Pharmacology 181

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• Pharmacology 181
• Autonomic Nervous system
• CHAPTER 13
• Dr. Jay Shahed

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Definition

• ANS Divisions
• Sympathetic
• Body under stress
• Flight or fight
• Parasympathetic
• Body returning to normal
• Mediators
• Neurotransmitters
• Chemical substances that are released at the
  nerve endings that are responsible for all cell
  activity.

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Drugs

• Adrenergics
• Sympathomimetics.
• Adrenergic Blockers
• Beta blockers
• Anti-adrenergics
• Cholinergics
• Parasympathomimetics
• Cholinergic blockers
• Anticholinergics

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Adrenergics (Sympathomimetics)

• Enhance the Sympathetic Nervous System.
• Epinephrine (ADRENALIN)
• Bronchospasm
• Anaphalaxis reactions
• cardiac arrest
• Asthma
• Ephedrine ( EPHEDRINE )
• raises Blood pressure
• Decongestant
• Bronchodilater

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• Dopamine ( INTROPIN)
• Elevates BP
• Cardiotonic
• Isoproterenol ( ISUPREL)
• Bronchospasm
• Ventricular arrhythmia
• Metraminol ( ARAMINE )
• Raises BP in shock
• Norepinephrine ( LEVOPHED)
• Raises BP in Severe Shock

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Actions

• Cardiac stimulation
• Increase blood flow to skeletal muscles
• Increase peripheral vasoconstriction
• Bronchodilation
• Dilatation of the Pupils ( Midriasis).

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Indications

• Restoration of rhythm in cardiac arrest
• Elevation of B.P in situations of shock
• Capillary constriction
• Nose bleed
• Local Anesthesia
• Nasal congestion

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• Bronchodilation
• Asthmatic attack
• Anaphylactic reactions
• Bronchospasm
• Opthalmic procedures
• Mydriatic agents
• Surgery

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Side Effects

• Palpitations
• Nervousness
• Tremors
• Cardiac arrhythmias
• Angina
• Hypertension
• Tissue necrosis,
• Hyperglycemia
• Insomnia
• Headaches.

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Contra indications

• Angina
• Arrhythmia
• Coronary insufficiency
• Hypertension
• Closed angled Glaucoma,
• Hyperthyroidism.

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Interactions

• CNS drugs
• Antidepressants and alcohol
• Beta Adrenergic Blockers
• ( Inderal ).

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Adrenergic blockers (Beta blockers/
antiadrenergics)

• Action
• Blocks the action of the Sympathetic Nervous
  System.

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Drugs

• Propranolol ( Inderal ).

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Indications

• Hypertension
• Angina Pectoris
• Cardiac arrhythmias
• Migraine Headaches

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Side Effects

• Hypotension
• Bradycardia
• Fatigue
• Lethargy
• Nausea and vomiting
• Hypoglycemia
• Confusion

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Contraindications

• Congestive Heart Failure
• Hypotension
• Asthma
• Diabetes

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Interactions

• Digitalis
• Insulin and other Oral hypogycemic
• Aminophylline
• Isuprel
• Epinephrine
• Alcohol

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Caution

• Pts on Beta blockers are advised to rise slowly
• Report dizziness and weakness
• Avoid alcohol and sedatives
• Report sexual dysfunction .
• Report depression.

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Cholinergics (parasympathomimetics)

• Enhances the action of the parasympathetic
  nervous system.
• Mechanism
• Releases a neurotransmitter (
  Acetylcholine) which is able to mimic the
  function of the parasympathetic nervous system.

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Drugs

• Bethanochol Urecholine
• Reduces urinary retention
• Neostigmine Prostigmine
• Treatment of Myasthenia gravis.
• Edrophonium - Tensilon
• Test for Myasthenia gravis
• Pilocarpine Isopto Carpine
• Treat Glaucoma

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Actions

• Increase GI peristalsis
• Increase contraction of the bladder
• Increase secretions
• Sweat, saliva, gastric juices)
• Increases skeletal muscle strength
• Lower intraocular pressure.
• Pupil constriction
• Slowing heart rate

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Side Effects

• Nausea, vomiting, diarrhea.
• Muscle cramping and weakness
• Hypotension
• Bradycardia
• Diaphoresis
• Depressed respiration
• Acute toxicity
• Treated with Atropine.

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Contraindications

• Benign Prostatic Hypertrophy.
• GI disorders ( Ulcers )
• Asthma
• Cardiac disorders

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Interactions

• Procainamidine
• ( Procan)
• Quinidine

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Cholinergic Blockers ( Anticholinergics)

• These drugs block the action of the
  Parasympathetic Nervous System.

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Drugs

• Atropine
• Treatment of insecticide poisoning
• AV block
• Bradycardia
• Antispasmodic
• Pre-anesthetic
• Mydriatic (pupil dilation)
• Bronchodilator.

