Autonomic nervous system - pharmacology

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Manila Central University

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Autonomic nervous system - pharmacology

  1. 1. AUTONOMIC DRUGS
  2. 2. Autonomic Nervous System ( Visceral Efferent Nervous SYSTEM) <ul><li>Involuntary </li></ul><ul><li>Efferent( motor fibers) </li></ul><ul><li>Preganglionic and Postganglionic neurons </li></ul><ul><li>Effectors: smooth muscles, cardiac muscle, gland </li></ul>
  3. 3. Autonomic Nervous System <ul><li>CNS </li></ul><ul><li>Sympathetic } smooth muscle </li></ul><ul><li>preganlionic postganglionic effector } cardiac muscle </li></ul><ul><li>● ---------------- ●---------------------- Ο </li></ul><ul><li>↓ ↓ </li></ul><ul><li>acetylcholine norepinephrine </li></ul><ul><li>adrenal </li></ul><ul><li>preganglionic gland </li></ul><ul><li>● ------------------------ Ο -> epinephrine </li></ul><ul><li>↓ </li></ul><ul><li>acetylcholine </li></ul><ul><li>Parasympathetic </li></ul><ul><li>preganglionic postganglionic effector </li></ul><ul><li>● -------------------- ●---------------------- Ο </li></ul><ul><li>↓ ↓ </li></ul><ul><li>acetylcholine acetylcholione </li></ul>
  4. 4. Divisions <ul><li>a. Sympathetic (Thoracolumbar )- </li></ul><ul><li>* 1 st thoracic vertebrae extending through the 2 nd and 3 rd lumbar </li></ul><ul><li> * fight and flight division </li></ul><ul><li> * Epinephrine and Nor epinephrine </li></ul>
  5. 5. <ul><li>b. Parasympathetic (Cranio-Sacral) </li></ul><ul><li>* Nuclei of the 3 rd , 7 th , and 10 th cranial </li></ul><ul><li>nerve and 1 to the 4 th sacral spinal </li></ul><ul><li>segments </li></ul><ul><li>* acetycholine </li></ul>
  6. 6. Pharmacology of the parasympathetic division
  7. 7. Pharmacology of the Parasympathetic Division <ul><li>Cholinergic agonist (Parasympathomimetic) </li></ul><ul><li>Choline esters: acetylcholine chloride methacholine chloride </li></ul><ul><li> bethanecol chloride </li></ul><ul><li> carbachol chloride </li></ul><ul><li>Alkaloids: Muscarine, </li></ul><ul><li>Pilocarpine- miotic in glaucoma </li></ul><ul><li>increase salivation </li></ul>
  8. 8. <ul><li>II. Cholinesterase inhibitors </li></ul><ul><li>Slowly reversible </li></ul><ul><li>neostigmine ( drug of choice for </li></ul><ul><li>myasthenia gravis) </li></ul><ul><li> physostigmine </li></ul><ul><li>b. Rapidly reversible: Edrophonuim </li></ul><ul><li>c. Non Reversible: chemical warfare and insecticides </li></ul>
  9. 9. <ul><li>III. Cholinergic blocking drugs (parasympathomimetic) </li></ul><ul><li>a. Naturally occurring alkaloids: </li></ul><ul><li>1. Atropine </li></ul><ul><li>* Atropine sulfate, 0.5-1mg 1-2 hours before dental </li></ul><ul><li>procedure </li></ul><ul><li> * antisialogogue </li></ul><ul><li> * mydriasis, antispasmodic, decrease gastric and </li></ul><ul><li>salivary flow </li></ul><ul><li>2. Scopolamine </li></ul><ul><li>* Scopolamine Hydrobromide, 0.3- 0.6mg </li></ul><ul><li>* pre-anesthetic </li></ul>
  10. 10. <ul><li>b. Synthetic anticholonergic </li></ul><ul><li>* propantheline bromide (Pro-Banthine) </li></ul><ul><li>* aid in ulcer therapy </li></ul><ul><li>Side effects: blurred vision, tachycardia sweating and </li></ul><ul><li>dry skin </li></ul>
  11. 11. Pharmacology of the Sympathetic Division
  12. 12. <ul><li>Adrenergic Agonist (Sympathomimetic ) </li></ul><ul><li>a. Epinephrine hydrochloride </li></ul><ul><li>( adrenaline) </li></ul><ul><li>Cardiac stimulant </li></ul><ul><li>Alpha and beta stimulating ( vessels of skin, mucous membrane, kidney- vasoconstriction </li></ul><ul><li>Smooth muscles of the bronchi- vasodilation </li></ul>
  13. 13. <ul><li>* topical solution (1:1000) –gingival retraction, hemostatic agent </li></ul><ul><li>* drug of choice for acute anaphylaxis </li></ul><ul><li>and asthmatic attack </li></ul><ul><li>(0.2-0.5 ml: 1:100,000 aqueous solution) </li></ul><ul><li>* Vasoconstrictor in local anesthesia </li></ul><ul><li>(1: 50, 000, 1:100, 000) </li></ul><ul><li>* Used in caution: elderly, CV disease, </li></ul><ul><li>hypertension, hyperthyroidism </li></ul>
