Pharmacology Week 2: Autonomic drugs and Substance Use Disorders

What is the nervous system we are focusing on and what are their 2 subdivisions?

autonomic nervous system that is involuntary and functions without conscious effort - sympathetic and parasympathetic

Cervical nerves

Thoracic nerves

Lumbar nerves

Sacral nerves

What does the autonomic nervous system control?

BP , pulse, respiration, temp, salivary gland excretion

The space in between 2 neurons is called the _________ & the neuronal junction is called the _________

synaptic cleft ; synapse

If the connection between 2 neurons is outside the CNS it is called a

ganglion

How does one neuron communicate with another neuron and w the rogan they innervate?

via neurotransmitter

What is the function of neurotransmitters?

carry nerve impulses across the synapse

Where are neurotransmitter synthesized?

in the neuron

Preganglionic neuron

neuron located before the synaptic cleft aka presynaptic neuron

Postganglionic neuron

neuron located after the synaptic cleft - aka postsynaptic neuron

What is synaptic transmission?

action potential reaches synapse, presynaptic neuron and action potential forms synaptic cleft with receptor and postsynaptic neuron

Neurotransmitter released in synaptic cleft

neuron has neurotransmitters that are transferred over to a receptor or another neuron causing an action potential

What are the types of neurotransmitters in the ANS?

acetylcholine and norepinephrine

Sympathetic

fight or flight for emergency situations

Sympathetic autonomic nervous system: where do the neurons originate?

thoracolumbar portion of the spinal cord

Fight or flight in relation to organ systems:

dilated pupils, inhibits saliva, heart beats faster breathing is faster and easier due to dilation, increase BP inhibits digestion, sex organs, releases glucose, secretes noepi and epinephrine

Sympathetic receptors are classified as either

alpha -1

alpha - 2

or beta -1

beta - 2

beta -3

Beta 1 receptor

heart

Beta 2 receptor

lungs

Drugs that interact with these receptors and stimulate the sympathetic nervous system are called

adrenergic or sympathomimetic or further defined as alpha adrenergic or beta adrenergic

Chemicals that interact with the sympathetic nervous system receptors are classified as

catecholamines or sympathomimetics

T or F: sympathetic adrenergic drugs mimic the effects of the sympathetic nervous system

TRUE

In the sympathetic nervous system, where is acetylcholine released?

from all preganglionic neurons

In the sympathetic nervous system , where is norepinephrine released from?

postganglionic neurons

What are exceptions to the sympathetic system that act differently than we expect?

sweat glands and the adrenal medulla

Parasympathetic

rest and digest

Parasympathetic system: the cell bodies of the preganglionic nervous originate from what?

4 cranial nerves: III, VII, IX, X - from the sacral regions of the spinal cord

Rest in digest in relation to organ systems:

pupil constricts, stimulates sex organs , stimulates saliva, digestion, and gallbladder, constricts breathing and slows heart, contracts bladder

Dilation of pupils

mydriasis

Constriction of pupils

miosis

Parasympathetic receptors are classified as either:

muscarinic or nicotinic

The term associated or another word for parasympathetic activity is

cholinergic

REVIEW: What is another word for sympathetic?

adrenergic

Drugs that interact with muscarinic or nicotinic receptors and stimulate parasympathetic nervous system may be...

cholingeric, cholinomimetic, parasympathomimetic - called muscarinic or nicotinic agonists

T or F: parasympathetic / cholinergic drugs mimic the effects of the parasympathetic nervous system

true

what are the 2 types of cholinergic receptors ?

muscarinic and nicotinic

What is the neurotransmitter released form the parasympathetic pre and post ganglionic nerves

Ach

Antagonists at alpha or beta receptors (sympathetic) are called

sympatholytics

Antagonists at muscarinic or nicotinic receptors are called

parasympatholytics

True or false: PANS and SANS divisions of the ANS tend to act in opposite directions

true

PANS is concerned with

conservation of body process

SANS is designed for

emergencies

T or F: almost all body tissues are innervated by the ANS receiving Bothe parasympathetic and sympathetic innervation

True

What is the mnemonic to remember the effects of the parasympathetic nervous system?

