• PROTOTYPE muscarinic antagonist
• 2-4 hour half life
• can penetrate CNS
• dilates pupil, reduces GI secretion/motility, inc fever/delirium, inc flushing, tachycardia, bronchial relaxation
• preanesthetic to reduce secretions and induce amnesia

• blocks parasympathetic so: dry mouth, urinary retention, decreased sweating
• atropine blush due to vasodilation
• Poisoning: parasympathetic blockade
• can treat w/ physostigmine

• muscarinic blocker: greater CNS action than atropine
• otherwise similar to atropine
• preanesthetic
• antimotion sickness agent transdermally
• treatment in parkinsons

• muscarinic antagonist
• does NOT cross BBB
• rarely used but in peptic ulcer disease

• muscarinic antagonist
• INHALATION in reversible airway disease

• ganglionic blocking drug
• SE: constipation, bladder atony, cycloplegia, ↓sweating, and tachycardia
• of historical interest

• IV
• 20-40 min duration of action
• releases histamine
• SE: sequence of paralysis
• small rapid muscles (eyes,ears,etc) > limbs, neck > intercostals > diaphragm

• motor end-plate blockade
• similar to d-tubocurarine
• presently popular

• nicotinic agonists that cause persistent depolarization
• prevent repolarization
• produce transient contraction of skeletal muscles
• may change to "phase II block" which is both competetive and depolarizing therefore slow mechanism for recovery

• depolarizing motor end-plate blockade
• 2-3 min action
• IV drip
• rapidly inactivated by cholinesterase
• action more prolonged when plasma/liver cholinesterases are deficient
• Clinical use: adjunct in anesthesia, orthopedic procedures, facilitate intubation (all by muscle relaxant), electroshock therapy

• volatile anesthetics tend to increase blockade induced by competitive NMJ blockers (reduce effects of depolarization agents)
• cholinesterase inhibitors antagonize competitive agents and potentiate depolarizing agents
• some antibiotics can potentiate depolarization
• calcium channel blockers enhance the blockade

• myasthenia gravis - very sensitive to nondepolarizing --> diagnostic
• reduced plasma cholinesterase - prolonged apnea w/ succinylcholine
• malignant hyperthermia - halothane + succinylcholine --> muscular rigidity and fever spike --> deadly
• extensive soft tissue damage - succinylcholine can exacerbate potential hyperkalemia

Angle is shallow but still allows normal flow of aqueous humor.

Closure results in blockage and rise in IOP

Immediate tx needed:

• pilocarpine (muscarinic agonist) or physostigmine (AChesterase inhibitor) given topically short term
• surgery needed asap

• chronic glaucoma
• beta₁-adrenergic antagonist
• inhibits secretion
• DRUG OF CHOICE

• chronic glaucoma
• alpha2 agonist
• inhibits secretion and increases uveoscleral outflow
• also prvents loss of retinal ganglion cells

• chronic glaucoma
• carbonic anhydrase inhibitor
• decreased secretion
• it is a sulfa drug (allergies!)

• chronic glaucoma
• prostaglandin analog (FP receptor)
• increases uveoscleral outflow

• chronic glaucoma
• Prostamide (prostaglandin-ethanolamide)
• increases trabecular and uveoscleral outflow
• Most efficacious anti-glaucoma drug