Your SlideShare is downloading. ×
0
Autonomics Claro M. Isidro M.D.
Parasympathetic Drugs <ul><li>Drugs Affecting the ANS: </li></ul><ul><li>Cholinergic drugs – act on the receptor that is a...
Cholinergic Neurons <ul><li>Preganglionic fibers terminating in the adrenal medulla </li></ul><ul><li>Preganglionic fibers...
 
 
<ul><li>Neurotransmission at Cholinergic neurons </li></ul><ul><li>Synthesis of acetylcholine </li></ul><ul><li>Storage of...
<ul><li>Cholinergic Receptors </li></ul><ul><li>Muscarinic : </li></ul><ul><li>M1 – nerves </li></ul><ul><li>M2 – heart, n...
 
Effector Organs Receptors Action Eye sphincter m.  ciliary m. M3 M3 Contraction (meiosis) Contraction (accomodation) Heart...
Effector Organs Receptor Action Blood Vessels most BV  skeletal  m. - - Small doses – vasodilatation  Large doses – vasoco...
Effector Organs Receptor Action Secretory glands sweat intestinal bronchial lacrimal M M 3 M M Generalized secretion ↑  se...
<ul><li>Cholinomimetics  / Parasympathetic Agonist/Cholinergic Agonist </li></ul><ul><li>Drugs that have effects producing...
<ul><li>Direct-Acting (Choline Esters) : </li></ul><ul><li>Acetylcholine </li></ul><ul><ul><li>quarternary ammonium compou...
Susceptibility to Cholinesterase Muscarinic Effects Nicotinic Effects Therapeutic Use  Ach + +++ +++ Miotic Metacholine + ...
<ul><li>Direct-Acting (Choline Esters): </li></ul><ul><li>Naturally-occurring: </li></ul><ul><li>Pilocarpine </li></ul><ul...
<ul><li>ARECOLINE </li></ul><ul><li>chief alkaloid of areca or betel nuts </li></ul><ul><li>muscarinic & nicotinic recepto...
Indirect-Acting : Anticholinesterase <ul><li>REVERSIBLE (Anticholinesterases) </li></ul><ul><li>IRREVERSIBLE (Organophosph...
Anticholinesterase <ul><li>AcetylCholine  Choline + Acetic acid </li></ul><ul><li>Cholinesterase </li></ul>-
<ul><li>Indirect-Acting : </li></ul><ul><li>REVERSIBLE (Anticholinesterases): </li></ul><ul><ul><ul><li>Physostigmine </li...
<ul><li>PHYSOSTIGMINE </li></ul><ul><ul><li>Alkaloid, tertiary ammmonium grp. </li></ul></ul><ul><ul><li>Enters the CNS </...
<ul><li>NEOSTIGMINE </li></ul><ul><ul><li>Quarternary ammonium grp. </li></ul></ul><ul><ul><li>Does not enter the CNS    ...
<ul><li>PYRIDOSTIGMINE and AMBENONIUM  </li></ul><ul><ul><li>DOA:  PYRIDOSTIGMINE - 3 to 6 hrs </li></ul></ul><ul><ul><li>...
<ul><li>EDROPHONIUM  </li></ul><ul><ul><li>Quarternary amine </li></ul></ul><ul><ul><li>DOA:  5 to 15 mins </li></ul></ul>...
<ul><li>Tacrine, Donezepil, Rivastigmine, </li></ul><ul><li>Galantamine </li></ul><ul><ul><li>Alzheimer disease    defici...
<ul><li>Indirect-Acting   IRREVERSIBLE :  </li></ul><ul><ul><li>ORGANOPHOSPHATES </li></ul></ul><ul><ul><ul><li>ISOFLUROP...
<ul><li>ORGANOPHOSPHATE  POISONING: </li></ul><ul><ul><li>Signs & Symptoms </li></ul></ul><ul><ul><li>miosis </li></ul></u...
<ul><li>ORGANOPHOSPHATE POISONING: </li></ul><ul><ul><li>Therapy: </li></ul></ul><ul><ul><ul><li>maintenance of VS    res...
