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Tutorial on
AUTONOMIC Nervous System
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Effects on body organs
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M- Receptors
M1 &
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Nicotionic Receptors
Parasympathetic ganglia
Sympathetic ganglia
Suprarenal medulla
Motor end plate
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alkaloidsCholinomimeticii)Pilocarpine
esters:Choline)i1. Acetyl choline2. Methacholine3. Carbachol4. Bethanechol
Parasympathomimetics
a) Direct
b) Indirect(Anticholinesterases)
Reversible1. Physostigmine
2. Neostigmine3. ..
IrreversibleOrganophosphorouspoisoning
http://images.google.com.eg/imgres?imgurl=http://www.duopharma.com.my/images/tablets-img02.gif&imgrefurl=http://www.duopharma.com.my/products.html&h=194&w=150&sz=21&hl=en&start=3&tbnid=61VKQZc4-CjNBM:&tbnh=103&tbnw=80&prev=/images?q=tablets&svnum=10&hl=en&lr=&sa=G8/3/2019 Tutorial ANS 2011
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Neostigmine:
1. Myasthenia gravis
2. Antidote to curare
3. Paralytic ileus4. Post-operative urine retention
Therapeutic uses of reversible
anticholinestrases
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Treatment of atropine poisoning.
Physotigmine
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Diagnosis of myasthenia gravis.
Differentiation between "myasthenic
crisis" & cholinergic crisis
Edrophonium
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Irreversible Anticholinesterases
1. Causes
[2]Organic Phosphate Poisoning
Eating
Dusting
accidental
[1] Insecticides
http://rds.yahoo.com/_ylt=A9gnMiliCWlFp3gBNAiJzbkF;_ylu=X3oDMTBjZmpxdmw3BHBvcwM3BHNlYwNzcg--/SIG=1h3cjo7mm/EXP=1164597986/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=eating&ei=UTF-8&fr=yfp-t-501&x=wrt&w=638&h=523&imgurl=www.leica-gallery.net/photo-lib/image/large/milena-eating-corn-on-the-c-87307.jpg&rurl=http://www.leica-gallery.net/k1gd/image-87307.html&size=53.4kB&name=milena-eating-corn-on-the-c-87307.jpg&p=eating&type=jpeg&no=7&tt=970,264&oid=fda4b4e906b3d444&ei=UTF-8http://rds.yahoo.com/_ylt=A9iby6Lk1yJF4gQB_8WJzbkF;_ylu=X3oDMTBkbmE3a2tyBHBvcwM3NgRzZWMDc3I-/SIG=1g25hsbcc/EXP=1159997796/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=parathion&ei=UTF-8&fr=yfp-t-500&b=61&w=252&h=165&imgurl=ehp.niehs.nih.gov/docs/1997/105-7/forumfigspray.JPEG&rurl=http://ehpnet1.niehs.nih.gov/docs/1997/105-7/forum.html&size=13.7kB&name=forumfigspray.JPEG&p=parathion&type=jpeg&no=76&tt=386&oid=294869a4173d2aa0&ei=UTF-88/3/2019 Tutorial ANS 2011
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R of organic phosphatepoisoning Atropine IV or IM till
Oximes (if patient is seen within 6-8hs)
