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Peripheral Autonomic Neuropathies
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
The treatment of diabetic cystopathy includes use of an indwelling catheter for 10 days together with appropriate antibiotics. Thereafter, the patient should void every 3 h, aided by manual compression of the suprapubic area (Crede manoeuvre) and receive parasympathomimetic drugs. About 40% of patients respond to this therapy, at least temporarily, until urinary tract infection recurs. Transurethral surgery and bladder neck resection in those without obvious mechanical obstruction may also be useful. Initially, the parasympathomimetic drug can be given parenterally, for example, bethanechol twice weekly and may be continued orally in a dose of 40-50 mg every 6 or 8 h. Cholinergic treatment is withdrawn when residual volumes are less than 100 ml for at least a week (Ellenberg, 1980a).
Parasympathomimetic Amines
Published in Kenneth J. Broadley, Autonomic Pharmacology, 2017
Parasympathomimetic amines may be defined as agonists that mimic the effects of stimulating the parasympathetic nerve innervating an organ or tissue. This was the original term used by Dale (1914) to describe the effects of Ach. Since the tissue responses to parasympathetic nerve activity are mediated via the release of Ach onto muscarinic receptors, the actions of parasympathomimetic amines are essentially their muscarinic properties. Ach and its analogues do, however, also stimulate nicotinic receptors at the somatic nerve-skeletal muscle junction, at autonomic ganglia and the adrenal medulla and in the brain. These effects are usually overwhelmed and masked by the muscarinic actions of parasympathomimetic amines.
Ogilvie’s Syndrome and Colonic Volvulus
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
A recent systematic review by De Giorgio et al. [4] has summarized the current evidence for neostigmine use and recommends neostigmine as the drug of choice for acute colonic pseudo-obstruction. Despite the effectiveness of this medication, due to its parasympathomimetic effects it can lead to bronchospasm, bradycardia, and hypotension. Risk can be minimized by reducing the dose to 1 mg versus 2 mg, or by selecting an intravenous infusion rather than bolus administration. Recommendation: Given the level I and III evidence available including prospective trials, systematic reviews, and consensus statements, neostigmine should be considered the drug of choice for the treatment of acute colonic pseudo-obstruction unresponsive to conservative treatment. With the relative paucity of negative data regarding the use of neostigmine for the treatment of acute colonic pseudo-obstruction, this deserves a Category A recommendation.
Nicotine Augments the Beneficial Effects of Mesenchymal Stem Cell-based Therapy in Rat Model of Multiple Sclerosis
Published in Immunological Investigations, 2018
Shiva Khezri, Seyyed Meysam Abtahi Froushani, Mozhgan Shahmoradi
As a quick overview, nicotine is an alkaloid with potent parasympathomimetic properties. It is typically found in high concentrations in tobacco leaves and at a more limited level in other Solanaceae (nightshade) families (Chakraborty et al., 2014). Some pesticides also may contain nicotine (Slotkin and Seidler, 2014). Although it is clear that nicotine is the main cause of addiction to smoking (Herning et al., 1983), the beneficial effects of nicotine in controlling some diseases, like ulcerative colitis (Hayashi et al., 2014; Lunney and Leong, 2012), Alzheimer’s disease (Lombardo and Maskos, 2014), and Parkinson’s disease (Liu et al., 2014; Meyer et al., 2014), have been well documented in several studies.
Brimonidine tartrate for the treatment of glaucoma
Published in Expert Opinion on Pharmacotherapy, 2019
Daniel J. Oh, Judy L. Chen, Thasarat S. Vajaranant, Mark S. Dikopf
As a consequence of alpha adrenergic activation in the iris, all generations of topical alpha agonists may alter pupil size. Earlier generations (e.g. apraclonidine) with higher alpha-1 activity led to pupillary mydriasis; however, brimonidine with high alpha-2 selectivity leads to dampening of pupillary mobility and miosis [33,34]. A number of pupillometry studies have demonstrated a moderate miotic effect of various concentrations of brimonidine, as well as an anti-mydriatic effect in scotopic conditions [35–37]. The authors believe that these effects may provide utility in primary angle closure (PAC) and pigmentary dispersion syndrome (PDS). In PAC, contact between the iris and crystalline lens leads to resistance of aqueous outflow from the posterior chamber, anteriorly bowing peripheral iris into the trabecular meshwork (TM). Laser or surgical treatments to relieve this iridolenticular contact are essential, as early relief of contact may prevent irreversible TM damage. When adjunctive medical therapy is employed, brimonidine may be preferable, as the induced miosis may pull peripheral iris from contacting the TM. While parasympathomimetic agents (e.g. pilocarpine) may also provide this benefit, significant ocular and systemic effects arise with parasympathomimetic use, especially in phakic individuals. In PDS, pupillary mobility and contact of the posterior iris and the crystalline lens and zonules leads to shedding of iris pigment. Liberated granules may cause short- or long-term dysfunction of the TM and IOP dysregulation[34]. The limitation of pupillary mobility and induced miosis by brimonidine may be preferable in preventing pigmentary release and lowering IOP, also in lieu of parasympathomimetic agents which have been reported to carry an increased risk of retinal detachment in this population[38].
Pharmacological treatments available for the management of underactive bladder in neurological conditions
Published in Expert Review of Clinical Pharmacology, 2018
Seyedeh-Sanam Ladi-Seyedian, Behnam Nabavizadeh, Lida Sharifi-Rad, Abdol-Mohammad Kajbafzadeh
Although parasympathomimetic drugs have minor beneficial effects, the risk of frequent mild and rare serious side effects should be considered when these drugs are prescribed. Therefore, the unfavorable balance between minor benefits and considerable side effects suggests that parasympathomimetics should not be used routinely in clinical practice for UAB [67].