Classification

Direct-acting (receptor agonists)

• Choline esters (carbachoi, bethanechol) which act at all sites like acetylcholine. They are resistant to degradation by cholinesterases. Muscarinic effects are much more prominent than nicotinic (see p. 435).

• Alkaloids (pilocarpine, muscarine) which act selectively on end-organs of postganglionic, cholinergic neurons.

Indirect-acting

• Cholinesterase inhibitors, or anticholinesterases (physostigmine, neostigmine, pyridostigmine, distigmine, rivastigmine, donepezil), which inhibit the enzyme that destroys acetylcholine, allowing the endogenous transmitter to persist and produce intensified effects.

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