Mechanism of action:1. Set the enzyme free
2. Bind circulating poison before reachingthe enzyme.
Anticonvulsants
Care of respiration
Gastric lavage/ wash skin
http://rds.yahoo.com/_ylt=A9gnMiiBCGlF_fcA2wmJzbkF;_ylu=X3oDMTBjZmpxdmw3BHBvcwM3BHNlYwNzcg--/SIG=1g15uh5fq/EXP=1164597761/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=ICU&fr=yfp-t-501&toggle=1&cop=mss&ei=UTF-8&w=559&h=406&imgurl=www.ncvc.go.jp/hsp/kango/icu/images/icu_002.jpg&rurl=http://www.ncvc.go.jp/hsp/kango/icu/kangobu_icu.html&size=63.4kB&name=icu_002.jpg&p=ICU&type=jpeg&no=7&tt=63,589&oid=32371b417157b646&ei=UTF-88/3/2019 Tutorial ANS 2011
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Atropine
Mechanism of action
By competing withacetylcholine forM receptors
http://rds.yahoo.com/_ylt=A9ibyiFQ2iJFIwoBfpSJzbkF;_ylu=X3oDMTBkc2Fsb3QxBHBvcwM0MARzZWMDc3I-/SIG=1i5kkq9jk/EXP=1159998416/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&b=21&w=800&h=600&imgurl=www.kmhk.kmu.edu.tw/medhome/Intra_med/med_o/search/images/a1/Atropine2.jpg&rurl=http://www.kmhk.kmu.edu.tw/medhome/Intra_med/med_o/search/ENdata.asp?EN_data=A&size=70.7kB&name=Atropine2.jpg&p=atropine&type=jpeg&no=40&tt=966&oid=0d081d5db5782cd8&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGaD2SJFJH0AiBCJzbkF;_ylu=X3oDMTBjMzRvMDBnBHBvcwM5BHNlYwNzcg--/SIG=1fboqsr8i/EXP=1159998211/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&x=wrt&w=73&h=146&imgurl=www.kmwcgh.gov.tw/3/drugimages/atropine%20eye.jpg&rurl=http://www.kmwcgh.gov.tw/3/pharmacy602.htm&size=3.6kB&name=atropine+eye.jpg&p=atropine&type=jpeg&no=9&tt=966&oid=677dc9292873aff6&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGaD2SJFJH0AgBCJzbkF;_ylu=X3oDMTBjMHZkMjZyBHBvcwMxBHNlYwNzcg--/SIG=1fvphl4q6/EXP=1159998211/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&x=wrt&w=566&h=455&imgurl=www2.unil.ch/lpc/images/docu04/0_doc/atropine.gif&rurl=http://www.unil.ch/lpc/images/docu04/illustr_metabo.htm&size=46.5kB&name=atropine.gif&p=atropine&type=gif&no=1&tt=966&oid=ef94d21aec80c6ba&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGVV2yJFlGUAafWJzbkF;_ylu=X3oDMTBjdmNoOTVjBHBvcwMyBHNlYwNzcg--/SIG=1g834q3dd/EXP=1159998677/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=tablet&ei=UTF-8&fr=yfp-t-500&x=wrt&w=275&h=275&imgurl=www.promotiontopia.com/promotional-images/sugar-free-tablet-gum.jpg&rurl=http://www.promotiontopia.com/c/sugar-free-tablet-gum.htm&size=10.0kB&name=sugar-free-tablet-gum.jpg&p=tablet&type=jpeg&no=2&tt=328,556&oid=e76c60b9fdbd9392&ei=UTF-88/3/2019 Tutorial ANS 2011
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Pharmacological actions
1) Heart:
If IV, initial bradycardiafollowed by tachycardia2) BV and BP:.
Tone, motilityand secretion(antispasmodic)
Antispasmodic, urine retention
secretions
Bronchodilatation& secretions
1) Passive mydriasis
2) Cycloplegia3) IOP4) Loss of light reflex5) lacrymation
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(2) CNS actions
Stimulant actionsTherapeutic dose:1. CIC bradycardia2. RCLarge dose:Cereberal cortex
Depressant actions1. tremors &
rigidity RC
