the SA and AV nodes (increased heart rate, increased AV conduction). Parasympa slows HR/AV conduction. Inhibition results in opposite

  • Elevated heart watch: antimuscarinics (e.g. atropine) increase heart rate (useful in the treatment of bradycardia)

  • Heart shield: heart block (atrioventricular block)

  • Falling heart shields: antimuscarinics (e.g. atropine) increase AV conduction (useful in the treatment of heart block)

  • Cat-ipra-tio-tropillar: ipratropium and tiotropium (M3 muscarinic antagonists)

  • Puffing: ipratropium and tiotropium are inhaled antimuscarinic bronchodilators

  • Blue bloater with pink puffer: ipratropium and tiotropium are useful in the management of COPD (antagonize M3 receptors -> bronchodilation, decreased secretions)

  • Long lasting TIO smoke rings: tiotropium dissociates more slowly from the M3 receptor (longer bronchodilator action)

  • Ox butler: oxybutynin (M3 muscarinic antagonist)

  • Turtle butler: tolterodine (M3 muscarinic antagonist)

  • Turning off bladder: oxybutynin and tolterodine treat incontinence (antagonize M3 receptors -> relax smooth muscle in ureters and bladder wall)

  • CENTER over M1: M1 muscarinic receptors are found in the CNS

  • PARKING over M1: M1 receptor antagonists can reduce tremors and rigidity in Parkinson's disease

  • Benz parked in M1: benztropine (centrally acting M1 muscarinic antagonist)

  • Tri-hex car parked in M1: trihexyphenidyl (centrally acting M1 muscarinic antagonist)

  • Shaking antenna: centrally acting antimuscarinics (e.g. benztropine, trihexyphenidyl) treat tremor and rigidity in Parkinson's (block excess cholinergic activity)

  • Cogwheel: excessive M1 activation is associated with cogwheel rigidity in Parkinson's disease

  • Falling "cextra parking" cone: antimuscarinics treat extrapyramidal side effects caused by antipsychotics: e.g. dystonia, akathisia, parkinsonism (re-establish dopaminergic- cholinergic balance)

  • Hot as a hare: antimuscarinics inhibit M3 receptors on sweat glands -> decreased sweating -> hyperthermia

  • Dry as a cracker: antimuscarinics decrease salivation and lacrimation -> dry mouth and eyes

  • Blind as a bat: antimuscarinics cause mydriasis and cycloplegia-> blurred vision

  • High-pressure as a kettle: antimuscarinics cause mydriasis -> decreased outflow of aqueous humor -> acute angle closure glaucoma

  • Mad as a hatter: antimuscarinics cross the BBB and antagonize central M1 receptors -> sedation, agitation, hallucination, coma (especially in elderly patients)

Cycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation

Large pupil gazing into the distance: antimuscarinics cause pupillary dilation (mydriasis) and cycloplegia (inability to accommodate the lens for near vision)