 
<ul><li>Parasympathetic Antagonists/Cholinergic Antagonist (Parasympatholytics) </li></ul><ul><li>ANTIMUSCARINIC </li></ul...
 
<ul><li>ATROPINE </li></ul><ul><ul><li>prototype </li></ul></ul><ul><ul><li>Belladona alkaloid </li></ul></ul><ul><ul><li>...
<ul><li>ATROPINE </li></ul><ul><li>Actions: </li></ul><ul><li>1. CNS  </li></ul><ul><ul><li>minimal stimulant effect </li>...
<ul><li>ATROPINE </li></ul><ul><li>6. CVS </li></ul><ul><li>divergent effects depending on dose </li></ul><ul><li>Low dose...
<ul><li>Effects in relation to dose: </li></ul>Dose Effects 0.5 mg Slight cardiac slowing  some dryness of mouth  inhibiti...
Dose Effects 2.0 mg Rapid HR; palpitations  marked dryness of mouth  Dilated pupils; some blurring of vision 5.0 mg All of...
Dose Effects 10.0 mg and more Above symptoms more marked Pulse rapid and weak Iris practically obliterated Vision very blu...
<ul><li>ATROPINE </li></ul><ul><li>Therapeutic Uses: </li></ul><ul><li>1. Ophthalmic </li></ul><ul><ul><li>Permits measure...
<ul><li>SCOPOLAMINE </li></ul><ul><li>Belladona alkaloid </li></ul><ul><li>Peripheral effects similar to atropine </li></u...
<ul><li>Therapeutic Uses: </li></ul><ul><ul><li>anti-motion sickness </li></ul></ul><ul><ul><li>adjunct in anesthesia proc...
<ul><li>GANGLIONIC  BLOCKERS </li></ul><ul><li>Specifically act on NICOTINIC receptors </li></ul><ul><li>No selectivity to...
<ul><li>GANGLIONIC BLOCKERS </li></ul><ul><li>NICOTINE </li></ul><ul><li>TRIMETHAPHAN </li></ul><ul><li>MECAMYLAMINE </li>...
 
<ul><li>The End </li></ul>
<ul><li>Write A if  cholinergic agonist </li></ul><ul><li>B if cholinergic antagonist </li></ul><ul><li>Bethanicol </li></...
Short Quiz <ul><li>1. Describe the pharmacodynamic difference between direct and indirect acting cholinomimetics </li></ul...
<ul><li>A. NICOTINE </li></ul><ul><li>Low dose : </li></ul><ul><li>   ganglionic stimulation by depolarization  </li></ul...
Upcoming SlideShare
Loading in...5
×

Autonomics Parasympathetic

3,680

Published on

Published in: Travel, Business
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
3,680
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
198
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Transcript of "Autonomics Parasympathetic"

  1. 1. Autonomics Claro M. Isidro M.D.
