Tutorial ANS 2011

8/3/2019 Tutorial ANS 2011

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Tutorial on

AUTONOMIC Nervous System


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Effects on body organs


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M- Receptors

M1 &


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Nicotionic Receptors

Parasympathetic ganglia

Sympathetic ganglia

Suprarenal medulla

Motor end plate


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alkaloidsCholinomimeticii)Pilocarpine

esters:Choline)i1. Acetyl choline2. Methacholine3. Carbachol4. Bethanechol

Parasympathomimetics

a) Direct

b) Indirect(Anticholinesterases)

Reversible1. Physostigmine

2. Neostigmine3. ..

IrreversibleOrganophosphorouspoisoning
http://images.google.com.eg/imgres?imgurl=http://www.duopharma.com.my/images/tablets-img02.gif&imgrefurl=http://www.duopharma.com.my/products.html&h=194&w=150&sz=21&hl=en&start=3&tbnid=61VKQZc4-CjNBM:&tbnh=103&tbnw=80&prev=/images?q=tablets&svnum=10&hl=en&lr=&sa=G


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Neostigmine:

1. Myasthenia gravis

2. Antidote to curare

3. Paralytic ileus4. Post-operative urine retention

Therapeutic uses of reversible

anticholinestrases


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Treatment of atropine poisoning.

Physotigmine


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Diagnosis of myasthenia gravis.

Differentiation between "myasthenic

crisis" & cholinergic crisis

Edrophonium


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Irreversible Anticholinesterases

1. Causes

[2]Organic Phosphate Poisoning

Eating

Dusting

accidental

[1] Insecticides
http://rds.yahoo.com/_ylt=A9gnMiliCWlFp3gBNAiJzbkF;_ylu=X3oDMTBjZmpxdmw3BHBvcwM3BHNlYwNzcg--/SIG=1h3cjo7mm/EXP=1164597986/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=eating&ei=UTF-8&fr=yfp-t-501&x=wrt&w=638&h=523&imgurl=www.leica-gallery.net/photo-lib/image/large/milena-eating-corn-on-the-c-87307.jpg&rurl=http://www.leica-gallery.net/k1gd/image-87307.html&size=53.4kB&name=milena-eating-corn-on-the-c-87307.jpg&p=eating&type=jpeg&no=7&tt=970,264&oid=fda4b4e906b3d444&ei=UTF-8http://rds.yahoo.com/_ylt=A9iby6Lk1yJF4gQB_8WJzbkF;_ylu=X3oDMTBkbmE3a2tyBHBvcwM3NgRzZWMDc3I-/SIG=1g25hsbcc/EXP=1159997796/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=parathion&ei=UTF-8&fr=yfp-t-500&b=61&w=252&h=165&imgurl=ehp.niehs.nih.gov/docs/1997/105-7/forumfigspray.JPEG&rurl=http://ehpnet1.niehs.nih.gov/docs/1997/105-7/forum.html&size=13.7kB&name=forumfigspray.JPEG&p=parathion&type=jpeg&no=76&tt=386&oid=294869a4173d2aa0&ei=UTF-8


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R of organic phosphatepoisoning Atropine IV or IM till

Oximes (if patient is seen within 6-8hs)

Mechanism of action:1. Set the enzyme free

2. Bind circulating poison before reachingthe enzyme.

Anticonvulsants

Care of respiration

Gastric lavage/ wash skin
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Atropine

