This invention relates to compounds that are agonists of the muscarinic M1 receptor and/or M4 receptor and which are useful in the treatment of muscarinic M1/M4 receptor mediated diseases. Also provided are pharmaceutical compositions containing the compounds and the therapeutic uses of the compounds. Compounds include those according to formula (1a) or a salt thereof, wherein p, q, r, s, Q, R3 and R4 are as defined herein.本發明係關於為毒蕈鹼M1受體及/或M4受體之促效劑且適用於治療毒蕈鹼M1/M4受體介導之疾病的化合物。亦提供含有該等化合物之醫藥組合物及該等化合物之治療用途。化合物包括根據式(1a)之彼等化合物或其鹽,其中p、q、r、s、Q、R3及R4係如本文所定義。