  2. 2. Parasympathetic Drugs <ul><li>Drugs Affecting the ANS: </li></ul><ul><li>Cholinergic drugs – act on the receptor that is activated by acetylcholine </li></ul><ul><li>Adrenergic drugs – acts on the receptor that are stimulated by norepinephrine or epinephrine </li></ul>
  3. 3. Cholinergic Neurons <ul><li>Preganglionic fibers terminating in the adrenal medulla </li></ul><ul><li>Preganglionic fibers of both parasympathetic & sympathetic nervous system </li></ul><ul><li>Postganglionic fibers of the parasympathetic nervous system </li></ul><ul><li>Voluntary muscles of the somatic nervous system </li></ul>
  4. 6. <ul><li>Neurotransmission at Cholinergic neurons </li></ul><ul><li>Synthesis of acetylcholine </li></ul><ul><li>Storage of acetylcholine in vesicles </li></ul><ul><li>Release of acetylcholine </li></ul><ul><li>Binding to receptor </li></ul><ul><li>Degradation of acetylcholine </li></ul><ul><li>Recycling of choline </li></ul>
  5. 7. <ul><li>Cholinergic Receptors </li></ul><ul><li>Muscarinic : </li></ul><ul><li>M1 – nerves </li></ul><ul><li>M2 – heart, nerves, smooth </li></ul><ul><li>muscles </li></ul><ul><li>M3 – glands, smooth muscles </li></ul><ul><li>Endothelium </li></ul><ul><li>M4 - ? CNS </li></ul><ul><li>M5 - ? CNS </li></ul><ul><li>Nicotinic: </li></ul><ul><li>Nm – skeletal muscles </li></ul><ul><li>Neuromuscular junction </li></ul><ul><li>Nn – Preganglionic parasympathetic & sympathetic </li></ul>
  6. 9. Effector Organs Receptors Action Eye sphincter m. ciliary m. M3 M3 Contraction (meiosis) Contraction (accomodation) Heart SA node AV node Contractility M 2 M 2 M 2 ↓ Heart rate ↓ conduction velocity & ↑ refractory period ↓ contraction Lung bronchial m. M 3 contraction
  7. 10. Effector Organs Receptor Action Blood Vessels most BV skeletal m. - - Small doses – vasodilatation Large doses – vasoconstriction GIT sphincter motility & tone M 3 M 3 Relaxation Increase GUT trigone & sphincter m. bladder wall & detrusor m. Penis, seminal v. M 3 M 3 M Relaxation Contraction Erection
  8. 11. Effector Organs Receptor Action Secretory glands sweat intestinal bronchial lacrimal M M 3 M M Generalized secretion ↑ secretion ↑ secretion Profuse secretion
  9. 12. <ul><li>Cholinomimetics / Parasympathetic Agonist/Cholinergic Agonist </li></ul><ul><li>Drugs that have effects producing parasympathetic dominance </li></ul><ul><li>Direct-Acting Cholinoceptor Stimulants </li></ul><ul><ul><li>A. Esters of Choline: Synthetic </li></ul></ul><ul><ul><li>1. Acetylcholine 3. Carbachol </li></ul></ul><ul><ul><li>2. Metacholine 4. Betanechol </li></ul></ul><ul><ul><li>B. Alkaloids: Naturally occurring </li></ul></ul><ul><ul><li>1. Muscarinic </li></ul></ul><ul><ul><li>Muscarine, Pilocarpine, Oxotremorine </li></ul></ul><ul><ul><li>2. Nicotinic </li></ul></ul><ul><ul><li>Nicotine, Lobeline, </li></ul></ul><ul><ul><li>Dimethylphenylpiperazinium (DMPP) </li></ul></ul>
  10. 13. <ul><li>Direct-Acting (Choline Esters) : </li></ul><ul><li>Acetylcholine </li></ul><ul><ul><li>quarternary ammonium compound </li></ul></ul><ul><ul><li>muscarinic & nicotinic receptors equally </li></ul></ul><ul><ul><li>Actions: </li></ul></ul><ul><ul><ul><li>↓ HR and CO, ↓ BP </li></ul></ul></ul><ul><ul><ul><li>↑ salivary & intestinal secretion and GI motility </li></ul></ul></ul><ul><ul><ul><li>Enhances bronchiolar secretions </li></ul></ul></ul><ul><ul><ul><li>↑ detrussor muscle tone </li></ul></ul></ul><ul><ul><ul><li>stim. Ciliary m. -> near vision </li></ul></ul></ul><ul><ul><ul><li>miosis </li></ul></ul></ul>