http://rds.yahoo.com/_ylt=A9gnMiKlTGpFqAQBdwSJzbkF;_ylu=X3oDMTBjZGM1ZGE1BHBvcwM1BHNlYwNzcg--/SIG=1fmdhq37l/EXP=1164680741/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Brain&ei=UTF-8&fr=yfp-t-501&x=wrt&w=265&h=278&imgurl=www.aa-ckd.com/images/Choi_Kwang_Do_Brain_Development.jpg&rurl=http://www.aa-ckd.com/brain_development.htm&size=29.6kB&name=Choi_Kwang_Do_Brain_Development.jpg&p=Brain&type=jpeg&no=5&tt=1,045,997&oid=c02352dd45f00832&ei=UTF-8http://rds.yahoo.com/_ylt=A9gnMiKlTGpFqAQBdwSJzbkF;_ylu=X3oDMTBjZGM1ZGE1BHBvcwM1BHNlYwNzcg--/SIG=1fmdhq37l/EXP=1164680741/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Brain&ei=UTF-8&fr=yfp-t-501&x=wrt&w=265&h=278&imgurl=www.aa-ckd.com/images/Choi_Kwang_Do_Brain_Development.jpg&rurl=http://www.aa-ckd.com/brain_development.htm&size=29.6kB&name=Choi_Kwang_Do_Brain_Development.jpg&p=Brain&type=jpeg&no=5&tt=1,045,997&oid=c02352dd45f00832&ei=UTF-8http://rds.yahoo.com/_ylt=A9gnMiKlTGpFqAQBdwSJzbkF;_ylu=X3oDMTBjZGM1ZGE1BHBvcwM1BHNlYwNzcg--/SIG=1fmdhq37l/EXP=1164680741/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Brain&ei=UTF-8&fr=yfp-t-501&x=wrt&w=265&h=278&imgurl=www.aa-ckd.com/images/Choi_Kwang_Do_Brain_Development.jpg&rurl=http://www.aa-ckd.com/brain_development.htm&size=29.6kB&name=Choi_Kwang_Do_Brain_Development.jpg&p=Brain&type=jpeg&no=5&tt=1,045,997&oid=c02352dd45f00832&ei=UTF-88/3/2019 Tutorial ANS 2011
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Uses of atropine
Preanaesthetic
medication (Why?)
Colic
Heart block
Eye: .
Organic phosphate
poisoning.
http://rds.yahoo.com/_ylt=A9ibyiFQ2iJFIwoBfpSJzbkF;_ylu=X3oDMTBkc2Fsb3QxBHBvcwM0MARzZWMDc3I-/SIG=1i5kkq9jk/EXP=1159998416/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&b=21&w=800&h=600&imgurl=www.kmhk.kmu.edu.tw/medhome/Intra_med/med_o/search/images/a1/Atropine2.jpg&rurl=http://www.kmhk.kmu.edu.tw/medhome/Intra_med/med_o/search/ENdata.asp?EN_data=A&size=70.7kB&name=Atropine2.jpg&p=atropine&type=jpeg&no=40&tt=966&oid=0d081d5db5782cd8&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGaD2SJFJH0AiBCJzbkF;_ylu=X3oDMTBjMzRvMDBnBHBvcwM5BHNlYwNzcg--/SIG=1fboqsr8i/EXP=1159998211/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&x=wrt&w=73&h=146&imgurl=www.kmwcgh.gov.tw/3/drugimages/atropine%20eye.jpg&rurl=http://www.kmwcgh.gov.tw/3/pharmacy602.htm&size=3.6kB&name=atropine+eye.jpg&p=atropine&type=jpeg&no=9&tt=966&oid=677dc9292873aff6&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGaD2SJFJH0AgBCJzbkF;_ylu=X3oDMTBjMHZkMjZyBHBvcwMxBHNlYwNzcg--/SIG=1fvphl4q6/EXP=1159998211/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&x=wrt&w=566&h=455&imgurl=www2.unil.ch/lpc/images/docu04/0_doc/atropine.gif&rurl=http://www.unil.ch/lpc/images/docu04/illustr_metabo.htm&size=46.5kB&name=atropine.gif&p=atropine&type=gif&no=1&tt=966&oid=ef94d21aec80c6ba&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGVV2yJFlGUAafWJzbkF;_ylu=X3oDMTBjdmNoOTVjBHBvcwMyBHNlYwNzcg--/SIG=1g834q3dd/EXP=1159998677/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=tablet&ei=UTF-8&fr=yfp-t-500&x=wrt&w=275&h=275&imgurl=www.promotiontopia.com/promotional-images/sugar-free-tablet-gum.jpg&rurl=http://www.promotiontopia.com/c/sugar-free-tablet-gum.htm&size=10.0kB&name=sugar-free-tablet-gum.jpg&p=tablet&type=jpeg&no=2&tt=328,556&oid=e76c60b9fdbd9392&ei=UTF-88/3/2019 Tutorial ANS 2011
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Dryness of mouth, blurred vision and tachycardia.
Retention of urine in patients with enlarged
prostate.
Acute glaucoma
In children, cutaneous VD with flushing and
elevation of body temperature.
