In what emergency situation would cholinergic agents be contraindicated?

Cholinergic agents facilitate the activity of the neurotransmitter acetylcholine, leading to various physiological effects including bronchoconstriction and increased mucus secretion in the airways. In the context of an acute asthma attack, where the primary concern is the obstruction of airways due to bronchospasm, the administration of cholinergic agents could exacerbate the situation. By causing bronchoconstriction, these agents could further narrow the airways, worsening respiratory distress and making it more difficult for the patient to breathe. Therefore, in emergency situations involving acute asthma attacks, cholinergic agents are contraindicated because they can contradict the therapeutic goals of relieving airway obstruction and improving airflow.

In contrast, in situations like severe dehydration, diabetic shock, and acid reflux, the effects of cholinergic agents may either be neutral or beneficial, depending on the specific clinical context. For example, in diabetic shock, the primary concern is the stabilization of blood glucose levels and addressing the underlying metabolic derangement, where cholinergic agents do not play a direct harmful role.