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SANS 4 PANS, Parasympatholytics (Anticholinergic), Indirect…

- - - - Vasoconstriction:
        
        Hemostasis: stop bleeding
        
        Prolong action of the local anesthetics
        
        Nasal decongestion
      - Cardiac Effects:
        
        Treatment of shock
        
        Treatment of cardiac arrest
      - Bronchodilation:
        
        Helps treatment of respiratory disease
      - Overactive Bladder:
        
        Mirabegron
      - CNS Stimulation:
        
        "diet pills"
        
        Diethypropion
        
        treatment for ADD and narcolepsy
        
        Methylphenidate
        
        Dextroamphetamine
    - - CNS Effects
        
        Produces CNS excitation or alertness
      - Cardiovascular Effects
        
        Heart
        
        Increase its force and strength of contraction
        
        With Epi: produces widening of pulse pressure
        
        With NE: increase in BP, the vagal reflex decreases the heart rate
        
        With isoproterenol: produces vasodilation which triggers an increase in heart rate
        
        Vessels
        
        responses depend on location of vessels and the type of receptors are innervated
        
        a receptors: produce vasoconstriction in skin and mucosa
        
        b receptors: produce vasocodilation of skeletal muscle
        
        Blood Pressure
        
        Generally an increase
        
        With Epi: systolic increases and diastolic decreases
        
        With NE: increase in both systolic and diastolic
        
        With isoproterenol: no change in systolic, but diastolic decreases
      - Effects on the Eyes
        
        Decrease in intraocular pressure
        
        Useful in treatment of glaucoma and mydriasis
      - Effects on Respiratory System
        
        Causes relaxation of the bronchial smooth muscle
        
        Useful in treatment of asthma and anaphylaxis
      - Metabolic Effects
        
        Hyperglycemia: increased glycogenolysis and decreased insulin release
      - Effects on the Salivary Glands
        
        Mucus secreting cells of submandibular and submental glands are stimulated
        
        Produce vasoconstriction, the flow of saliva is reduced causing xerostomia
      - Effects on the Bladder
        
        B3 receptor: relaxes bladder
        
        Allows bladder to fill with urine until sending message to brain that they need to urinate
    - - Epinephrine
      - Phenylephrine
      - Albuterol
      - Dopamine
  - - - Blocks sympathetic response
      - Mimics the PANS
      - Reduces the action of Epinephrine and Norepinephrine
      - Common dental drugs that affect this division
        
        Beta-blockers
        
        Propranolol
        
        Alpha-blockers
        
        Metoprolol
        
        Prazosin
        
        USES
        
        Glaucoma
        
        Hypertension
        
        Heart failure
        
        Anxiety
        
        Arrhythmias
        
        Dental Implications
        
        Epinephrine
        
        NSAIDS
        
        Fluoride
        
        Opioids
      - Blocks adrenergic receptors or inhibits neurotransmitter release
      - Used in lowering blood pressure (Hypertension)
      - Used to decrease heart rate and cardiac output
      - vasodilation
- - - - Direct Action: mimics ACh and bind directly on receptors.
        
        Bethanechol: Treats urinary retention (stimulates bladder contraction).
        
        Pilocarpine ( Salagen) : Used in treatment of Xerostomia
        
        Pilocarpine (Isopto) (ophthalmic) :Reduces intraocular pressure.
      - Dental Implications
        
        Excessive Salivation
        
        Management: Suction, Cotton roll, Rubber dam.
        
        Slow Heart Rate
        
        Management: Monitor vitals, Reposition.
        
        Hypotension
        
        Management: Position changes, Monitor BP
        
        Bronchoconstriction
        
        Management: Minimize stress, have broncodilator available.
        
        Drug Interaction
        
        Possible with Anesthetics and Opioids. Review medical history.
- - - - Glaucoma
      - Prostatic Hypertrophy
      - Cardiovascular Disease
      - Intestinal or Urinary Obstruction or Retention
    - - Reduction of Parkinson-like movements
      - Preoperative
      - Overreactive Bladder
      - Ophthalmologic Examination
      - Gastrointestinal Disorders
      - Motion Sickness
- - - - Donepezil/ Rivastigmine: Alzheimer ( Enhance memory)
      - Neostigmine/Pyridostigmine : Myasthenia Gravis (Muscles)
  - - - Malathion/ Parathion: Pesticides
      - Sarin: Chemical Warfare