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• Scopalamine ( Transderm scop).
• Motion sickness
• Glycopyrrolate ( Robinul)
• Preopretave
• Methantheline ( Banthine )
• Bladder spasm
• Homatropine (Isopto - Homatropine ).
• Mydriatic

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Actions

• Drying
• Decreased all secretions
• Decreased GI and GU motility
• Pupil Dilation

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Side Effects

• Fever
• Blurred vision
• Dry mouth
• Constipation and/ or urinary retention
• Confusion and Headaches
• Palpitations and tachycardia

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Contraindications

• Closed angled glaucoma
• GI and GU obstruction
• Cardiac arrhythmias
• Hypertension
• Hypothyroidism
• Hepatic or renal disease

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Interactions

• Antihistamines
• Benadryl
• Increase drying further

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Caution

• When using it on Asthmatics and COPD patients.
• Increases drying that leads to narrowing and
  blockage.

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• Pharmacology 181
• Anticonvulsants and Anti-Parkinson drugs.
• CHAPTER 22
• Dr. Jay Shahed

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Anticonvulsants

• General Indication
• Used to reduce the number of episodes and the
  complexity of seizures.

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Seizures

• Definition
• Abnormal involuntary brain waves
• Etiology
• Idiopathic ( Most common).
• Head injury
• Fever
• Tumors
• Intoxication
• Chemical imbalance

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Seizure classification

• Generalized seizures
• Grand mal
• Petit mal

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• Partial ( Focal )
• Complex Symptomatology
• Temporal Lob.
• Confusion, impaired judgement, staggering,
  purposeless movement, bizzare behavior
• No convulsions

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• Unilateral Seizures
• One side of the body
• Unclassified
• Insufficient Data to classify

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Generalized Seizures

• Grand Mal
• Loss of consciousness with generalized
  convulsions that involves the whole body
• Tonic - Clonic seizures
• May involve urinary and fecal incontinence.
• Petit Mal ( Absence )
• Few or No convulsions, temporary or no loss of
  consciousness.

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Grand Mal Drugs

• Phenytoin ( Dilantin )
• Psychomotor, Grand mal and focal.
• Drug of choice
• Usually administered with Phenobarbital
• Carbamazepine ( Tegretol )
• psychomotor ( Partial or mixed seizure).
• Primidone ( Mysoline )
• Psychomotor seizures

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Side effects

• Sedation
• Dizziness
• GI disturbance
• Headaches
• Gingivitis
• Rash
• Megloblastic anemia
• Osteoporesis.

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Contraindications

• Hepatic disorders
• Renal disorders
• DM
• CHF
• Hypotension
• Pregnancy and lactation.

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Petit mal drugs

• Ethosuximide ( Zarontin )
• Drug of choice
• Clonazepam ( Klonopin )
• Valproic Acid ( Depakene, Depakote )

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Side effects

• Sedation
• Dizziness
• Irritability
• GI distress
• rash
• Leukoplakia

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Caution

• Hepatic and renal disorders
• Pregnancy and lactation.

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Special instructions

• Drugs must be taken at the correct time and the
  correct dose required.
• Caution should also be undertaken when driving or
  operating heavy equipment.

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Anti-Parkinson Medications

• Mechanism
• Decrease in the Dopamine level
• Etiology
• Uknown
• Clinical Manifestation
• Shuffling gait
• Rigidity and weakness of muscle
• Muscle tremors

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Dopamine Agonists Drugs

• Levodopa (L Dopa )
• Usually given with bromocriptine ( parlodel) for
  long term treatment.
• Bromocriptine ( parlodel)
• Dopamine agonist
• Sinemet (L dopa carbidopa)
• Selegiline ( Elderpryl )
• A MOA inhibitor
• used after L- Dopa begins to wear off.

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• Side effects
• Lvodopa
• Dyskinesia
• Involuntary movement of many parts
• N/V/D
• Behavior change,anxiety, agitation, confusion,
  psychosis
• Hypotension, dizziness and syncope.
• Brmocriptine
• Psychosis
• Hypotension
• Nausea

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• Contraindications
• L- Dopa
• Asthma
• emphysema
• Glaucoma
• Hepatic and renal disorders
• DM
• CHF
• Hypotension
• Pregnancy and lactation.
• Slegiline
• Demrol
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors ( SSRI)

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• Interactions
• Vitamin B6
• Phenytoin
• Antihypertensives.
• MAOIs

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Anticholinergics Drugs

• Atropine like drugs
• Benzotryptane Artane
• Trihexyphenidyl ( Cogentin )
• Indications
• Parkinsonlike tremors
• Side effects
• Dry mouth
• Dizziness
• Blurred vision
• confusion and depression.
• Constipation

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Amantadine

• Antiviral
• Anti-parkinsonian
• Side effects
• Depression
• Confusion
• Hallucination
• Dizziness
• CHF
• N/V/D

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• Contraindications
• Epilepsy
• Hepatic and renal disorders
• Psychosis
• CHF.