S - salivation

L - lacrimation

U - urination

D - defecation

Sympathetic effects include

xerostomia, dry eyes, constipation

Adrenergic receptors effects

alpha causes vasoconstriction beta 1 stimulates heart muscle and beta 2 causes lung dilation

Sympathetic drugs mimic sympathetic nervous system

yes

Cardiovascular effects of adrenergic agents

increase force and strength of contractions, increase BP

Adrenergic effects of the eye

mydriasis, decrease in pressure of eye

adrengergic effects on respiration

relaxation of bronchiole smooth muscle

Adrenegeric effects ons alivcary glands

thick saliva - reduced flow xerostomia

Adverse effects of adrenergic affects:

excitation, fear, tremor, arrhythmia, hypertension, xerostomia

Contraindications to adrenergic agents

uncontrolled HTN , angina, uncontrolled hyperthyroidism

What are examples of adrenergic agents?

albuterol

isoproterenol

Epinephrine

dopamine

Albuterol (ventolin)

used for asthma

Isoproterenol (isuprel)

used for asthma

EPI

anaphylactic reactions and cardiac arrest

dopamine (intropin)

treats shock

effects on the heart - isoproterenol

non selective has effects on the heart

effects on the heart - albuterol

selective - no effects on the heart

If adrengeric drugs mimic the sympathetic system thennnn drugs that block it would

mimic effects of parasympathetic NS

Adrenergic blocking agents are used to treat what?

arrhythmia, htn, angina, glaucoma, MI

What are examples of adrenergic or sympathetic blocking agents:

doxazosin

propranolol

atenolol

metoprolol

ALL for hypertension

timolol - treats glaucoma

BLOCKS ONLY BETA 1 RECEPTORS

Effects on the lungs: propranolol

nonselective - has effect on the lungs

effects on the lungs: atenolol

selective - has no effect on lungs

What is used as a vasoconstrictor in LA?

EPI - use no more than 2 cartridges 0.04 mg and 1:100,000 in cardiac pts taking non selective beta blockers (since it affects the heart)

What is the major transmitter in the parasympathetic autonomic NS:

acetylcholine

2 types of cholingeric receptors:

nicotinic and muscarinic

cholingeric effects

mimic parasympathetic system

since the cholinergic agents act like the parasympathetic system, what are the 2 ways they can act?

direct acting by acting like acetylcholine OR indirect acting and causes increase in amount of acetylcholine by inhibiting acetylcholinesterase (enzyme that breaks down ach)

What are DIRECT acting cholinergic agents?

pilocarpine (treats dry mouth and glaucoma) nicotine (tobacco cessation)

What are INDIRECT acting cholinergic agents?

Donepezil for alzheimers

DH considerations

xerostomia treated with pilocarpine

What are the anticholingeric agents - blocking agents that block acetylcholine action for the parasympathetic nervous system?

Atropine - decrease salivary flow

Loperamide - treats diarrhea

Scopolamine - motion sickness (know this one)

Name of med for motion sickness that is a blocker :

scopolamine, meclizine, and dimenhydrinate

What are adverse effects of anticholinergic drugs? think ABCD

xerstomia, urinary bladder renentuon, blurred vision, constipation

Medication to clear field of salivary glands?

atropine

Abuse

use of a drug for nonmusical purposes for altering consciousness

Misuse

using a drug in the wrong dose or for a longer period than prescribed

Abstinence syndrome

state of being free of drugs

Drug abuse

self administration of drug in socially unacceptable manner results in negative consequences

Drug dependence

state that is physical, physiological or both occurs w consequence of interaction between drug and the pt

enabling

behavior of family or friends that resulting in continues drug abuse

withdrawal

symptoms that occur when physically dependent person stops using drug

Psychological dependence

state after withdrawal where emotional abnormalities and drug seeking behavior occur

Physical dependence

altered physiologic state that results from constantly increasing drug amt, established by withdrawal or abstinence syndrome

T or F: withdrawal symptoms are opposite of symptoms when using drug

true

Tolerance

need to increase the dose to achieve desired effect - giving same dose dont work

central tolerance

decrease in the response of brain tissue too constantly increasing amounts of drug

addiction

compulsive use despite complications and frequent relapses after quitting

habituation

physiological tolerance to or psychological dependence on drug

Cross tolerance

aka cross dependence - substitution to suppress withdrawal between different drugs

What are CNS depressants?

ethyl alcohol

nitrous oxide

opioids

Where is ethyl alcohol oxidized?

liver

What is the term for withdrawal of ethyl alcohol?

delirium tremens (DTs) - causes shaky movements

Alcoholism

drinking despite having negative consequences, shaking when not drinking, blackouts, inappropriate time

Treatment of alcohol:

disulfiram - makes u sick if u drink on it

naltrexone (revia) - reduces alcohol cravings

Nitrous oxide

abused by dentists, dh's, da's

What is the effects of a high from nitrous oxide?

psychological - 50-75% inhalation produces high for 30 seconds followed by euphoria and detachment from 2 to 3 mins

What happens if you use nitrous oxide for a long time?

myeloneuropathy - loss of finger dexterity and numbness, paresthesia of extremities