Mechanism of action

By competing withacetylcholine forM receptors
http://rds.yahoo.com/_ylt=A9ibyiFQ2iJFIwoBfpSJzbkF;_ylu=X3oDMTBkc2Fsb3QxBHBvcwM0MARzZWMDc3I-/SIG=1i5kkq9jk/EXP=1159998416/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&b=21&w=800&h=600&imgurl=www.kmhk.kmu.edu.tw/medhome/Intra_med/med_o/search/images/a1/Atropine2.jpg&rurl=http://www.kmhk.kmu.edu.tw/medhome/Intra_med/med_o/search/ENdata.asp?EN_data=A&size=70.7kB&name=Atropine2.jpg&p=atropine&type=jpeg&no=40&tt=966&oid=0d081d5db5782cd8&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGaD2SJFJH0AiBCJzbkF;_ylu=X3oDMTBjMzRvMDBnBHBvcwM5BHNlYwNzcg--/SIG=1fboqsr8i/EXP=1159998211/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&x=wrt&w=73&h=146&imgurl=www.kmwcgh.gov.tw/3/drugimages/atropine%20eye.jpg&rurl=http://www.kmwcgh.gov.tw/3/pharmacy602.htm&size=3.6kB&name=atropine+eye.jpg&p=atropine&type=jpeg&no=9&tt=966&oid=677dc9292873aff6&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGaD2SJFJH0AgBCJzbkF;_ylu=X3oDMTBjMHZkMjZyBHBvcwMxBHNlYwNzcg--/SIG=1fvphl4q6/EXP=1159998211/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&x=wrt&w=566&h=455&imgurl=www2.unil.ch/lpc/images/docu04/0_doc/atropine.gif&rurl=http://www.unil.ch/lpc/images/docu04/illustr_metabo.htm&size=46.5kB&name=atropine.gif&p=atropine&type=gif&no=1&tt=966&oid=ef94d21aec80c6ba&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGVV2yJFlGUAafWJzbkF;_ylu=X3oDMTBjdmNoOTVjBHBvcwMyBHNlYwNzcg--/SIG=1g834q3dd/EXP=1159998677/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=tablet&ei=UTF-8&fr=yfp-t-500&x=wrt&w=275&h=275&imgurl=www.promotiontopia.com/promotional-images/sugar-free-tablet-gum.jpg&rurl=http://www.promotiontopia.com/c/sugar-free-tablet-gum.htm&size=10.0kB&name=sugar-free-tablet-gum.jpg&p=tablet&type=jpeg&no=2&tt=328,556&oid=e76c60b9fdbd9392&ei=UTF-8


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Pharmacological actions

1) Heart:

If IV, initial bradycardiafollowed by tachycardia2) BV and BP:.

Tone, motilityand secretion(antispasmodic)

Antispasmodic, urine retention

secretions

Bronchodilatation& secretions

1) Passive mydriasis

2) Cycloplegia3) IOP4) Loss of light reflex5) lacrymation


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(2) CNS actions

Stimulant actionsTherapeutic dose:1. CIC bradycardia2. RCLarge dose:Cereberal cortex

Depressant actions1. tremors &

rigidity RC
http://rds.yahoo.com/_ylt=A9gnMiKlTGpFqAQBdwSJzbkF;_ylu=X3oDMTBjZGM1ZGE1BHBvcwM1BHNlYwNzcg--/SIG=1fmdhq37l/EXP=1164680741/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Brain&ei=UTF-8&fr=yfp-t-501&x=wrt&w=265&h=278&imgurl=www.aa-ckd.com/images/Choi_Kwang_Do_Brain_Development.jpg&rurl=http://www.aa-ckd.com/brain_development.htm&size=29.6kB&name=Choi_Kwang_Do_Brain_Development.jpg&p=Brain&type=jpeg&no=5&tt=1,045,997&oid=c02352dd45f00832&ei=UTF-8http://rds.yahoo.com/_ylt=A9gnMiKlTGpFqAQBdwSJzbkF;_ylu=X3oDMTBjZGM1ZGE1BHBvcwM1BHNlYwNzcg--/SIG=1fmdhq37l/EXP=1164680741/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Brain&ei=UTF-8&fr=yfp-t-501&x=wrt&w=265&h=278&imgurl=www.aa-ckd.com/images/Choi_Kwang_Do_Brain_Development.jpg&rurl=http://www.aa-ckd.com/brain_development.htm&size=29.6kB&name=Choi_Kwang_Do_Brain_Development.jpg&p=Brain&type=jpeg&no=5&tt=1,045,997&oid=c02352dd45f00832&ei=UTF-8http://rds.yahoo.com/_ylt=A9gnMiKlTGpFqAQBdwSJzbkF;_ylu=X3oDMTBjZGM1ZGE1BHBvcwM1BHNlYwNzcg--/SIG=1fmdhq37l/EXP=1164680741/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=Brain&ei=UTF-8&fr=yfp-t-501&x=wrt&w=265&h=278&imgurl=www.aa-ckd.com/images/Choi_Kwang_Do_Brain_Development.jpg&rurl=http://www.aa-ckd.com/brain_development.htm&size=29.6kB&name=Choi_Kwang_Do_Brain_Development.jpg&p=Brain&type=jpeg&no=5&tt=1,045,997&oid=c02352dd45f00832&ei=UTF-8


