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Autonomic Drugs (Parasympathetic (Pre-ganglion (Ach -> Nn (ligand gated…

- - - - Post ganglion
        
        Ach -> M1(g-protein coupled receptors)
        
        Phospholipase C -> IP3 -> Protein kinase C -> Calcium increase
        
        higher cognitive function, enteric nervous system
        
        Ach -> M2(g-protein coupled receptors)
        
        Adenylyl cyclase -> ATP -> cAMP -> protein kinase A -> Calcium increase
        
        Decrease HR and contractility of atria
        
        Ach -> M3(g-protein coupled receptors)
        
        Phospholipase C -> IP3 -> Protein kinase C -> Calcium increase
        
        Increase exocrine gland secretion, increase peristalsis, increase bladder contraction, bronchoconstriction, pupillary sphincter muscle contraction, ciliary muscle contraction, insulin release
        
        Agonists- parasympathetic affectts
        
        DIRECT - CHOLINOMIMETIC AGENTS: Selective agonists for muscurinic receptors and not for nicotinic
        
        Carbachol
        
        relieves intraocular pressure in open angle glaucoma
        
        Methacholine
        
        challenge test for asthma - bronchoconstriction
        
        Pilocarpine
        
        stimulator of sweat, tears, saliva, open angle and closed angle glaucoma
        
        Bethanchol
        
        activates bowel and bladder
        
        INDIRECT AGONISTS: Anticholinesterases
        
        Galantamine, donepezil, rivastigmine
        
        Alzheimer
        
        Edrophonium
        
        Diagnose Myasthenia gravis
        
        Neostigmine
        
        Post-op and neuro ileum and urinary retention
        
        Physostigmine
        
        Antiodote for anticholinergic toxicity
        
        Pyridostigmine
        
        Myesthenia gravs
        
        Antagonists (anti-cholingeric) - sympathetic affects
        
        Atropine / homatropine / tropic amide
        
        Eye - mydriasis / cycloplegia
        
        Benztropine
        
        Parkinsons
        
        Glycopyrrolate
        
        Preop reduce airway secretions, drooling
        
        Hyoscyamine
        
        Antispasmodics for IBS
        
        Ipratropium
        
        COPD/ asthma
        
        Oxybutynin
        
        Reduce bladder spasms and urinary incontinence
        
        Scopolamine
        
        Motion sickness
- - - - Post ganglion
        
        Ach -> M (g-protein coupled receptors)
        
        Sweat glands
        
        Alpha
        
        Ne / Epi -> A2
        
        Adenylyl cyclase -> ATP -> cAMP -> protein kinase A -> Calcium increase
        
        Decrease in sympathetic outflow, insulin, lipolysis, aqueous humour production, increase in platelet aggregation
        
        Clonidine/guanfacine - hypertension urgency, ADHD / Tourette
        
        Methyldope - hypertension
        
        Ne / Epi -> A1
        
        Phospholipase C -> IP3 -> Protein kinase C -> Calcium increase
        
        Increase in vascular smooth muscle contraction, pupillary dilator muscle contraction, intestinal and bladder sphincter contraction
        
        Midodrine: autonomic insufficiency and postural hypotension.
        
        Norepineprhine. Hypotension and septic shock
        
        Phenylephrine - hypotension, ocular procedures, rhinitis
        
        Alpha blockers: (PSN)
        
        Phenoxylbenzamine : Pheo
        
        Phentolamine: MAO inhibitors who eat termini containing food
        
        A1 selective: Prazosin / terazosin/ tamsulosin: Urinary symptoms of BPH . PTHS, hypertension
        
        A2 selective: Mirtazapine: Depression
        
        Beta
        
        Epi -> B2
        
        Adenylyl cyclase -> ATP -> cAMP -> protein kinase A -> Calcium increase
        
        Vasodilation, bronchodilation, lipolysis, insulin. Decrease uterine tone, ciliary muscle relaxation
        
        Albuterol / Salmeterol
        
        Epinephrine . Anaphylaxis, asthma, open angle glaucoma, a effects predominate at higher doses.
        
        Ne / Epi -> B1
        
        Adenylyl cyclase -> ATP -> cAMP -> protein kinase A -> Calcium increase
        
        Increase in HR/contractility, renin, lipolysis
        
        Dobutamine. - Heart Failure
        
        Isoproterenol: Evaluation of tachyarrhythmias
        
        B3
        
        Adenylyl cyclase -> ATP -> cAMP -> protein kinase A -> Calcium increase
        
        Lipolysis, thermogenesis, bladder relaxation
        
        Urinary urge incontinence or overactive bladder
        
        B-blockers : olol
        
        Angina, MI, SVT, HTN, HF, Glaucoma, variceal bleeding.
        
        B1 = selective = A to M
        
        B2 = selective = N to Z
        
        Nonselective have modified suffixes instead of olol
        
        D -> D1
        
        Adenylyl cyclase -> ATP -> cAMP -> protein kinase A -> Calcium increase
        
        Relaxes renal vascular smooth muscle
        
        Dopamine: Unstable bradycardia / HF / shock. Inotropic and chronotropic effects.
        
        Fenoldopam: Postop hypertension, hypertensive crisis.
        
        Ach -> Nm
        
        Skeletal muscle