  14. 14. <ul><li>b. Nor epinehrine </li></ul><ul><li>* alpha stimulating </li></ul><ul><li>* hypotension in shock </li></ul><ul><li>c. Isoproterenol ( Isuprel) </li></ul><ul><li>* beta stimulating </li></ul><ul><li>* cardiac stimulant </li></ul><ul><li>* primary used in the treatment of </li></ul><ul><li>asthma and heart problem </li></ul>
  15. 15. <ul><li>d. Dopamine </li></ul><ul><li>* alpha and beta </li></ul><ul><li>* shock associated with sepsis and myocardial etiology </li></ul><ul><li>e. Ephedrine </li></ul><ul><li>* alpha and beta </li></ul><ul><li>* intranasal solution for localized decongestive effect </li></ul>
  16. 16. Synthetic adrenergic drugs <ul><li>Phenylephrine- nasal decongestant </li></ul><ul><li>Terbutaline- bronchodilator </li></ul><ul><li>Dextroamphetamine sulfate- narcolepsy, attention deficient disorder </li></ul>
  17. 17. Adrenergic Blocking drugs (sympatholytic) <ul><li>Alpha blockers </li></ul><ul><li>prazosin (Minipress) </li></ul><ul><li>b. Beta blockers </li></ul><ul><li>1. selective B1 (cardioselective </li></ul><ul><li>i. acetabutalol ( Sectral) </li></ul><ul><li>ii. Atenolol ( Tenormin) </li></ul><ul><li>iii. Metroprolol (Lopressor) </li></ul><ul><li>2. non selective </li></ul><ul><li>i. propranolol (Inderal) </li></ul><ul><li>ii. timolol ( Blocadren) </li></ul><ul><li>iii pindolol ( Visken) </li></ul>
  18. 18. <ul><li>C. Neuronal blocker </li></ul><ul><li>D. Ganglionic blocker </li></ul>
  19. 19. CNS STIMULANTS <ul><li>Heterogeneous group of compound that produce various degree of stimulation depending on the compound, the dose and occasion and use </li></ul>
  20. 20. Classification <ul><li>I. Analeptics and Respiratory stimulants </li></ul><ul><li>Pentelynetetrazol (Metrazol) </li></ul><ul><li>Nikethamide( Coramine) </li></ul><ul><li>Doxapram (Dopram) </li></ul><ul><li>Picrotoxin </li></ul><ul><li>Strychine </li></ul>
  21. 21. <ul><li>II. Xanthine Bases </li></ul><ul><li>(Caffeine, theophylline and theobromine ) </li></ul><ul><li>pharmacologic effects: </li></ul><ul><li>CNS and Respiratory stimulants </li></ul><ul><li>diuretics </li></ul><ul><li> cardiac stimulants </li></ul><ul><li> bronchodilator </li></ul>
  22. 22. <ul><li>A. Caffeine </li></ul><ul><li>□ most widely ingested CNS stimulants </li></ul><ul><li>□ insomia, nervousness, palpitation </li></ul><ul><li>tachycardia </li></ul><ul><li>□ Increase gastric secretion </li></ul><ul><li>□ habituation </li></ul>
  23. 23. <ul><li>B. theophylline </li></ul><ul><li>+ ethylne diamide= aminophylline </li></ul><ul><li>severe cases of asthma </li></ul><ul><li>C. theobromine </li></ul>
  24. 24. <ul><li>III. Sympathomimetic amide </li></ul><ul><li>A. Amphetamine and related drugs) </li></ul><ul><li>□ Wakefulness, alertness, </li></ul><ul><li>decrease fatigue </li></ul><ul><li>□ Increase ability to concentrate </li></ul><ul><li>□ Euphoric effect </li></ul><ul><li>□ Mood will be elevated </li></ul>
  25. 25. <ul><ul><li>Headache </li></ul></ul><ul><ul><li>Hallucination </li></ul></ul><ul><ul><li>Dysphoria </li></ul></ul><ul><ul><li>Anorexia </li></ul></ul><ul><ul><li>Psychotic episode </li></ul></ul>
  26. 26. <ul><li>B. Cocaine – local anesthetic </li></ul>
  27. 27. <ul><li>Drugs </li></ul><ul><li>hemostatics/ antihemorragic </li></ul><ul><li>Antibiotic </li></ul><ul><li>Antihistmine </li></ul><ul><li>Analgesic, Antipyretic </li></ul><ul><li>Antiinflammatory </li></ul><ul><li>V. Anesthetics </li></ul><ul><li>VI . Minor tranquilizer, sedative-hypnotic </li></ul><ul><li>sedative antihistamine </li></ul><ul><li>Bleeding </li></ul><ul><li>infection </li></ul><ul><li>Allergy </li></ul><ul><li>Pain, Fever Inflammation </li></ul><ul><li>Pain </li></ul><ul><li>Anxiety/fear </li></ul>

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