Pharmacology

• Autonomic nervous system

Lecture No.- 6 Dr Ankit Kumar (MD, DM)

1 Ganglionic blockers

2 Sympathetic nervous system

3
If it makes you happy,

Its never a waste of time!

Ganglionic blockers
on post ganglionic neums
↳ Block Nn receptor

* sympathetic * Parasympathetic

reduce activity
reduce activity

/ SNS • PSMS

£3

/ ( (m

1 Nn
Nn"
 SNS PSNS

(T-Ts) ✗ AGUS

Added

M HR x HR Ganglionic

Blocker.

: HR 60-100 BPM
N

DENERVATED HEART

HR = 105-110 BPM

no nerve supply
 Block Both SMS & PSNS

Organ system Predominant nerves Action of Ganglionic blockers

Heart PSMS: * HR.

TACHYCARDIA

GIT DUMBBELLS
PSNS : 9 Motility CONSTIPATION. Atropine

Glands PSNS: A sech. DRY EYES/mouth/sweating} like

Bladder PSNS: A urination URINARY Retention

1
Intestine
Dodo EYES PSNS : 9 MIOSIS. MYDRIASIS.

Blood pressure SNS. IBP. Postural Hypotension.

Penile erection PSMS: Merchan Erectile Dysfunction

Penile ejaculation SNS: A ejaculation. Inhibit ejaculation.

Lot of Sle ⇒ ganglionic Blocker are Rarely used!.

 which Ste of Ganglionic Blockees is not Atropine we.?

E- DRY eye/mouth

B: TACHYCARDIA

C: Constipation

D: Hypotension.
 DRUGS in Ganglionic Blockies

Competitive Blockes Persistant depolarizing Blocker

0 (Block NN) (Den sensitization of Mn)

receptor

• Hexamethonium OFF- LABEL

• Organophosphate

1 Smoking Cessation.

• succinyl choline
• MECA MYLAMINE 2 Nicotine poisoning

continuously stimulate
@ TRIMETHAPHAN.→ Ifv: ULTRASHORT.

NOW DOC DURING ARTERY SX

Nn Depolarize

(AORTIC DISSECTION)
B P BLOCKER: ESMOLOL.fr
DESENSKI
 Effect of acetyl choline on Heart rate and BP
Reflex sympathetic
Nn &}
Tachycardia
❤pi +
M2 Mz +
: t.HR. ABP
Heart HR.

Brady C

Rapidly degraded: PACHE

→ if Ach. M3 +
N

+ BP
M3
BY
+ BP

NO

/
VASODILATOR.
if Ach.

BI +
NN
+ BARO receptor → EZ BP
÷ ÷❤
+ SNS Ach Nor
ep THR
 Mean Arterial pressure. (DBP + SBP)
MAP
Brain:
→

Normal BP
% ,

❤
BP It
E}
HR
DBP SBP

, HR.
BP 99

%
Reflex Tachycardia.

VASODILATION (II
*
inversely

proportion.
Reflex Brady cerde
ap
Vasoconstriction (MBP)
 SNS
Stils overachuity
C: & when Hexamethonium is given
: 'I
Pi NN.
AllMS
along c- Acetylcholine
N 2019
HR
Mz B

which wave will

BP
A
'I Not be seen?

9 in Ach Answer: c
Block NN

prevent Reflex tachycardia

 Sympathetic nervous system
1

KI ADRENERGIC nervous system

+
EMERGENCY

Dog BITE
Adrenergic drugs Nervous system

Endogenous Catecholamines

•1 ADRENALINE (14s Epinephrine)

•2 NOR- ADRENALINE (14s Nor-epinephrine

•3 DOPAMINE
 TYROSINE QQ.

Synthesis sympathetic TYROSINE HYDROXYLASE (RATE Limitin

Q
OF step.
neuron DOPA METYROSINE
CATECHOLAMINES

DOPA DECARBOXYLASE
CARBIDOPA.BE NSA RAZIDE

Dopamine 1st

enter
RESERPINE Vesacle
Adrenal Hormone
VMAT-2 •
Tetrabenazine Epi Medulla o o o o o o
Dopamine"
VALBENAZINE Dopamine
Hydroxylase. ont
Blood
Dopamine
2
÷.. Norepi PEN MT enzyme
- QQ. *
• CNS
Phenyl Ethanolamine N Methyl Transferase.
• GIT
• Kidney
All ORGANS
Methyl group
DISULFIRAM
Add

Epi
Norepi
✗
Post synapticP
organs
 DRUGS MOA uses

QQ

① METYROSINE DOC
inhibit Tyrosine Hydroxylase HEOCHROMO cytoma

(Rate Limiting) (inoperable cases)

7ft of Parkinson Db
Inhibit DOPA decarboxylase
2 CARBIDOPAO
along i L-DOPA
BENSARAZIDE (only outside Brain

Use: Hypertension

VMAT inhibitors
3 RESERPINE Banned: Depression

DA suicides
(irreversible ① (Vesicular Mono Amine)

Transporter DA

DOC
Terrabenazine HUNTINGTON'S
0,
VALBEN Azine (Reversible " DOPAMINE DEPLETORS CHOREA
 Prodry of Nor-epi It: HYPOTENSION.
4 DROXIDOPA

to

norepi

00 MBP
°

+ # Hypertension
Inhibit Norepi release
5 GUANETHIDINE

Adrenergic Neuron Blocker

norepi k s

Not used Anymore

-

Release Q.
- Severe Postural
00 O SE
o do
HYPOTENSION
AFTER RELEASE OF CATECHOLAMINES

Epi.

Dopamine Blood

8:

Norepi.

0::

Receptors

B.
 HOIN Action of CATECHOLAMINE is finished

QQ

Neurons
DAT
Liver.
Reuptake

• Dopamine Transponer > epi oo

- Nor epi Transporter Blood

Dopamine

NET
Neurons
Norepi
ENT

EXTRA. Neunnal

Transporter
 DRUGS → inhibit Reuptake of Catecholamines

* 1st Local Anesthetic DRUG

① Cocaine that 9 sympathetic activity

LA
① DAT, ① NET etc * Only

(sympathomimetic
⇒

* only LA that produce Vasoconstriction

$

9BP)
* Highly Addictive

2 Antidepressants also
? HAPPEN After Reuptake CATECHOLAMINES

are degraded inside neurons/ liver

by Enzymes.

COMT enzyme.
MAO enzyme

(CATECHOL 0 methyl)
(Mono Amine Oxidase
=
Transferase

nonspeape enzyme: Deprades other Amines also specific enzyme

Leg Histamines Serotonin, Tyramine) for catecholamine.

ef
MAO
DOPAC
① Dopamine

COMT
3 Methyl Dopamine

Nor metanephrin
2 Nor epi
COMT

excreted in Urine
Metanephrin.
Epi
COMT

VMA (V Anilyl Mandellee aced)

Norepi & Epi
3 MAO + COMT
① A young male pt- came to OPD I High BP, Tachycardee,

sweating and Anxiety ! (9SMS)

Metanephan, nor-metanephon & VMA

HIS 24hr urina Levels

are HIGHLY RAISED !

COLD standard test to diagnose

? Diagnosis

PHEOCHROMOCYTOMA

_
NEXT: Adrenergic Receptors (✗ , B)

CLASS

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thank You

END