Direct Acting Cholinergic Agonists

Direct acting cholinergic drugs mimic acetylcholine and bind to nicotinic and muscarinic receptors.  These drugs are generally not considered very specific to nicotinic or muscarinic receptors; however, pilocarpine and bethanechol show preference for muscarinic receptors.

Class Drugs

• Bethanechol

• Carbachol

• Cevimeline

• Pilocarpine

Class Mechanism of Action

• Directly stimulates nicotinic and muscarinic receptors

Class Application

• See individual drugs

Class Adverse Effects

Useful mnemonic "DUMBELLS"

• Diarrhea

• Urination

• Miosis

• Bradycardia

• Emesis

• Lacrimation

• Lethargy

• Salivation

Drug Table

Drug Name	Application	Comments	Image
Bethanechol	Treatment of atonic bladder post-operatively		"Beth" and "Coal"
Carbachol	Glaucoma (induces miosis)	Not used systemically	"Car" and "Coal"
Cevimeline	Treatment of dry mouth		"Seven Melons"
Pilocarpine	Glaucoma (induces miosis); Dry mouth (Sjogren's syndrome)		"Pile of Carp"