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Gq protein
signaling
cascade
Phospholipase C
Inositol 1,4,5-
trisphosphate
receptor type 1
Protein kinase
C alpha type
Voltage-
dependent
P/Q-type
calcium channel
subunit
alpha-1A
Voltage-
dependent
L-type calcium
channel subunit
beta-1
Voltage-
dependent
calcium channel
subunit
alpha-2/delta-2
Myosin light
chain kinase,
smooth muscle
Muscarinic
acetylcholine
receptor M3
Myosin LC-P
Myosin light
chain 3
Calmodulin-1
Myosin light
chain
phosphatase
Calmodulin-1
Inositol 1,4,5-trisphosphate
Ca
+
Ca
+
Ca
+
Fesoterodine
Fesoterodine
Fesoterodine
Phosphatidylinositol
4,5-bisphosphate
5-Hydroxymethyltolterodine
Calcium
Ca
+
Diacylglycerol
Muscle
Contraction
Muscle
Relaxation
Magnesium
Calcium
Manganese
Sarcoplasmic Reticulum
Myosin unbinds from actin
causing muscle relaxation
Decreased calcium is unable
to bind readily to
calmodulin so it does not
activate myosin light chain
kinase
Activation of myosin light
chain kinase leading to high
concentration of myosin LC-P
There is an overall decrease
in calcium levels in the
cytosol caused by the
inhibition of the Gq
signaling cascade
Cytosol
Smooth Muscle Myocyte
5-Hydroxymethyltolterodine
(the active metabolite of
fesoterodine) is an
antagonist of the muscarinic
acetylcholine receptor M3
Actin
Myosin
Endoplasmic Reticulum
Hepatocyte
Converted to active
metabolite by nonspecific
esterases
Fesoterodine is administered
as an oral tablet
Endoplasmic Reticulum
GNAQ
PLCB1
ITPR1
PRKCA
CACNA1A
CACNB1
CACNA2D2
MYLK
CHRM3
MYL3
MYL3
CALM1
PPP1CB
CALM1
Inositol 1,4,5-
trisphosphate
Calcium
Calcium
Calcium
Fesoterodine
Fesoterodine
Fesoterodine
Phosphatidylinositol
4,5-
bisphosphate
5-
Hydroxymethyltolterodine
Calcium
Diacylglycerol
Muscle
Contraction
Muscle
Relaxation