Side effects of atropine
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Hyoscine
Preferred over atropine inpre-anaestheticmedication. (Why?)
Colic
Motion sickness
http://rds.yahoo.com/_ylt=A9gnMiCdVmpFmuUAVu.JzbkF;_ylu=X3oDMTBjdmNoOTVjBHBvcwMyBHNlYwNzcg--/SIG=1g2q6m49m/EXP=1164683293/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=airplane&ei=UTF-8&fr=yfp-t-501&x=wrt&w=665&h=375&imgurl=organizingla.blogs.com/photos/uncategorized/sas_airplane.jpg&rurl=http://organizingla.blogs.com/organizingla_blog/2005/09&size=21.5kB&name=sas_airplane.jpg&p=airplane&type=jpeg&no=2&tt=700,647&oid=b81dc9f1d3f278ce&ei=UTF-8http://rds.yahoo.com/_ylt=A9gnMiD2VmpFl.cAld2JzbkF;_ylu=X3oDMTBkNHNkYWE3BHBvcwMyNwRzZWMDc3I-/SIG=1du10m95k/EXP=1164683382/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=headache&ei=UTF-8&fr=yfp-t-501&b=21&w=180&h=153&imgurl=www.byheadache.com/images/headache.jpg&rurl=http://www.byheadache.com/&size=8.7kB&name=headache.jpg&p=headache&type=jpeg&no=27&tt=104,334&oid=6b5e5a19dec6b6c0&ei=UTF-8http://rds.yahoo.com/_ylt=A9iby4K33SJFOMYAolyJzbkF;_ylu=X3oDMTBkbzMyZHR2BHBvcwMzOQRzZWMDc3I-/SIG=1fqa6f4gp/EXP=1159999287/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=anaesthesia&ei=UTF-8&fr=yfp-t-500&b=21&w=220&h=187&imgurl=www.avdha.nshealth.ca/programs/images/anaesthesia2.jpg&rurl=http://www.avdha.nshealth.ca/programs/anaesthesia.asp&size=8.0kB&name=anaesthesia2.jpg&p=anaesthesia&type=jpeg&no=39&tt=20,162&oid=1f25affdc10feeea&ei=UTF-88/3/2019 Tutorial ANS 2011
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Synthetic Atropine Substitutes
1. Mydriatics.
2. Antisecretory-antispasmodic
3. Antiparkinsonian.
4. urinary bladder activity.
5. Bronchial asthma.
M d i i A i S b i
http://rds.yahoo.com/_ylt=A9gnMiMOW2pFdv4AgNKJzbkF;_ylu=X3oDMTBkYTNuNGk0BHBvcwMxMARzZWMDc3I-/SIG=1f1m71aei/EXP=1164684430/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=tropicamide&ei=UTF-8&fr=yfp-t-501&x=wrt&w=300&h=454&imgurl=www.drugs.com/pdr/images/pills/o03103a3.jpg&rurl=http://www.drugs.com/pdr/TROPICAMIDE.html&size=27.5kB&name=o03103a3.jpg&p=tropicamide&type=jpeg&no=10&tt=37&oid=93baaea95f7c7130&ei=UTF-8http://rds.yahoo.com/_ylt=A9gnMiNuWmpFGx0BU6eJzbkF;_ylu=X3oDMTBkM3VyNWF1BHBvcwMxNQRzZWMDc3I-/SIG=1h07lj1t6/EXP=1164684270/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=pharmacology&ei=UTF-8&fr=yfp-t-501&x=wrt&w=200&h=159&imgurl=www.ncl.ac.uk/photos/teaching_excellence/research_led/pharmacology.jpg&rurl=http://www.ncl.ac.uk/teachingexcellence/researchled/medical.htm&size=8.4kB&name=pharmacology.jpg&p=pharmacology&type=jpeg&no=15&tt=100,870&oid=349d895f5c8b79e2&ei=UTF-88/3/2019 Tutorial ANS 2011
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Atropine Homatropine Tropicamide Cyclopentolate
Duration of
action7-10 days 24 hrs. 6 hrs. 24 hrs
Concentration 1% 2% 2-5% 0.5%
Cycloplegia + + + +
Antagonismby eserine
Not complete Complete Complete Complete
Mydriatic Atropine Substitutes
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Questions
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Atropine is useful in treating poisoning
produced by organophosphate
insecticides because it:
a) Reactivates inhibited A. cholinesterase.
b) Stimulates nicotinic receptors directly.
c) Stimulates - receptors directly.
d) Inhibits normal ganglionic transmission.
e) Blocks the action of acetylcholine at peripheral
sites.
