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Chapter 5

Autonomic Drugs

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Autonomic Pharmacology

Autonomic Nervous System


This system is divided into two separate systems. These systems are called the parasympathetic nervous system and the sympathetic nervous system. These systems often produce opposite effects. Drugs in this group are designed to either enhance or mimic the autonomic nervous system or to block the effects of the neurotransmitters at their receptor sites.

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Autonomic Nervous System

Parasympathetic Nervous System


This system is concerned with the conservation of the body processes. Its main neurotransmitter is acetylcholine. Its receptors are muscarinic, nicotinic, and the somatic-skeletal muscles.

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Autonomic Nervous System

Sympathetic Nervous System


This nervous system is designed to cope with emergency situations. This is commonly known as the fright or flight response. Its neurotransmitters are epinephrine and norepinephrine. Its receptors are the and receptors.

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Autonomic Pharmacology

Cholinergic or Parasympathomimetic Drugs

These drugs are classified as either direct or indirect acting agents. Direct acting drugs act directly on the parasympathetic receptors. Indirect acting drugs work by either of two methods. They can cause the release of the neurotransmitter which then goes to the receptor site or they inhibit the enzyme cholinesterase.

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Autonomic Pharmacology

Cholinergic Pharmacology

Cardiovascular Direct effects include negative chronotropic and



inotropic actions. Relaxation of smooth muscles causes a decrease in total peripheral resistance. Indirect effects include increased heart rate and cardiac output. The resulting effect depends upon the dose used. Usually, the patient experiences bradycardia and a decrease in blood pressure and cardiac output.

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Autonomic Pharmacology

Cholinergic Pharmacology

Gastrointestinal These drugs excite the smooth muscle of the


gastrointestinal tract and cause an increase in activity, motility, and secretion.

Eye These drugs cause miosis and cycloplegia. They cause a decrease in intraocular pressure.

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Autonomic Pharmacology

Adverse Reactions

Adverse reactions are an extension of the drugs pharmacologic effects. They include: Salivation Lacrimation Urination Defecation Paralysis Overdose

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Cholinergic Pharmacology

Contraindications

The contraindications and relative cautions are a result of the drugs pharmacologic and adverse effects. They include: Bronchial asthma Hyperthyroidism Gastrointestinal or urinary tract obstruction Myasthenia gravis treated with neostigmine Peptic ulcer disease Severe cardiac disease
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Cholinergic Drugs

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Anticholinergic Drugs

These drugs prevent the action of acetylcholine at postganglionic parasympathetic endings. Acetylcholine is released but its receptor site is completely blocked by anticholinergic drugs. These drugs only block muscarinic receptors.

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Anticholinergic Drugs

Pharmacology

Central Nervous System Depending on the dose, these drugs can cause
stimulation or depression.

Exocrine Glands They reduce the flow and volume of secretions in the
respiratory, gastrointestinal, and genitourinary tracts.

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Anticholinergic Drugs

Pharmacology

Smooth Muscle Relax smooth muscles in the respiratory and


gastrointestinal tracts. They delay gastric emptying and decrease esophageal and gastric emptying. These drugs also cause bronchial dilation.

Eye These drugs cause mydriasis and cycloplegia.

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Anticholinergic Drugs

Pharmacology

Cardiovascular With large doses, these drugs produce vagal


blocking which results in tachycardia. Bradycardia can occur with low doses.

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Anticholinergic Drugs

Adverse Reactions

The adverse reactions are an extension of the drugs pharmacologic effects. They include: Xerostomia Constipation Urinary retention Blurred vision Hyperpyrexia Hallucinations Photophobia Tachycardia
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Anticholinergic Drugs

Contraindications

Contraindications are usually due to the drugs pharmacologic and adverse effects. They include: Glaucoma Prostatic hypertrophy Intestinal or urinary obstruction or retention Cardiovascular disease

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Anticholinergic Drugs

Uses

Preoperative Medication They inhibit salivary and bronchial secretions. They block the vagal slowing of the heart that can
occur with general anesthesia.

Gastrointestinal Disorders They decrease gastrointestinal motility and can be


used to treat ulcers, diarrhea, and hypermotility.

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Anticholinergic Drugs

Uses

Ophthalmologic Examinations Topical use can cause mydriasis which causes a full
visualization of the retina. Cycloplegia relaxes the lens so that proper prescriptions for glasses can be determined.

Parkinson Disease They reduce the tremors and rigidity associated with
Parkinson and drug-induced Parkinson disease.

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Anticholinergic Drugs

Uses

Motion Sickness These drugs are used to treat or prevent motion


sickness because of their central nervous system depressant action.

Dentistry These drugs are used to create a dry, oral field.

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Adrenergic Drugs

Adrenergic drugs can be classified as having direct action, indirect action, or mixed action. These drugs stimulate and receptors throughout the body. Drugs with direct action (epinephrine, norepinephrine, isoproterenol) produce their effect by directly stimulating the receptor site. Drugs with indirect action (amphetamine) release endogenous norepinephrine which then stimulates the receptor. Drugs with mixed action (ephedrine) either directly stimulate the receptor or release endogenous norepinephrine.
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Adrenergic Drugs

Pharmacology

Central Nervous System (CNS) These drugs produce CNS excitation or alertness. Higher doses produce anxiety, apprehension,
restlessness, and tremors.

Cardiovascular System These drugs increase the force and rate of


contraction of the heart. Blood pressure is also increased. Total peripheral resistance is also increased.

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Adrenergic Drugs

Pharmacology

Eye These drugs lower intraocular pressure and can cause


mydriasis.

Respiratory System These drugs cause a relaxation of bronchiole smooth


muscles.

Metabolic Effects Increased glycogenolysis from -receptor stimulation


causes hyperglycemia.

Salivary Glands These drugs produce vasoconstriction of the salivary


glands which leads to decreased salivary flow which results in xerostomia.
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Adrenergic Drugs

Adverse Reactions

The adverse reactions associated with these drugs are an extension of the drugs pharmacologic effects. They include: Anxiety Tremors Tachycardia Increased blood pressure Arrhythmias

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Adrenergic Drugs

Uses

Vasoconstriction These drugs are used in dentistry because of their


vasoconstrictive actions on blood vessels. They are added to local anesthetics because they prolong the action of the local anesthetic, reduce the risk for systemic toxicity, and help to create a dry field.

Cardiac Effects These drugs are used to raise blood pressure and to
treat cardiac arrest.

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Adrenergic Drugs

Uses

Bronchodilation These drugs are used to treat asthma, emphysema,


and allergic reaction.

Central Nervous System Stimulation These medications are used for the treatment of
attention deficit hyperactivity disorder, narcolepsy, and as diet aids.

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Adrenergic Blocking Drugs

These drugs competitively inhibit and receptor sites. One group of drugs is specific for receptors. One group of drugs is specific for both 1 and 2 receptors. One group is specific for 2 receptors. One group is specific for both and receptors.

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Antiadrenergic Drugs

Pharmacology

These drugs reduce sympathetic tone in the blood vessels and decrease total peripheral resistance. This results in a reduction in blood pressure.

Uses

These drugs are used to treat hypertension, peripheral vascular disease (i.e., Raynaud syndrome) and benign prostatic hypertrophy.

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