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Uses of atropine

Preanaesthetic

medication (Why?)

Colic

Heart block

Eye: .

Organic phosphate

poisoning.
http://rds.yahoo.com/_ylt=A9ibyiFQ2iJFIwoBfpSJzbkF;_ylu=X3oDMTBkc2Fsb3QxBHBvcwM0MARzZWMDc3I-/SIG=1i5kkq9jk/EXP=1159998416/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&b=21&w=800&h=600&imgurl=www.kmhk.kmu.edu.tw/medhome/Intra_med/med_o/search/images/a1/Atropine2.jpg&rurl=http://www.kmhk.kmu.edu.tw/medhome/Intra_med/med_o/search/ENdata.asp?EN_data=A&size=70.7kB&name=Atropine2.jpg&p=atropine&type=jpeg&no=40&tt=966&oid=0d081d5db5782cd8&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGaD2SJFJH0AiBCJzbkF;_ylu=X3oDMTBjMzRvMDBnBHBvcwM5BHNlYwNzcg--/SIG=1fboqsr8i/EXP=1159998211/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&x=wrt&w=73&h=146&imgurl=www.kmwcgh.gov.tw/3/drugimages/atropine%20eye.jpg&rurl=http://www.kmwcgh.gov.tw/3/pharmacy602.htm&size=3.6kB&name=atropine+eye.jpg&p=atropine&type=jpeg&no=9&tt=966&oid=677dc9292873aff6&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGaD2SJFJH0AgBCJzbkF;_ylu=X3oDMTBjMHZkMjZyBHBvcwMxBHNlYwNzcg--/SIG=1fvphl4q6/EXP=1159998211/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=atropine+&ei=UTF-8&fr=yfp-t-500&x=wrt&w=566&h=455&imgurl=www2.unil.ch/lpc/images/docu04/0_doc/atropine.gif&rurl=http://www.unil.ch/lpc/images/docu04/illustr_metabo.htm&size=46.5kB&name=atropine.gif&p=atropine&type=gif&no=1&tt=966&oid=ef94d21aec80c6ba&ei=UTF-8http://rds.yahoo.com/_ylt=A9ibyGVV2yJFlGUAafWJzbkF;_ylu=X3oDMTBjdmNoOTVjBHBvcwMyBHNlYwNzcg--/SIG=1g834q3dd/EXP=1159998677/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=tablet&ei=UTF-8&fr=yfp-t-500&x=wrt&w=275&h=275&imgurl=www.promotiontopia.com/promotional-images/sugar-free-tablet-gum.jpg&rurl=http://www.promotiontopia.com/c/sugar-free-tablet-gum.htm&size=10.0kB&name=sugar-free-tablet-gum.jpg&p=tablet&type=jpeg&no=2&tt=328,556&oid=e76c60b9fdbd9392&ei=UTF-8


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Dryness of mouth, blurred vision and tachycardia.

Retention of urine in patients with enlarged

prostate.

Acute glaucoma

In children, cutaneous VD with flushing and

elevation of body temperature.

Side effects of atropine


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Hyoscine

Preferred over atropine inpre-anaestheticmedication. (Why?)

