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Drugs and the Sympathetic and Parasympathetic Nervous System Jenny Suepiantham Y5Content - Basic anatomy of the sympathetic and parasympathetic nervous system - Common drugs that act on adrenergic receptors (alpha 1, alpha 2, beta 1, beta 2) their indications and side-effects - Common drugs that act on cholinergic receptors (M1, M2, M3) their indications and side-effectsWhich of the following statements is false? a) The sympathetic nervous system originates in the thoracolumbar region of the spine b) The postganglionic neurons of the sympathetic nervous system are adrenergic neurons c) The postganglionic neurons of the parasympathetic nervous system are adrenergic neurons d) Dopamine is a precursor of noradrenaline in its synthesis pathwayThe autonomic nervous system Credit: Simplypsychology.orgThe autonomic nervous system NB: NE/Epi = norepinephrine/epinephrine = noradrenaline/adrenaline Credit: Speed PharmacologyThe Sympathetic NS: The adrenergic neuron Credit: Speed PharmacologyActivation of which receptor causes vasoconstriction? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2Credit: Hackney et al 2018Which of the following may be indicated in the treatment of asthma? a) Alpha 1 agonist b) Beta 1 agonist c) Beta 1 antagonist d) Beta 2 agonist Which best describes atenolol? A) Alpha 1 receptor agonist B) Alpha 2 receptor antagonist C) Beta 1 receptor antagonist D) Beta 2 receptor agonistAlpha 1 agonists Alpha 1 antagonists Treats nasal congestion Treats hypertension (high BP) - Oxymetazoline - Prazosin - Phenylephrine - Doxazosin Treats red eyes Enlarged prostate (BPH) Treats hypotension (low BP) - Tamsulosin Side effects: increased work and Side effects: hypotension, nasal oxygen requirment of heart, congestion, dizziness reflex bradycardia, headacheBeta 1 agonists Beta 1 antagonists Treats cardiac decompensation (“Beta-blockers”) - Dobutamine Treats angina - (‘Inotropic support’ / Treats atrial fibrillation ‘Inotrope’) Treats hypertension (Prevent migraines) Side effects: tachycardia, palpitations (Hyperthyroidism) - Atenolol - Bisoprolol Side effects: bradycardia, heart failureAlpha 2 agonists Treats hypertension - Clonidine Beta 2 agonists Treats asthma - Salbutamol (short acting - 4hr) - Salmeterol (long acting - 12hr) Side effects: palpitations, fine tremor, headache, hypokalaemia Mr X is a white 60 year old with type 2 diabetes mellitus and asthma. His GP would like to prescribe him an additional medication to treat his poorly controlled hypertension. Which of the following anti-hypertensive drugs should not be prescribed to Mr X? a) Amlodipine b) Bendroflumethiazide c) Lisinopril d) PropranololNB: Some non-selective drugs to be aware of Propranolol: β 1 a2tagonist Contraindicated in asthma NB: Other beta-blockers also avoided in asthmatics Epinephrine Used in anaphylaxis, cardiopulmonary resuscitation, severe respiratory problems (eg Croup in children)The Parasympathetic NS: The cholinergic neuron Acetylcholine (ACh) Acetylcholinesterase / cholinesterase (AChE) enzyme Credit: Speed PharmacologyCholinergic receptor types Gq - calcium Gi - potassium Gq - calciumWhich of the following is not a possible use for anticholinesterases? a) Diagnosis of myasthenia gravis b) Treatment of glaucoma c) Treatment of heart palpitations d) Treatment of Alzheimer’s disease Which of the following is an irreversible anticholinesterase? a) Edrophonium b) Echothiophate c) Neostigmine d) PyridostigmineDirect-acting agonists Acetylcholine Carbachol - constricts pupils, reduces intraocular pressure Pilocarpine - constricts pupils, reduces intraocular pressure, treatment of glaucoma Bethanechol - treats urinary retentionIndirect acting agonists (‘anticholinesterase’) Increase ACh availability by binding to acetylcholinesterase Reversible Edrophonium - diagnosis of myasthenia gravis Physostigmine -treat overdose of anticholinergic drugs such as atropine Neostigmine Treat symptoms of myasthenia gravis Stimulate bladder and GI tract Reverse effects of neuromuscular blocking anaesthesia Pyridostigmine Same as neostigmineAlzheimer’s disease Donepezil Rivastigmine GalantamineIndirect acting agonists Irreversible Military nerve agents eg Sarin gas Echothiophate - treat open angle glaucomaSide effects of cholinergic drugs ‘DUMBBELS’ Diarrhoea Urination Miosis, muscle weakness Bronchorrhoea Bradycardia Emesis Lacrimation Salivation, sweatingMuscarinic antagonists Ipratropium - treats asthma, COPD Atropine - treats bradycardia, used pre-anaesthetic to reduce salivary and bronchial secretions, pupil dilatation and ciliary muscle paralysis for eye surgeryFeedback Please take a minute now to fill in feedback form.Which of the following is an effect of activating the beta 1 receptor? a) Bronchodilation b) Positive inotropic effect on the myocardium c) Inhibition of insulin release d) Systemic vasoconstrictionA patient develops anaphylaxis and is given adrenaline. Which of the following is least likely to occur? a) Peripheral vasoconstriction b) Gluconeogenesis c) Lipolysis d) Tachycardia e) Coronary artery narrowingBonus: Which of the following adrenaline preparations is used to treat anaphylaxis a) Adrenaline 1:1,000 IM b) Adrenaline 1:1,000 IV c) Adrenaline 1:10,000 IM d) Adrenaline 1:10,000 IV80 year old male patient complains of urinary frequency, he feels he cannot fully empty his bladder. Examination reveals an enlarged prostate. He was prescribed alfuzosin. What is the mechanism of action of this drug? a) Alpha 1 receptor agonist b) Alpha 1 receptor antagonist c) Beta 1 receptor antagonist d) M1 receptor antagonistAn agricultural worker has ingested a pesticide. He presents with difficulty breathing, excessive salivation, diarrhoea and a drop in heart rate and blood pressure. By what mechanism is it likely that the pesticide is causing these effects? a) Reduction in re-uptake of norepinephrine into neurons b) Reduction in re-uptake of acetylcholine into neurons c) Inhibition in norepinephrine metabolism d) Inhibition in acetylcholine metabolism AIM Facebook Page ▶ Give our Facebook page a like for updates and opportunities,just search @AIMEdinburgh Thank you for coming! ▶ If you have any more questions, feel free to email me at s1707446@ed.ac.uk, or email accessibilityinmedicine@gmail.com