  11. 14. Susceptibility to Cholinesterase Muscarinic Effects Nicotinic Effects Therapeutic Use Ach + +++ +++ Miotic Metacholine + ++++ + Dx of bronchial hyperactivity Carbachol - +++ ++ Miotic Betanechol - ++ - Non-obstructive urinary retention
  12. 15. <ul><li>Direct-Acting (Choline Esters): </li></ul><ul><li>Naturally-occurring: </li></ul><ul><li>Pilocarpine </li></ul><ul><ul><li>tertiary amine </li></ul></ul><ul><ul><li>dominant muscarinic action </li></ul></ul><ul><ul><li>resistant to acetylcholinesterase </li></ul></ul><ul><ul><li>Use as topical eye drop. Produce rapid meiosis & contraction of ciliary muscle </li></ul></ul><ul><ul><li>Increase gastric acid secretion & bronchoconstiction </li></ul></ul><ul><ul><li>Potent stimulator of secretions (sweat, tears, saliva) </li></ul></ul><ul><ul><li>Therapeutic Use: </li></ul></ul><ul><ul><ul><li>DOC in emergency lowering of IOP in glaucoma </li></ul></ul></ul><ul><ul><li>Adverse Effects: CNS disturbances, profuse sweating and salivation </li></ul></ul>
  13. 16. <ul><li>ARECOLINE </li></ul><ul><li>chief alkaloid of areca or betel nuts </li></ul><ul><li>muscarinic & nicotinic receptors </li></ul><ul><li>enhances salivary secretion </li></ul><ul><li>no therapeutic indication </li></ul><ul><li>MUSCARINE </li></ul><ul><li>quarternary amine </li></ul><ul><li>muscarinic receptors </li></ul><ul><li>found in mushrooms (Amanita muscaria) </li></ul><ul><li>small amounts  edible </li></ul><ul><li>large amounts  poisonous </li></ul><ul><li>effects: fall in BP, temporary cessation of heart beat, diaphoresis </li></ul><ul><li>antidote: ATROPINE </li></ul>
  14. 17. Indirect-Acting : Anticholinesterase <ul><li>REVERSIBLE (Anticholinesterases) </li></ul><ul><li>IRREVERSIBLE (Organophosphate) </li></ul>
  15. 18. Anticholinesterase <ul><li>AcetylCholine Choline + Acetic acid </li></ul><ul><li>Cholinesterase </li></ul>-
  16. 19. <ul><li>Indirect-Acting : </li></ul><ul><li>REVERSIBLE (Anticholinesterases): </li></ul><ul><ul><ul><li>Physostigmine </li></ul></ul></ul><ul><ul><ul><li>Neostigmine </li></ul></ul></ul><ul><ul><ul><li>Pyridostigmine </li></ul></ul></ul><ul><ul><ul><li>Ambenonium </li></ul></ul></ul><ul><ul><ul><li>Edrophonium </li></ul></ul></ul><ul><ul><ul><li>Tacrine, Donezepil, Rivastigmine, Galantamine </li></ul></ul></ul><ul><li>IRREVERSIBLE </li></ul><ul><ul><li>1. Organophosphates </li></ul></ul><ul><ul><ul><li>Isoflurophate </li></ul></ul></ul><ul><ul><ul><li>Echothiophate </li></ul></ul></ul><ul><ul><ul><li>Malathion, Parathion </li></ul></ul></ul><ul><ul><li>2. Chemical Warfares </li></ul></ul><ul><ul><ul><li>Sarin, Soman </li></ul></ul></ul>
