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PARASIMPATIS
Tri Widyawati
Kolinergik dan Antikolinergik
Syaraf pasca ganglion parasimpatik
AChE N
Acetate
+ ACh
Choline ACh ACh
M1
M2
Acetate +Choline
M3
M4
M5
Parasimpatotomimetika langsung
Cholinergic
Neurotransmission
Termination
Enzymatic by
acetylcholinesterase
(AchE)
Syaraf pasca ganglion parasimpatik
AChE N
Acetate Tidak langsung
+ ACh
Choline ACh ACh
M1
M2
Acetate +Choline
M3
M4
Langsung M5
Cholinergic Stimulants
D
AchE
Bekerja langsung
Bekerja Tidak
Langsung
AchE Reversibel
AchE Irreversibel
SLUDGE DUMBBELS
S - Salivation D - Diarrhea
L - Lacrimation U - Urination
U - Urination M - Miosis/muscle weakness
D - Diarrhea B - Bronchorrea (mucus) B - Bradycard
G - Gastric upset E - Emesis
E - Emesis L - Lacrimation
S - Salivation/sweating
Antikolinergik
parasimpatolitika
N
AChE
Acetate
+ ACh
Choline ACh ACh
M1
M2
Acetate +Choline
M3
M4
Penghambat reseptor M5
Cholinergic Inhibitors
Receptor -Antagonists
Muscarinic nicotinic
Atropine Neuromuscular
Curare, Succinylcholine
PARASIMPATOLITIKA
Antimuscarinic (parasympatholytic)
blockade is competitive and can be overcome by
increasing Ach levels
"parasympatholytic" block at the NEJ (M-3)
Antimuscarinic Drugs
Anticholinergics/Antispasmodics
L-hyoscyamine (Anaspaz)
Ach D reseptor
Ach D
Ach
Gastrointestinal
Atropin Prabedah untuk mengurangi salivasi dan IM:0,4 mg, IV: 0,5-2 mg
sekresi bronkial
Propantelin Antispasmodik untuk irritable bowel PO:7,7-15 mg,tid,qid
syndrome (IBS)
Skopolamin Obat praanastesi, IBS, mabuk perjalanan PO:0,5-1 mg,tid,qid. IM:0,3-0,6 mg
Mata
Neuromuskular/
antiparkisnonism
Triheksifenidil Penyakit parkinson PO: 1 mg/hr, dpt diaikkan sp. 5-
15 mg/hr, dalam dosis terbagi
Benztropin Parkinson. Mengatasi ES fenotiazin dan PO:0,5-6 mg/hr dlm dosis
agen antipsi terbagi
Clinical uses of Antimuscarinic Agents
Toxicity:
dry mouth, mydriasis, tachycardia, hot flushed skin,
agitation and delirium.
Glaucoma:- Open angle (wide, chronic) treated with beta-blockers and other
agents
- Closed-angle (narrow-angle) dilated iris can occlude outflow
Pilocarpine or surgical removal of part of iris (iridectomy)
Glaucoma treatment
1. -Agonist: Outflow
2. M-Agonists: Outflow
3. -Blocker: Secretion
4. 2-Agonist: Secretion
5. Prostaglandins: Outflow
Ach effects on smooth muscle in the eye