Autonomic Agents Flashcards
How is the CNS divided?
- Parasympathetic (cholinergic/muscarinic)
- Sympathetic (adrenergic)
Autonomic Agents Overview
- influence and regulate vital functions within the nervous system
- these agents lead to metabolic and endocrine changes that include glycogenolysis and modulation of insulin and other hormones
Central Nervous System
- divided into parasympathetic and sympathetic
- each of these systems have receptors that are responsive to endogenous neurotransmitters and exogenous drug therapy
- respiration, GI motility, and muscular movements are also influenced and controlled by the autonomic system
Sympathetic Nervous System (SNS)
- one of the 2 divisions of the autonomic nervous system
- nerve fibers of the SNS arise from the shorter preganglionic neurons in the thorcolumbar division of the spinal cord at T1-L2/L3 “thoracolumbar outflow”
- Preganglionic neurons release acetylcholine (Ach) that activated the nicotinic receptors stimulating the postganglionic neurons to release norepinephrine which activates adrenergic receptors
Parasympathetic Nervous System (PSNS)
- one of the 2 divisions of the autonomic nervous system (ANS)
- nerve fibers of the PSNS arise from the CNS “craniosacral outflow”
- Acetylcholine (Ach) is the primary neurotransmitter
+ muscarinic receptors
+ nicotinic receptors
Autonomic-Parasympathomimetric (Cholinergic) Agents
- imitate or influence (Ach); AKA “agonists”
+ nicotinic receptors
+ muscarinic receptors - muscarinic acetylcholine receptors in the peripheral nervous system are most abundant in the CNS
- ACh is responsible for “cholinergic activity” that includes vasodilation, increased secretions and decreased HR
- influence sweat glands, skeletal muscle, smooth muscle in blood vessels and other cardiac tissue
What are Autonomic-Parasympathomimetic (Cholinergic) Agents used to treat?
Myasthenia Gravis
Examples of Autonomic-Parasympathomimetic (Cholinergic) Agents
- Ambenonium
- Bethanechol
- Cevimeline
- Donepezil
- Galantamine
- Neostigmine
- Physostigmine
- Pyridostigmine
- Rivastigmine
Side Effects of Autonomic-Parasympathomimetic (Cholinergic) Agents
- bone marrow suppression
- sore throat
- blurred vision
- increased sweating/salivation
- urinary frequency
- fever
- rash
- palpitations
Cholinergic Crisis
S - salivation
L - lacrimation
U - urination
D - defecation
Autonomic-Anticholinergic Agents
- muscarinic antagonists responsible for “anticholinergic effects” such as decreased secretions, increased HR and decreased GI motility (“universal prescribing alerts”)
- include Antiparkinsonian agents
- include antimuscarinic/antispasmodics
Antiparkinsonian Agents
- a type of autonomic-antichoinergic agent
1. Benztropine
2. Diphenhydramine
3. Procyclidine
4. Trihexyphenidyl
Antimuscarinic/Antispasmodics
- Aclidinium
- Atropine
- Belladonna
- Dicyclomine
- Glycopyrrolate
- Hyoscyamine
- Ipratropium
- Mepenzolate
- Methscopolamine
- Propantheline
- Scopolamine
Anticholinergic Toxidrone Symptoms
- “blind as a bat”
+ dilated pupils - “mad as a hatter”
+ confused - “red as a beet”
+ flushed skin - “hot as a desert”
+ hyperthermia - ” dry as a bone”
+ dry mouth
+ urinary retention - grabbing invisible options
- tachycardia
- shaking
- absent bowel sounds
Autonomic-Sympathomimetic Adrenergic Agents
- imitate or influence norepinephrine (i.e. facilitate the release, block reuptake or decrease the metabolism of NE)
- adrenergic receptor “agonists” produce stimulant effects
- are associated with increased HR, BP, and vasoconstriction
- are divided into alpha and beta subtypes