  17. 20. <ul><li>PHYSOSTIGMINE </li></ul><ul><ul><li>Alkaloid, tertiary ammmonium grp. </li></ul></ul><ul><ul><li>Enters the CNS </li></ul></ul><ul><ul><li>DOA: O.5 to 2 hrs. </li></ul></ul><ul><ul><li>Therapeutic Uses: </li></ul></ul><ul><ul><ul><ul><li>1 . Atony of intestines and bladder </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2. Glaucoma  lowers IOP </li></ul></ul></ul></ul><ul><ul><ul><ul><li>3. Antidote  atropine, phenothiazines, TCA </li></ul></ul></ul></ul><ul><ul><ul><ul><li>4. NDMR (tubocurarine) reversal </li></ul></ul></ul></ul><ul><ul><li>Adverse effects: convulsions, bradycardia, CO </li></ul></ul>
  18. 21. <ul><li>NEOSTIGMINE </li></ul><ul><ul><li>Quarternary ammonium grp. </li></ul></ul><ul><ul><li>Does not enter the CNS  peripheral </li></ul></ul><ul><ul><li>DOA: 0.5 to 2 hrs </li></ul></ul><ul><ul><li>Therapeutic Uses: </li></ul></ul><ul><ul><ul><ul><li>Atony of intestines and bladder </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Myasthenia gravis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>NDMR (tubocurarine) antidote </li></ul></ul></ul></ul><ul><ul><li>Adverse effects: salivation, flushing, ↓ BP, nausea, abdominal pain, diarrhea, bronchospasm </li></ul></ul>
  19. 22. <ul><li>PYRIDOSTIGMINE and AMBENONIUM </li></ul><ul><ul><li>DOA: PYRIDOSTIGMINE - 3 to 6 hrs </li></ul></ul><ul><ul><li>AMBENONIUM – 4 to 8 hrs </li></ul></ul><ul><ul><li>Therapeutic Uses: </li></ul></ul><ul><ul><ul><ul><li>Myasthenia gravis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>NDMR (tubocurarine) antidote </li></ul></ul></ul></ul><ul><ul><li>Adverse effects: salivation, flushing, ↓ BP, nausea, abdominal pain, diarrhea, bronchospasm </li></ul></ul>
  20. 23. <ul><li>EDROPHONIUM </li></ul><ul><ul><li>Quarternary amine </li></ul></ul><ul><ul><li>DOA: 5 to 15 mins </li></ul></ul><ul><ul><li>Therapeutic Uses: </li></ul></ul><ul><ul><ul><ul><li>Diagnosis of Myasthenia gravis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>NDMR (tubocurarine) antidote </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Arrhythmias (SVT) </li></ul></ul></ul></ul><ul><ul><li>Antidote: Atropine </li></ul></ul><ul><ul><li>Adverse effects: salivation, flushing, ↓ BP, nausea, abdominal pain, diarrhea, bronchospasm </li></ul></ul>
  21. 24. <ul><li>Tacrine, Donezepil, Rivastigmine, </li></ul><ul><li>Galantamine </li></ul><ul><ul><li>Alzheimer disease  deficiency of cholinergic neurons in the CNS </li></ul></ul><ul><ul><li>Tacrine – hepatotoxic </li></ul></ul><ul><ul><li>Adverse effect: GI distress </li></ul></ul>
  22. 25. <ul><li>Indirect-Acting  IRREVERSIBLE : </li></ul><ul><ul><li>ORGANOPHOSPHATES </li></ul></ul><ul><ul><ul><li>ISOFLUROPHATE </li></ul></ul></ul><ul><ul><ul><ul><li>tx of open angle glaucoma </li></ul></ul></ul></ul><ul><ul><ul><li>ECHOTHIOPHATE </li></ul></ul></ul><ul><ul><ul><ul><li>Produce intense miosis  tx of open angle glaucoma </li></ul></ul></ul></ul><ul><ul><ul><li>PARATHION, MALATHION </li></ul></ul></ul><ul><ul><ul><ul><li>Insecticides </li></ul></ul></ul></ul>
  23. 26. <ul><li>ORGANOPHOSPHATE POISONING: </li></ul><ul><ul><li>Signs & Symptoms </li></ul></ul><ul><ul><li>miosis </li></ul></ul><ul><ul><li>salivation, frothy secretions </li></ul></ul><ul><ul><li>sweating </li></ul></ul><ul><ul><li>bronchial constriction </li></ul></ul><ul><ul><li>vomiting and diarrhea </li></ul></ul><ul><ul><li>muscle fasciculation </li></ul></ul>
