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the ciliary muscle, which adjusts the curvature of the lens Contraction of the ciliary muscle pulling the ciliary body forwards and inwards, thus relaxing the tension on the suspensory ligament of the lens, allowing the lens to bulge more, reducing its focal length
This parasympathetic reflex is necessary to accommodate the eye for near vision
the constrictor pupillae muscle, which is important not only for adjusting the pupil in response to changes in light intensity but also in regulating the intraocular pressure
The main use of muscarinic agonists is in treating glaucoma, by local instillation in the form of eye drops. Pilocarpine is the most effective as, being a tertiary amine, it can cross the conjunctival membrane
The anterior chamber of the eye, showing the pathway for secretion and drainage of the aqueous humor
The anterior chamber of the eye, showing the pathway for secretion and drainage of the aqueous humor
Adverse Effects: (most of them are related to its non-selective action as a muscarinic receptor agonist)
1. 2. 3. 4. 5. 6. Excessive sweating Excessive salivation Bronchospasm and increased bronchial mucus secretion Bradycardia, hypotension Nausea and diarrhea It may result in miosis when used chronically as an eye drop
Muscarinic Antagonists
Nonselective Muscarinic Antagonists
The classical muscarinic antagonists are derived from plants and are nonselective competitive antagonists. Atropa belladonna contains atropine. Hyoscyamus niger contains primarily scopolamine and hyoscine Clinically, atropine is used for raising heart rate during situations where vagal activity is pronounced (for example, vasovagal syncope). It is also used for dilating the pupils. Its most widespread current use is in pre-anesthetic preparation of patients; in this situation, atropine reduces respiratory tract secretions and thus facilitates intubation Ipratropium is used by inhalation as a bronchodilator Cyclopentolate and tropicamide are developed for ophthalmic use and administered as eye drops (for dilating the pupil to aid examination of the eye)
Oxybutinin and tolterodine are new drugs developed for urinary incontinence
Muscarinic Antagonists
Side effects of muscarinic antagonists include:
constipation urinary retention xerostomia (dry mouth) hypohidrosis (decreased sweating) mydriasis (dilated pupils) precipitation of glaucoma decreased lacrimation tachycardia decreased respiratory secretions