Colic

Motion sickness
http://rds.yahoo.com/_ylt=A9gnMiCdVmpFmuUAVu.JzbkF;_ylu=X3oDMTBjdmNoOTVjBHBvcwMyBHNlYwNzcg--/SIG=1g2q6m49m/EXP=1164683293/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=airplane&ei=UTF-8&fr=yfp-t-501&x=wrt&w=665&h=375&imgurl=organizingla.blogs.com/photos/uncategorized/sas_airplane.jpg&rurl=http://organizingla.blogs.com/organizingla_blog/2005/09&size=21.5kB&name=sas_airplane.jpg&p=airplane&type=jpeg&no=2&tt=700,647&oid=b81dc9f1d3f278ce&ei=UTF-8http://rds.yahoo.com/_ylt=A9gnMiD2VmpFl.cAld2JzbkF;_ylu=X3oDMTBkNHNkYWE3BHBvcwMyNwRzZWMDc3I-/SIG=1du10m95k/EXP=1164683382/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=headache&ei=UTF-8&fr=yfp-t-501&b=21&w=180&h=153&imgurl=www.byheadache.com/images/headache.jpg&rurl=http://www.byheadache.com/&size=8.7kB&name=headache.jpg&p=headache&type=jpeg&no=27&tt=104,334&oid=6b5e5a19dec6b6c0&ei=UTF-8http://rds.yahoo.com/_ylt=A9iby4K33SJFOMYAolyJzbkF;_ylu=X3oDMTBkbzMyZHR2BHBvcwMzOQRzZWMDc3I-/SIG=1fqa6f4gp/EXP=1159999287/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=anaesthesia&ei=UTF-8&fr=yfp-t-500&b=21&w=220&h=187&imgurl=www.avdha.nshealth.ca/programs/images/anaesthesia2.jpg&rurl=http://www.avdha.nshealth.ca/programs/anaesthesia.asp&size=8.0kB&name=anaesthesia2.jpg&p=anaesthesia&type=jpeg&no=39&tt=20,162&oid=1f25affdc10feeea&ei=UTF-8


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Synthetic Atropine Substitutes

1. Mydriatics.

2. Antisecretory-antispasmodic

3. Antiparkinsonian.

4. urinary bladder activity.

5. Bronchial asthma.

M d i i A i S b i
http://rds.yahoo.com/_ylt=A9gnMiMOW2pFdv4AgNKJzbkF;_ylu=X3oDMTBkYTNuNGk0BHBvcwMxMARzZWMDc3I-/SIG=1f1m71aei/EXP=1164684430/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=tropicamide&ei=UTF-8&fr=yfp-t-501&x=wrt&w=300&h=454&imgurl=www.drugs.com/pdr/images/pills/o03103a3.jpg&rurl=http://www.drugs.com/pdr/TROPICAMIDE.html&size=27.5kB&name=o03103a3.jpg&p=tropicamide&type=jpeg&no=10&tt=37&oid=93baaea95f7c7130&ei=UTF-8http://rds.yahoo.com/_ylt=A9gnMiNuWmpFGx0BU6eJzbkF;_ylu=X3oDMTBkM3VyNWF1BHBvcwMxNQRzZWMDc3I-/SIG=1h07lj1t6/EXP=1164684270/**http:/images.search.yahoo.com/search/images/view?back=http://images.search.yahoo.com/search/images?p=pharmacology&ei=UTF-8&fr=yfp-t-501&x=wrt&w=200&h=159&imgurl=www.ncl.ac.uk/photos/teaching_excellence/research_led/pharmacology.jpg&rurl=http://www.ncl.ac.uk/teachingexcellence/researchled/medical.htm&size=8.4kB&name=pharmacology.jpg&p=pharmacology&type=jpeg&no=15&tt=100,870&oid=349d895f5c8b79e2&ei=UTF-8


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Atropine Homatropine Tropicamide Cyclopentolate

Duration of

action7-10 days 24 hrs. 6 hrs. 24 hrs

Concentration 1% 2% 2-5% 0.5%

Cycloplegia + + + +

Antagonismby eserine

Not complete Complete Complete Complete

Mydriatic Atropine Substitutes


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Questions


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Atropine is useful in treating poisoning

produced by organophosphate

insecticides because it:

a) Reactivates inhibited A. cholinesterase.

b) Stimulates nicotinic receptors directly.

c) Stimulates - receptors directly.

d) Inhibits normal ganglionic transmission.

e) Blocks the action of acetylcholine at peripheral

sites.