  24. 27. <ul><li>ORGANOPHOSPHATE POISONING: </li></ul><ul><ul><li>Therapy: </li></ul></ul><ul><ul><ul><li>maintenance of VS  respiration </li></ul></ul></ul><ul><ul><ul><li>Decontamination </li></ul></ul></ul><ul><ul><ul><li>Drugs: Atropine + Pralidoxime </li></ul></ul></ul><ul><ul><ul><ul><li>ATROPINE sulfate </li></ul></ul></ul></ul><ul><ul><ul><ul><li> 1 to 2 mg IV every 5-15 min until muscarinic effect disappears (maximum of 1 gm per day) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>PRALIDOXIME </li></ul></ul></ul></ul><ul><ul><ul><ul><li> A cholinesterase enzyme regenerator compound </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- 1 to 2 gm given over 30 min by IV infusion </li></ul></ul></ul></ul>
  25. 29. <ul><li>Parasympathetic Antagonists/Cholinergic Antagonist (Parasympatholytics) </li></ul><ul><li>ANTIMUSCARINIC </li></ul><ul><ul><li>Tertiary Amines: </li></ul></ul><ul><ul><ul><li>Natural – atropine, scopolamine </li></ul></ul></ul><ul><ul><ul><li>Semisynthetic – tropine, homatropine </li></ul></ul></ul><ul><ul><ul><li>Synthetic – dicyclomine, oxybutyrine, oxyphencyclimine </li></ul></ul></ul><ul><ul><li>Quarternary Amines: </li></ul></ul><ul><ul><ul><li>Anisotropine </li></ul></ul></ul><ul><ul><ul><li>Propantheline </li></ul></ul></ul><ul><ul><ul><li>Methanteline </li></ul></ul></ul>
  26. 31. <ul><li>ATROPINE </li></ul><ul><ul><li>prototype </li></ul></ul><ul><ul><li>Belladona alkaloid </li></ul></ul><ul><ul><li>high affinity for muscarinic receptors </li></ul></ul><ul><ul><li>central and peripheral muscarinic blocker </li></ul></ul><ul><ul><li>causes reversible (surmountable) blockade of the actions of cholinomimetics at muscarinic receptors </li></ul></ul><ul><ul><li>Unopposed sympathetic action </li></ul></ul>
  27. 32. <ul><li>ATROPINE </li></ul><ul><li>Actions: </li></ul><ul><li>1. CNS </li></ul><ul><ul><li>minimal stimulant effect </li></ul></ul><ul><li>2. Eye </li></ul><ul><ul><li>mydriasis, unresponsiveness to light </li></ul></ul><ul><ul><li>cycloplegia  inability to focus for near-vision </li></ul></ul><ul><li>3. GIT </li></ul><ul><ul><li>antispasmodic  reduce GIT activity </li></ul></ul><ul><li>4. GUT </li></ul><ul><ul><li>reduce urinary bladder hypermotility </li></ul></ul><ul><li>5. SECRETIONS </li></ul><ul><ul><li>blocks salivary glands  antisialogogue </li></ul></ul><ul><ul><li>decrease also lacrimal & sweat glands secretion </li></ul></ul>
  28. 33. <ul><li>ATROPINE </li></ul><ul><li>6. CVS </li></ul><ul><li>divergent effects depending on dose </li></ul><ul><li>Low dose – (-) M 1  ↑ Ach release </li></ul><ul><li>Higher dose – (-) M 2 on SA node  ↑ CR </li></ul>
  29. 34. <ul><li>Effects in relation to dose: </li></ul>Dose Effects 0.5 mg Slight cardiac slowing some dryness of mouth inhibition of sweating 1.0 mg Definite dryness of mouth; thirst acceleration of heart, sometimes preceded by slowing mild pupillodilatation
  30. 35. Dose Effects 2.0 mg Rapid HR; palpitations marked dryness of mouth Dilated pupils; some blurring of vision 5.0 mg All of the above symptoms marked; difficulty in speaking and swallowing; Restlessness and fatigue; Headache; dry, hot skin Difficulty in micturition Reduced intestinal peristalsis
  31. 36. Dose Effects 10.0 mg and more Above symptoms more marked Pulse rapid and weak Iris practically obliterated Vision very blurred Skin flushed, hot, dry, and scarlet Ataxia, restlessness and excitement Hallucinations and delirium Coma
