USMLE Why Anti CholineEsterase do not stimulate Presynaptic ganglions?

May 4, 2016
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Medical Student (Accepted)
-Acetylcholine esterase antagonist produce an increase of acetyl choline in the synapse.
*Acetylcholine suppose to go up not only in the muscarinic synapses but also in the:
1."pre"-Adrenal gland synapse- releasing NE & EPI
2.All the pre ganglionic synapses of the autonomic nervous system

Donepezil(anti AChE) is used for Alzheimer,thus Crossing the BBB must take place,then it can not be that the drug only work in the PNS, then why doesn't donepezil also produce autonomic ganglia stimulation?
 

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I can't say for certain but I would conjecture that each synapse has its own isoform of acetylcholinesterase and the drug has much greater activity against a single isoform.


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