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Characteristics of neostigmine include

all of the following EXCEPT:

a) It is a parasympathetic agent.

b) It exerts both nicotinic & muscarinic

effects.

c) It inhibits acetylcholinesterases

reversibly.

d) It has a direct stimulant action on MEP

e) It crosses the BBB readily


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Which of the following symptoms is not

likely to be present in a patient poisoned

with organophosphorous compound?

a) Excessive salivation.

b) Abdominal cramps.c) miosis .

d) Tachycardia.e) Convulsions.


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Which of the following drugs is

incorrectly paired with an appropriate

use?

Atropine : Urinary retention.

Physostigmine: For overdose with

atropine-like drug.

Neostigmine: antidote to curare


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Which of the following drugs are

recognized for treatment of raised

intraocular pressure?

a) Cyclopentolate.

b) Corticosteroid eye drops.

c) Topical timolol eye drops.

d) Both c and e.

e) Dipifevrin.


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Glaucoma may occur as a side effect of

which of the following drugs?

a) Neostigmine.

b) Pilocarpinec) Homatropine eye drops.

d) Bethanechol


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For these statements, write (T) for true

& (F) for false:

1) Neostigmine may cause constipation and

bronchodilation.

2) Accepted therapeutic indications for the use of

anti-muscarinic drugs include: parkinsons

disease and motion sickness.

3) Atropine is used in Curare poisoning.

4) Pilocarpine constricts the pupil.

F

T

F

T


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COMPLETE:

Hyoscine is preferred than atropine in pre-

anaesthetic medication because:

a) More CNS depressant

b) Stronger antisecretory

c) Stronger antispasmodic


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COMPLETE:

Atropine is given before neostigmine in

Myasthenia Gravis to:

block muscarinic SE


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THE SYMPATHETIC SYSTEM

The synapse in the sympathetic ganglionuses Ach as a neurotransmitter.

The post-ganglionic sympathetic neuronwithin the target organs uses NE as aneurotransmitter.

(there is one exception)


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ADRENERGIC RECEPTORS

1. ALPHA RECEPTORS:

1

& 22. BETA RECEPTORS:

1,2 &3

3. DOPAMINE RECEPTORS: D1 & D2


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Stimulation ofalpha-1 receptors

results primarily in (Ca2+

):

Vasoconstriction.

Mydriasis. Contraction of the GIT &urethral

sphincters.

Al h


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Alpha-2receptors are

mainlypresynaptic &their

stimulationresults in a

decrease of NArelease.


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Beta-1:

(+) inotropic effect ( force),

(+) chronotropic effect (rate),(+) dromotropic effect

(conduction acceleration) &increase of excitability


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Beta-2 :bronchodilatation, uterus , bladder &GIT relaxation.

Stimulation of glycogenolysis.

Skeletal muscle tremors,vasodilatation of b.vs.


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Selective

PhenylephirineSalbutamolRitodrine

Non selectiveAdrenaline

NoradrenalineDopamine

Sympathomimetics

a) Direct

b) Indirect

CocaineAmphetamine

C) Dual

EphedrineDopamine


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Catecholamines

Adrenaline alpha1, alpha2 1, 2

Noradrenaline alpha1, alpha2, 1

Dopamine

D1 (minimal doses)

1 (intermediate dose)alpha1 (high dose)

Non Catecholamines


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Phenylephrine Direct alpha1

Clonidine Direct alpha2

Salbutamol

RitodrineDirect 2

Amphetamine

CocaineIndirect

Ephedrine

Dual

alpha1, alpha2 1, 2

Non Catecholamines


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Adrenergic depressants

1- Adrenergic receptor blockers- adrenergic antagonists (- blockers).

- adrenergic antagonists (- blockers).&blockers.

