Drugs Acting on the Autonomic Nervous System (2) - PowerPoint Presentation

1. Drugs Acting on the Autonomic Nervous System (2)Prepared by Dr zainab eltrafiClinical pharmacist

2. Sympathomimetic amines that contain the 3,4-dihydroxybenzene group (such as epinephrine, norepinephrine, isoproterenol, and dopamine)are called catecholamines. These compounds share the following properties:High potencyRapid inactivation:Poor penetration into the CNS because they are polarCatecholamines

3. CatecholaminesNoncatecholamines

4. Compounds lacking the catechol hydroxyl groups have longer half-lives, because they are not inactivated by COMT. These include phenylephrine, ephedrine, and amphetamineThese are poor substrates for MAO and, thus,show a prolonged duration of action, because MAO is an important route of detoxification. Increased lipid solubility of many of the noncatecholamines(due to lack of polar hydroxyl groups) permits greater access to the CNS.Noncatecholamines

5. Classification of the adrenergic agonistsDirect-acting agonists: Include: epinephrine, norepinephrine, isoproterenol, and phenylephrine.Indirect-acting agonists: Include amphetamine, cocaine and tyramine.Mixed-action agonists: Include ephedrine, pseudoephedrine and metaraminol, may act directly to stimulate adrenoceptors and indirectly to release norepinephrine from the adrenergic neuronAdrenergic agonists

6. A. Epinephrine Is a catecholamine.Interacts with both α and β receptors. At low doses, β effects (vasodilatation) predominate, whereas at high doses, α effects (vasoconstriction) are strongest.Direct-Acting Adrenergic Agonists

7. a. Cardiovascular: Epinephrine strengthens the contractility of the myocardium (positive inotropic: β1 action) and increases the heart rate (positive chronotropic: β1 action). Epinephrine increases systolic blood pressure, coupled with a slight decrease in diastolic pressure..Actions

8. B. Respiratory: Epinephrine causes powerful bronchodilation (β2 action). Epinephrine inhibits the release of allergy mediators such as histamines from mast cells. c. Hyperglycemia :Epinephrine has a significant hyperglycemic effect because of increased glycogenolysis in the liver (β2 effect), increased release of glucagon (β2 effect), and a decreased release of insulin (α2 effect).

9. Lipolysis: Epinephrine initiates lipolysis through its agonist activity on the β receptors of adipose tissue

10. Treatment of acute asthma and anaphylactic shock, epinephrine is the drug of choice;. Glaucoma: in open-angle glaucoma. It reduces the production of aqueous humor. Cardiac arrest: Epinephrine may be used to restore cardiac rhythm.Anesthetics: Local anesthetic solutions usually contain 1:100,000 parts epinephrine. The effect of the drug is to greatly increase the duration of the local anesthesia. It does this by producing vasoconstriction at the site of injection.Therapeutic uses

11. Adrenaline is destroyed by a stomach acid is therefore not effective if taken orally. It usually given by SC or IM injection Pharmacokinetics:

12. CNS disturbances: include anxiety, fear, tension, headache, and tremor.Cerebral hemorrhage: as a result of a marked elevation of blood pressure.Cardiac arrhythmiasPulmonary edema.Adverse effects

13. Cardiovascular actions:Vasoconstriction: Both systolic and diastolic blood pressures increase Norepinephrine is used to treat shock, because it increases vascular resistance and, therefore, increases blood pressure. However, metaraminol is favored. Norepinephrine

14. Dopamine the immediate metabolic precursor of norepinephrine,occurs naturally in the CNS in the basal ganglia, whereit functions as a neurotransmitter, as well as in the adrenal medulla.Dopamine can activate α- and β-adrenergic receptors. For example, at higher doses, it can cause vasoconstriction by activating α1 receptors, whereas at lower doses, it stimulates β1 cardiac receptors. In addition, D1 and D2 dopaminergic receptors, distinct from the α- and β-adrenergic receptors, occur in the peripheral mesenteric and renal vascular beds,where binding of dopamine produces vasodilation. D2 receptors are also found on presynaptic adrenergic neurons, where their activation interferes with norepinephrine release.Dopamine

15. Dopamine is the drug of choice for cardiogenic and septic shock and is given by continuous infusion. It raises the blood pressure by stimulating the β1 receptors on the heart to increase cardiac output and α1 receptors on blood vessels to increase total peripheral resistance. In addition, it enhances perfusion to the kidney and splanchnic areasIt is also used to treat hypotension and severe congestive heart failure, primarily in patients with low or normal peripheral vascular resistance and in patients that have oliguria.Therapeutic uses:

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17. Isoproterenol is a direct-acting synthetic catecholamine that predominantly stimulates both β1- and β2-adrenergic receptorsTherapeutic uses:It can be employed to stimulate the heart in emergency situations. Isoproterenol

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19. Dobutamine is a synthetic, selective β1 agonist. Dobutamine is used to increase cardiac output in congestive heart failure. Dobutamine

20. The drug is an agonist at β2 receptors, producing little effect on β1 receptors of the heart. The drug is useful as a bronchodilator in the treatment of asthma Albuterol, pirbuterol, and terbutaline short-acting β2 agonists used primarily as bronchodilators .Metaproterenol

21. Salmeterol and formoterol are selective β2-agonists, long-acting bronchodilators. These agents are highly efficacious when combined with a corticorsteroid

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23. They potentiate the effects of norepinephrine produced endogenously, but these agents do not directly affect postsynaptic receptors.Indirect-Acting Adrenergic Agonists

24. AmphetamineCentral stimulant, abused drug - Its peripheral actions are mediated primarily through the release of stored norepinephrine and the blockade of norepinephrine uptake. -

25. B. Tyraminenot a clinically useful drug, but it is important because it is found in fermented foods, such as cheese. C. CocaineCocaine is a local anesthetic (sodium channel blocker) and is a CNS stimulant (blocks the reuptake of norepinephrine, thus potentiating NA effects).