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Characteristics of neostigmine include
all of the following EXCEPT:
a) It is a parasympathetic agent.
b) It exerts both nicotinic & muscarinic
effects.
c) It inhibits acetylcholinesterases
reversibly.
d) It has a direct stimulant action on MEP
e) It crosses the BBB readily
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Which of the following symptoms is not
likely to be present in a patient poisoned
with organophosphorous compound?
a) Excessive salivation.
b) Abdominal cramps.c) miosis .
d) Tachycardia.e) Convulsions.
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Which of the following drugs is
incorrectly paired with an appropriate
use?
Atropine : Urinary retention.
Physostigmine: For overdose with
atropine-like drug.
Neostigmine: antidote to curare
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Which of the following drugs are
recognized for treatment of raised
intraocular pressure?
a) Cyclopentolate.
b) Corticosteroid eye drops.
c) Topical timolol eye drops.
d) Both c and e.
e) Dipifevrin.
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Glaucoma may occur as a side effect of
which of the following drugs?
a) Neostigmine.
b) Pilocarpinec) Homatropine eye drops.
d) Bethanechol
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For these statements, write (T) for true
& (F) for false:
1) Neostigmine may cause constipation and
bronchodilation.
2) Accepted therapeutic indications for the use of
anti-muscarinic drugs include: parkinsons
disease and motion sickness.
3) Atropine is used in Curare poisoning.
4) Pilocarpine constricts the pupil.
F
T
F
T
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COMPLETE:
Hyoscine is preferred than atropine in pre-
anaesthetic medication because:
a) More CNS depressant
b) Stronger antisecretory
c) Stronger antispasmodic
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COMPLETE:
Atropine is given before neostigmine in
Myasthenia Gravis to:
block muscarinic SE
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THE SYMPATHETIC SYSTEM
The synapse in the sympathetic ganglionuses Ach as a neurotransmitter.
The post-ganglionic sympathetic neuronwithin the target organs uses NE as aneurotransmitter.
(there is one exception)
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ADRENERGIC RECEPTORS
1. ALPHA RECEPTORS:
1
& 22. BETA RECEPTORS:
1,2 &3
3. DOPAMINE RECEPTORS: D1 & D2
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Stimulation ofalpha-1 receptors
results primarily in (Ca2+
):
Vasoconstriction.
Mydriasis. Contraction of the GIT &urethral
sphincters.
Al h
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Alpha-2receptors are
mainlypresynaptic &their
stimulationresults in a
decrease of NArelease.
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Beta-1:
(+) inotropic effect ( force),
(+) chronotropic effect (rate),(+) dromotropic effect
(conduction acceleration) &increase of excitability
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Beta-2 :bronchodilatation, uterus , bladder &GIT relaxation.
Stimulation of glycogenolysis.
Skeletal muscle tremors,vasodilatation of b.vs.
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Selective
PhenylephirineSalbutamolRitodrine
Non selectiveAdrenaline
NoradrenalineDopamine
Sympathomimetics
a) Direct
b) Indirect
CocaineAmphetamine
C) Dual
EphedrineDopamine
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Catecholamines
Adrenaline alpha1, alpha2 1, 2
Noradrenaline alpha1, alpha2, 1
Dopamine
D1 (minimal doses)
1 (intermediate dose)alpha1 (high dose)
Non Catecholamines
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Phenylephrine Direct alpha1
Clonidine Direct alpha2
Salbutamol
RitodrineDirect 2
Amphetamine
CocaineIndirect
Ephedrine
Dual
alpha1, alpha2 1, 2
Non Catecholamines
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Adrenergic depressants
1- Adrenergic receptor blockers- adrenergic antagonists (- blockers).
- adrenergic antagonists (- blockers).&blockers.