2- Sympatholytics

I Pharmacodynamic Classification


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I. Pharmacodynamic Classification

B-blockers

Non selective

Propranolol

Pindolol

Selective 1Atenolol

Metoprolol

Combined & blocker

labetalol &carvedilol

II Ph ki ti Cl ifi ti


41/79

II. Pharmacokinetic Classification:

B-blockers

Lipophilic Hydrophilic

Li h li H d o hili


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Lipophylic Hydrophilic

oralabsorption

Complete Irregular

Livermetabolism Yes No

T 1/2 Short Long

CNS side

effects

High low

Anti hypertensive


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Anti-hypertensive

1. COP (1- blocking effect).2. Block rennin release, so Ag II &

aldosterone (1- effect).3. NE release from Nerve terminals.4. central sympathetic outflow.5. Ressetting of baroreceptor

Therapeutic Uses of Propranolol


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Therapeutic Uses of Propranolol

& other beta-blochers:

1. Hypertension.

2. Angina pectoris

3. Cardiac arrhythmia.4. Mild Myocardial infarction.

5. Prophylaxis of migraine

6. Hyperthyroidism


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OTHERS1. Familial tremors & anxiety.

2. Pheochromocytoma ( must be usedwith - blocker)

5. Open angle glaucoma

Side effects of Propranolol


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Block of cardiac 1-receptors: CHF / Severe bradycardia in patients with

impaired myocardial functions. Hypotension

Blockade of 2-(non-selective)

Severe bronchospasm ( non-selective) inasthmatics 1 are better.

Cold extremities .

Hypoglycemia if given with hypoglycemic drugs asinsulin

Sudden stoppage will give rise to a withdrawal syndrome:

Rebound angina, arrhythmia, myocardial infarction

and hypertension due to up-regulation of -receptors.

Side effects of Propranolol


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Contraindications:

1. Hypotention & heart block.

2. Severe heart failure & massive myocardial

infarction.3. Peripheral vascular disease (not CI with

cardio-selective -blockers).

4. Bronchial asthma (not CI with cardio-selective -blockers).

5. Diabetic patients. (Type I)


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PharmacokineticInteractions

PharmacodynamicInteractions

1. Hepatic enzyme

inhibitors as: cimetidine& isoniazid

1. Anti-diabetic drugs e.g.

insulin.

2. Hepatic enzyme inducersas: barbiturates,

phenytoin, & rifampin

2. Verapamil (calciumchannel blocker)

3. Non-steroidal anti-inflammatory drugs

Drug interactions

p a - T T : Prazos n


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p a T T : Prazos nTerazosin

Peripheral VD of arterial & venousSMs

PR, BP

Tachycardia (reflex)Therapeutic uses:

Hypertension Alternative to surgery in patients with

benign prostatic hyperplasia

Alpha 1 ANTAGONISTS: Prazosin


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Alpha 1-ANTAGONISTS: Prazosin

Terazosin

SIDE EFFECTS:

1. Orthostatic hypotension and syncope.

2. Salt and water retention.

3. Failure of ejaculation.


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ERGOT ALKALOIDS

Pharmacologicactions

Ergotamine Dihydro-ergotamine

Ergometrine& methyl-ergometrine

Direct VC Potent weak moderate

-blockingeffect

Weak Potent ++ weak

Oxytocic actionweak weak potent

CNS weak weak weak


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ERGOT ALKALOIDS

Uses Ergotamine Dihydro-ergotamine

Ergometrine& methyl-ergometine

Acute Migraine AcuteMigraine

Post-partumhemorrhage

Enhance placentadelivery

h i f G


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Pathogenesis of MIGRAINE

Triptans (serotonin receptor agonists)are now preferred in treatment of acute

attack of mi raine


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-Methyldopa


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-Methyldopa


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Therapeutic use

1. It is the antihypertensive drug ofchoice in pregnancy.

2. Mild, Moderate or severehypertension with impaired renal

function.

-Methyldopa

-Methyldopa


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Side effects1. Hypersensitivity reactions:

Liver damage

Hemolytic anemia

2. Sedation ( 5-HT)

-Methyldopa


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Questions


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Which of the following agents would

bring a rapid heart rate (120 beat/min)back to normal:

A. DopamineB. Atropine

C. Propranolol

D. Phenylephrine

E. Adrenaline


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At therpapeutic doses, this drug dilates thebronchioles, increases heart rate andconduction but does not elevate BP:

1. Salbutamol.

2. Adrenaline.3. Nor-adrenaline.

4. Prazosin.5. Atropine.

A drug injected I V into a dog


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A drug injected I.V. into a dog.Five minutes later, the following signs were observed :

bradycardia

broncho-constriction a fall in mean blood pressure.