- beta subtypes further divided into 1 and 2
- each category has unique benefits and side effects, refer to companion drug grid for additional information
Alpha Agonists
- a type of autonomic-sympathomimetic adrenergic agents
1. Midodrine
2. Phenylephrine
3. Clonidine
4. Guanabenz
5. Methyldopa
Nonselective beta agonists
- a type of autonomic-sympathomimetic adrenergic agents
1. Isoproproterenol
Selective beta (1) agonists
- a type of autonomic-sympathomimetic adrenergic agents
1. Dobutamine
2. Dopamine
Selective beta (2) agonists
- a type of autonomic-sympathomimetic adrenergic agents
1. Albuterol
2. Arformoterol
3. Formoterol
4. Indacaterol
5. Metaproterenol
6. Olodaterol
7. Salmeterol
8. Terbutaline
9. Vilanterol
Combined alpha and beta agonists
- a type of autonomic-sympathomimetic adrenergic agents
1. Droxidopa
2. Ephedrine
3. Epinephrine
4. Norepinephrine
5. Pseudoephedrine
Autonomic-Sympatholytic (adrenergic blocking) Agents
- associated with cardiac stimulating effects which increase cardiac oxygen demand
- many agents contraindicated for use in patients with recent MI, coronary insufficiency and/or angina (CAD)
- reflex tachycardia can be expected
- some agents within class may exhibit “histamine like” effects and thus stimulate gastric secretion
Types of Autonomic-Sympatholytic (adrenergic blocking) Agents
- Alpha adrenergic blocking agents
- Beta adrenergic blocking agents
Types of Alpha Adrenergic Blocking Agents
- nonselective alpha blocking agents
- nonselective alpha 1 blocking agents
- selective alpha 1 blocking agents
Types of Beta Adrenergic Blocking Agents
- nonselective beta blocking agents
- selective beta blocking agents
What are alpha adrenergic blocking agents used to treat?
- BPH
- migraines
Examples of nonselective alpha blocking agents
- Dihydroergotamine
- Ergoloid mesylate
- Ergotamine
- Phenoxybenzamine
- Phentolamine
Examples of nonselective alpha (1) blocking agents
- Doxazosin
- Prazosin
- Terazosin
Examples of selective alpha (1) blocking agents
- Alfuzosin
- Silodosin
- Tamsulosin
What are beta adrenergic blocking agents used to treat?
Majority of therapeutic uses are for hypertension
Examples of nonselective beta blocking agents
- Carvedilol
- Labetalol
- Nadolol
- Nebivolol
- Pindolol
- Propranolol
- Sotalol
- Timolol
Categories of Skeletal Muscle Relaxant Agents
- Centrally acting
- Direct acting
- GABA derived
- Neuromuscular blocking agents (NMBAs)
- Autonomic (misc.)
Centrally Acting
- a type of skeletal muscle relaxant
- are among the most common agents used in the community for typical muscle relaxation
- these agents interrupt neuronal “pain” pathways
Examples of Centrally Acting Skeletal Muscle Relaxants
- Carisoprodol
- Chlorzoxazone
- Cyclobenzaprine
- Metaxalone
- Tizanidine
GABA derived
- a type of skeletal muscle relaxants
- GABA derived agents such as baclofen are more effective when used for muscular spasm associated with multiple sclerosis
Examples of Direct Acting Skeletal Muscle Relaxants
- Dantrolene
Examples of GABA Derived Skeletal Muscle Relaxants
- Baclofen
Examples of NMBA Skeletal Muscle Relaxants
- Atracurium
- Cisatracurium
- Pancuronium
- Rocuronium
- Succinylcholine
- Vecuronium
Example of Miscellaneous Autonomic Agents
- Orphenadrine
- Nicotine
- Varenicline
Varenicline
- Chantix
- a type of nicotine receptor agonist
- can be used in place of nicotine replacement therapy
- stimulates the nicotine receptor sufficiently to reduce nicotine craving, however also adequately blocks the receptor to prevent pleasurable associated sensations if there is a smoking relapse