2- Sympatholytics
I Pharmacodynamic Classification
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I. Pharmacodynamic Classification
B-blockers
Non selective
Propranolol
Pindolol
Selective 1Atenolol
Metoprolol
Combined & blocker
labetalol &carvedilol
II Ph ki ti Cl ifi ti
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II. Pharmacokinetic Classification:
B-blockers
Lipophilic Hydrophilic
Li h li H d o hili
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Lipophylic Hydrophilic
oralabsorption
Complete Irregular
Livermetabolism Yes No
T 1/2 Short Long
CNS side
effects
High low
Anti hypertensive
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Anti-hypertensive
1. COP (1- blocking effect).2. Block rennin release, so Ag II &
aldosterone (1- effect).3. NE release from Nerve terminals.4. central sympathetic outflow.5. Ressetting of baroreceptor
Therapeutic Uses of Propranolol
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Therapeutic Uses of Propranolol
& other beta-blochers:
1. Hypertension.
2. Angina pectoris
3. Cardiac arrhythmia.4. Mild Myocardial infarction.
5. Prophylaxis of migraine
6. Hyperthyroidism
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OTHERS1. Familial tremors & anxiety.
2. Pheochromocytoma ( must be usedwith - blocker)
5. Open angle glaucoma
Side effects of Propranolol
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Block of cardiac 1-receptors: CHF / Severe bradycardia in patients with
impaired myocardial functions. Hypotension
Blockade of 2-(non-selective)
Severe bronchospasm ( non-selective) inasthmatics 1 are better.
Cold extremities .
Hypoglycemia if given with hypoglycemic drugs asinsulin
Sudden stoppage will give rise to a withdrawal syndrome:
Rebound angina, arrhythmia, myocardial infarction
and hypertension due to up-regulation of -receptors.
Side effects of Propranolol
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Contraindications:
1. Hypotention & heart block.
2. Severe heart failure & massive myocardial
infarction.3. Peripheral vascular disease (not CI with
cardio-selective -blockers).
4. Bronchial asthma (not CI with cardio-selective -blockers).
5. Diabetic patients. (Type I)
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PharmacokineticInteractions
PharmacodynamicInteractions
1. Hepatic enzyme
inhibitors as: cimetidine& isoniazid
1. Anti-diabetic drugs e.g.
insulin.
2. Hepatic enzyme inducersas: barbiturates,
phenytoin, & rifampin
2. Verapamil (calciumchannel blocker)
3. Non-steroidal anti-inflammatory drugs
Drug interactions
p a - T T : Prazos n
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p a T T : Prazos nTerazosin
Peripheral VD of arterial & venousSMs
PR, BP
Tachycardia (reflex)Therapeutic uses:
Hypertension Alternative to surgery in patients with
benign prostatic hyperplasia
Alpha 1 ANTAGONISTS: Prazosin
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Alpha 1-ANTAGONISTS: Prazosin
Terazosin
SIDE EFFECTS:
1. Orthostatic hypotension and syncope.
2. Salt and water retention.
3. Failure of ejaculation.
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ERGOT ALKALOIDS
Pharmacologicactions
Ergotamine Dihydro-ergotamine
Ergometrine& methyl-ergometrine
Direct VC Potent weak moderate
-blockingeffect
Weak Potent ++ weak
Oxytocic actionweak weak potent
CNS weak weak weak
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ERGOT ALKALOIDS
Uses Ergotamine Dihydro-ergotamine
Ergometrine& methyl-ergometine
Acute Migraine AcuteMigraine
Post-partumhemorrhage
Enhance placentadelivery
h i f G
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Pathogenesis of MIGRAINE
Triptans (serotonin receptor agonists)are now preferred in treatment of acute
attack of mi raine
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-Methyldopa
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-Methyldopa
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Therapeutic use
1. It is the antihypertensive drug ofchoice in pregnancy.
2. Mild, Moderate or severehypertension with impaired renal
function.