The drug most likely evoked these signs is :

A. Atropine

B. Ephedrine

C. PrazosinD. Propranolol


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Atenolol differ from propranolol in:1. Its oral absorption is complete.2. It does not affect the release of renin.

3. It has more central side effects4. It has minimal risk of producing

bronchospasm.

5. It does not inhibit gluconeogenesis


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Epinephrine would cause a decrease

in mean arterial blood pressure if itis administered after pre-treatment

with :

A. A beta 1 antagonist .

B. An alpha 1 antagonist .

C. A beta 2 antagonist .D. A non-selective beta antagonist.

E. Both alpha 1 and beta 1 antagonist

Dilatation of blood vessels in muscles


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Dilatation of blood vessels in muscles,

constriction of cutaneous vessels,

positive inotropic & chronotropiceffects are all actions of :

A. Salbutamol .

B. Nor-epinephrine. .

C. Acetylcholine .D. Epinephrine .

E. Isoprenaline .


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N h l i diff f


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Noncatecholamine differ from

catecholamine in that they :

A. Have a short duration of action

B. Not effective orallyC. Dont act indirectly, but usually

combine directly with 1 and 2

receptors subtypesD. Have greater CNS effects

E. Are metabolized at more rapid rate

beta adrenoceptor blockers may


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beta adrenoceptor blockers may

lower ABP by the following

mechanisms EXCEPT:

A. Decrease sympathetic mediated renin release

B. Causing vasodilatation in skeletal muscleC. Action on CNS

D. Decrease Norepinephrine release fromsympathetic nerve endings

E. Reconditioning of baroreceptors to a lowerlevel

Patients taking beta adrenoceptor


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Patients taking beta adrenoceptor

blockers may experience all of the

following EXCEPT:

A. Exacerbation of existing heart block

B. Precipitation of heart failure

C. Increased capacity to vigorous exercise

D. Cold extremity

E. Hypoglycemia if they are diabetic


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A directly acting sympathomimetic

decongestant drug is:

A. Ephedrine.

B.Amphetamine.C. Phenylephrine.

D. Dopamine

Sympathomimetics may be employed


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y p y p y

in all of the followings Except :

A. Relief symptoms of hypersensitivityreaction to drugs

B. Induction of laborC. Narcolepsy

D. Acute hypotensive states as duringspinal anesthesia

E. Reduction of nasal congestion causing

temporary relief


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Put True or False:

A. Propranolol can reduce tremors inthyrotoxicosis.

B. B-blockers often cause orthostatic hypotension.

C. Propranolol is used in the treatment of anginapectoris.

D. B-blockers can cause heart block or

bronchospasm in susceptible individuals.E. Phenylephrine cause dilation of conjuntival

blood vessels

T

F

T

T

F

C l t


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Complete

Adrenaline acts on -------------- receptors.

Nor adrenaline acts on ---------------- receptors.

Dopamine acts on ------, ----- & ------ receptors

1212

121

D1 , 1, 1


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Complete

Nor adrenaline is used in-----------------

Atenolol is preferred over propranololin treating hypertension because

Septic shock & severe hypotension

More B1 selective

A d f l i f


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A drug useful in treatment of

postpartum hemorrhage is:

1. Dihydroergotamine2. Methyl ergometrine.

3. Ergotamine.

4. Ritodrine.


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Match the drug and clinical


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Match the drug and clinical

effect with correct receptor

Phenylephrine, salbutamol,epinephrine, clonidine.

Bronchial relaxation, nasaldecongestion, heart rate and strength,

treatment of hypertension.1 2 1 2


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Receptor Drug Clinical effect1 Phenylephrine Nasal decongestion

1 Epinephrine heart rate &strength

2 Salbutmol Bronchialrelaxation

2 Clonidine Treatment ofhypertension


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Thank You

Documents

Tutorial ANS 2011