  32. 37. <ul><li>ATROPINE </li></ul><ul><li>Therapeutic Uses: </li></ul><ul><li>1. Ophthalmic </li></ul><ul><ul><li>Permits measurement of EOR </li></ul></ul><ul><li>2. Antispasmodic </li></ul><ul><li>3. Antidote for cholinergic agonists </li></ul><ul><ul><li>Organophosphate poisoning </li></ul></ul><ul><ul><li>Mushroom poisoning </li></ul></ul><ul><ul><li>acetylcholinesterase inhibitors </li></ul></ul><ul><li>4. Antisecretory agent </li></ul>
  33. 38. <ul><li>SCOPOLAMINE </li></ul><ul><li>Belladona alkaloid </li></ul><ul><li>Peripheral effects similar to atropine </li></ul><ul><li>Greater and longer CNS action </li></ul><ul><li>Action: </li></ul><ul><ul><li>Anti-motion sickness </li></ul></ul><ul><ul><li>Blocks short-term memory </li></ul></ul><ul><ul><li>Produces sedation, </li></ul></ul><ul><ul><li>excitement </li></ul></ul>
  34. 39. <ul><li>Therapeutic Uses: </li></ul><ul><ul><li>anti-motion sickness </li></ul></ul><ul><ul><li>adjunct in anesthesia procedures </li></ul></ul><ul><ul><li>> in obstetrics, + morphine  sedation </li></ul></ul><ul><ul><li>& amnesia </li></ul></ul><ul><li>IPRATROPIUM </li></ul><ul><li>Quarternary derivative of atropine </li></ul><ul><li>Does not enter CNS </li></ul><ul><li>Therapeutic Uses: </li></ul><ul><ul><li>Treat asthma in patients who are unable to take adrenergic agonists </li></ul></ul><ul><ul><li>Management of COPD </li></ul></ul>
  35. 40. <ul><li>GANGLIONIC BLOCKERS </li></ul><ul><li>Specifically act on NICOTINIC receptors </li></ul><ul><li>No selectivity towards PNS or SNS </li></ul><ul><li>Blocks entire ANS output </li></ul>
  36. 41. <ul><li>GANGLIONIC BLOCKERS </li></ul><ul><li>NICOTINE </li></ul><ul><li>TRIMETHAPHAN </li></ul><ul><li>MECAMYLAMINE </li></ul><ul><li>HEXAMETHONIUM </li></ul>
  37. 43. <ul><li>The End </li></ul>
  38. 44. <ul><li>Write A if cholinergic agonist </li></ul><ul><li>B if cholinergic antagonist </li></ul><ul><li>Bethanicol </li></ul><ul><li>Scopolamine </li></ul><ul><li>Isoflurophate </li></ul><ul><li>Trimethaphan </li></ul><ul><li>Arecoline </li></ul><ul><li>6. Main neurotransmitter of PNS </li></ul><ul><li>Amino acid precursor of Ach </li></ul><ul><li>Drug of choice in emergency lowering of IOP </li></ul><ul><li>Antidote for organophosphate poisoning </li></ul><ul><li>Aids in the diagnosis of myasthenia gravis </li></ul>
  39. 45. Short Quiz <ul><li>1. Describe the pharmacodynamic difference between direct and indirect acting cholinomimetics </li></ul><ul><li>2. Describe the effects of acetylcholine on the major organs </li></ul><ul><li>3. Describe the effects of atropine on the major organ system </li></ul><ul><li>4. Clinical uses of atropine & scopolamine </li></ul>
  40. 46. <ul><li>A. NICOTINE </li></ul><ul><li>Low dose : </li></ul><ul><li> ganglionic stimulation by depolarization </li></ul><ul><li> CNS: euphoria, arousal, relaxation </li></ul><ul><li>improves attention, learning, problem solving & reaction time </li></ul><ul><li> Peripheral: ↑ BP & HR, vasoconstriction </li></ul><ul><li>High dose  ganglionic blockade </li></ul><ul><li> BP falls, blocks GIT & bladder activity </li></ul>
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×