Pharmacology

• Autonomic nervous system

Lecture No.- 5 Dr Ankit Kumar (MD, DM)

1 Anti-Cholinergic drugs

2 Atropine and congeners

3
 Anticholinergic drugs
→ Block Acetylcholine Receptor

M N

Anti-MUSCARINIC S

NN NM

GANGLIONIC Non depolarizing

KI Anticholinergic
Blocker Muscle Relaxant

DRUGS
Anti muscarinics (Anticholinergic)

Semi synthetic synthetic

NATURAL

only 2
Plants
REST All

① ATROPINE: ATROPA Belladonna' other

DATURA

HYOSCINE: HYOSCANUS NIGER.

Z
(SCOPOL platt)
1

K s
SCOPOLAMINE
Belladonna Beautiful LADY

• Natural:
Mydriasis

Enshing & Red

Anti histaminic

TRI Cyclic Antidepressant

• Synthetic: Antipsychotic

Quinine.

Amantadine.

HAVE Anticholinergic Action

• Other class:
→
FRUIT
→ DATURA

plant

LEAVES

(Atropine
Tromphet
THORN
like
Apple
leaves
 HYOSCAMUS

NIGER

BLACK pigment (Hyoscine)

flower
 Atropine poisoning v.v. Imp

→ Blocks receptor of Ach. (Mach → DUMBBELLS)

? clinical features → opposite of DUMBBELLS

POEM

feature (Dangerous)
me
in children HOT AS HARE

HYPERTHERMIA
1
4, sweating
in Adult RED, AS BEAT

MC
FLUSHING
VASODILATIM DRY AS BONE
2

DRY EYES/MOUTH Blind As BAT

3 × Lacrymation/Salivation ⇒

MAD AS MATTER
PUPIL DILATES → MYDRIASIS + CYCLOPLEGIA
4

DELIRIUM. HALLUCI nation. Seizures

CNS: b memory..> confusion =
5

CONSTIPATION, URINARY Retention, TACHYCARDIA.

6
☒ : Antidote for Atropine →
Physostigmine : Mach

Tertiary Amine

✗
CROSS BBB

not NEOSTIGMINE

Quarter nay Amine.

Do not cross BBB

 ATROPINE & HYOSCINE
DIFFERENCE b) in > Comp. Blocker

M
All type

SLOIN Action
receptor
FAST Action

CMS: More entry.

* CNS: Less entry (Mitoms

↳ sedation *
↳ Excitation 1

(calmness)
(seizures)
USES of Anti-cholinergics DRUGI.

EACH ORGAN : effect

CNS

Heart

Eyes

Resp.

Bladder

GIT
CNS
✗ nation + A excitation (seizure)
ATROPINE: t memory/co

Cortex + A sedation (CALM)

HYO SAME: t, memory/cognition

IN ILL not tell

1¥
Lie

NARCO-ANALYSIS

or

TRUTH SERUM

O HYOSCINE

Barbiturate
2 THIO PENT one
in

- FAST

DOC
 Avoid Anticholinergic : Memory/cognitive loss
*

Alzheimers (DEMENTIA)

Twilight Sleep
Amnesic sleep
* Hyoscine
 BALANCE

Dopamine 1
Basal ganglia 1, Acetylcholine =

opposite
It dopamine
99 Ach

Dopamine gets reduced

in Parkinson Dis

TH OF Parkinson
v.Imp
3G.
(MUSCULAR
: DRUG induced DYSTONIA
use: Anti-cholinergic DRUGS
Parkinson's
Parkinson
Rigidity
BENZ HEXOR (TRI HEX PHENIDY)
•
° 2°
• BENZ TROPINE
NEURODEGEN" DRUG induced

- BIPERIDEN
Block
Do Samine deficency
Dopamine

9 dopamine level receptor • PROMETHAZI Ned

, Ach level. (Anti-histaminic

DOC LEVODOPA
DOC: Anticholinergies
 TH Motion sickness

Vestibule (inner ear) *

VESTIBULAR suppressant
Movement CAR/ BUS (MOTION)
Endolymph.
• Y
.
: •
•
: Anti muscarinic Antihistaminic
o +

VESTIBULAR
(Block MD (Block H1)
+ cerebellum
+
Ms 1

④ HYOSCINE • DIPHENHYDRAMINE
HI DOC

É CTZ Area
scopolamine) • PROMETHAZINE

MOTION • CYCLI ZINE

+ NAUSEA
vomiting
o MECLI ZINE
SICKNESS

• CININARI ZINE

y.X.JP
 ORAL
Route: All DRUGS →

Hyoscine & Diphenhydramine → Also Transdermal patch

Applied

Post auricular Area

f) E: Sedation 99

Behind pinna

> Eshedrine

Overcome sedation
(stimulant: 9 Alerting
 These Drugs must be taken At least 30min beforejourney!

↳ only for prevention of nausea/vomitry.

has started!

Not effective if Vomit

Noin alredy (T2)

Heart

PSMS (VAGUS)
SNS
ATROPINE
(Titots)

Norepiephrine

: 31 receptor
Block

÷ Acetylcholine: M2 receptor
+ SA: THR

- AV: A conduction
inhibit SA - t.HR (Bradycardia)

to conduction (AV mode)

inhibit AV Block.
 BRADYCARDIA 1 eas
ATROPINE DOC

All node Block Blocks 142

in + It
on SA/All node

Emergency Medicine

for All causes

ooine is Not effective in

exception: -T
I.
→
Isoprenaline
Transplanted HEART
Brady ardea in

+ Bi on Heart
 is Dennervated Heart

Atropine (Antagonist

Vagus

:: Ach
M2
&

310 Isoprenalese
pi Agonist:

Norepi
Transplanted

Heart
 WHAT is the effect of Atropine on Heart RATE?

A: Bradycardee Atropine inchal Brady cerdee (few seconds): Block Mi

on vagus

than tachycardia (main effect : Blocks M2 on Heart

B: TACHYCARDIA

C: Both
Atropine: Blocks Mi presynaptic

D: None. on vagus: Mach ⇒ Brady@

release

VAGUS

⇒Tacky
SA (M2) Blocks Mz postsynaptic
am
on SA
+
✗ M1 synapse
: -HR
M2: Postsynaptic
Mi: Presynaptic

receptor on vagus

/ Release of Ack.
 Respiratory
Bronchus

SNS: 132
PSNS: M3

mucous Bronchodilaton
• Broncho constriction.

• 99 mucous prod"

GA ASPIRATION

→ Broncho dilation + Reduce Mucous

Anticholinergic: Block M3
production
 KY & DILATED Bronchus

produce:

V • Pre-Anesthetic medication
1 Systemic DRUGS (oral, i

Intubation
→ Before Surgery: Helps

ATROPINE

Tertiary

Amine
HYOSCINE

CentLBB)
:
→EYY.LI?YIpirf
T mintowings
.
GLYCOPYRO LATE

Quaternary Amine
↳
(Do not enter BBB)
I
 Inhalational Drugs: Broncho dilation
2

ASTHMA & COPD

→ #

Anticholinergic
in combination I 132 Agonist

shortest
• IPRATROPIUM

• TIOTROPIUM
are Absorbed
¥: = 5% inhaled DRUGS
OXYTROPIUM.
into Blood

• UMECLIDINIUM

Atropine likes/e: Constipation

• ACLIDINIUM urinary retention

Longest
Tachycardia.
 /PRATROPIUM in some patients may cause

paradoxical Bronchoconstriction
0

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