-Methyldopa
-Methyldopa
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Side effects1. Hypersensitivity reactions:
Liver damage
Hemolytic anemia
2. Sedation ( 5-HT)
-Methyldopa
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Questions
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Which of the following agents would
bring a rapid heart rate (120 beat/min)back to normal:
A. DopamineB. Atropine
C. Propranolol
D. Phenylephrine
E. Adrenaline
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At therpapeutic doses, this drug dilates thebronchioles, increases heart rate andconduction but does not elevate BP:
1. Salbutamol.
2. Adrenaline.3. Nor-adrenaline.
4. Prazosin.5. Atropine.
A drug injected I V into a dog
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A drug injected I.V. into a dog.Five minutes later, the following signs were observed :
bradycardia
broncho-constriction a fall in mean blood pressure.
The drug most likely evoked these signs is :
A. Atropine
B. Ephedrine
C. PrazosinD. Propranolol
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Atenolol differ from propranolol in:1. Its oral absorption is complete.2. It does not affect the release of renin.
3. It has more central side effects4. It has minimal risk of producing
bronchospasm.
5. It does not inhibit gluconeogenesis
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Epinephrine would cause a decrease
in mean arterial blood pressure if itis administered after pre-treatment
with :
A. A beta 1 antagonist .
B. An alpha 1 antagonist .
C. A beta 2 antagonist .D. A non-selective beta antagonist.
E. Both alpha 1 and beta 1 antagonist
Dilatation of blood vessels in muscles
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Dilatation of blood vessels in muscles,
constriction of cutaneous vessels,
positive inotropic & chronotropiceffects are all actions of :
A. Salbutamol .
B. Nor-epinephrine. .
C. Acetylcholine .D. Epinephrine .
E. Isoprenaline .
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N h l i diff f
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Noncatecholamine differ from
catecholamine in that they :
A. Have a short duration of action
B. Not effective orallyC. Dont act indirectly, but usually
combine directly with 1 and 2
receptors subtypesD. Have greater CNS effects
E. Are metabolized at more rapid rate
beta adrenoceptor blockers may
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beta adrenoceptor blockers may
lower ABP by the following
mechanisms EXCEPT:
A. Decrease sympathetic mediated renin release
B. Causing vasodilatation in skeletal muscleC. Action on CNS
D. Decrease Norepinephrine release fromsympathetic nerve endings
E. Reconditioning of baroreceptors to a lowerlevel
Patients taking beta adrenoceptor
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Patients taking beta adrenoceptor
blockers may experience all of the
following EXCEPT:
A. Exacerbation of existing heart block
B. Precipitation of heart failure
C. Increased capacity to vigorous exercise
D. Cold extremity
E. Hypoglycemia if they are diabetic
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A directly acting sympathomimetic
decongestant drug is:
A. Ephedrine.
B.Amphetamine.C. Phenylephrine.
D. Dopamine
Sympathomimetics may be employed
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y p y p y
in all of the followings Except :
A. Relief symptoms of hypersensitivityreaction to drugs
B. Induction of laborC. Narcolepsy
D. Acute hypotensive states as duringspinal anesthesia
E. Reduction of nasal congestion causing
temporary relief
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Put True or False:
A. Propranolol can reduce tremors inthyrotoxicosis.
B. B-blockers often cause orthostatic hypotension.
C. Propranolol is used in the treatment of anginapectoris.
D. B-blockers can cause heart block or
bronchospasm in susceptible individuals.E. Phenylephrine cause dilation of conjuntival
blood vessels
T
F
T
T
F
C l t
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Complete
Adrenaline acts on -------------- receptors.
Nor adrenaline acts on ---------------- receptors.
Dopamine acts on ------, ----- & ------ receptors
1212
121
D1 , 1, 1
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Complete
Nor adrenaline is used in-----------------
Atenolol is preferred over propranololin treating hypertension because
Septic shock & severe hypotension
More B1 selective
A d f l i f
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A drug useful in treatment of
postpartum hemorrhage is:
1. Dihydroergotamine2. Methyl ergometrine.
3. Ergotamine.
4. Ritodrine.
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Match the drug and clinical
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Match the drug and clinical
effect with correct receptor
Phenylephrine, salbutamol,epinephrine, clonidine.
Bronchial relaxation, nasaldecongestion, heart rate and strength,
treatment of hypertension.1 2 1 2
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Receptor Drug Clinical effect1 Phenylephrine Nasal decongestion
1 Epinephrine heart rate &strength
2 Salbutmol Bronchialrelaxation
2 Clonidine Treatment ofhypertension
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Thank You