1987 (revised 2011)
PHARMACOLOGY / PHYSIOLOGY REVIEW
A review of certain terms and physiological principles is essential to understand the effectspharmacological agents have on the cardiovascular system,
DRUGS THAT AFFECT THE HEART
Autonomic drugs mimic or block the action of the autonomic (sympathetic and parasympathetic) nervoussystem. These drugs affect the vasculature, bronchial, and alter the rate, force, of myocardialcontraction. Terms that describe some of these autonomic actions include: inotropic, chronotropic,dromotropic, and pressor effect.1.
: Drugs with an inotropic action affect myocardial contractility.a). A positive inotropic action increases myocardial contractility, e.g. epinephrine.b). A negative inotropic action decreases myocardial contractility, e.g. propranolol.2.
: Drugs with a chronotropic action affect the rate of the heart. The ancient GreekGod Chronos personified time.a). A positive chronotropic increases heart rate by increasing the rate of impulse formation in the SAnode, e.g., epinephrine.b). A negative chronotropic decreases heart rate by slowing the rate of impulse formation in the SAnode, e.g. propranolol.3.
: Dromotropic drugs affect conduction velocity through specialized conductingtissue.a). A positive dromotropic drug speeds conduction, e.g. epinephrine.b). A negative dromotropic action slows conduction, e.g., digitalis.4.
: Pressor drugs cause vasoconstriction and increase peripheral vascular resistance,e.g., epinephrine.
THE AUTONOMIC NERVOUS SYSTEM
Nerves transmit impulses across synapses via chemical called “neurohormonal transmitters”. Autonomicdrugs affect smooth muscle, cardiac muscle, and gland cells by mimicking or modifying the actions of theneurohormonal transmitters. For the most part, the neurohormonal transmitters associated with thesympathetic fibers are the catecholamines (dopamine, norepinephrine, and epinephrine) whileacetylcholine (ACh) effects the parasympathetic fibers. Fibers that release ACh are called
. Fibers that release catecholamines (i.e., norepinephrine) are called
.In most instances the sympathetic and parasympathetic systems can be viewed as antagonists. Onesystem augments a function (i.e., the sympathetic fight or flight response) while the other inhibits thatfunction and restores homeostasis (the parasympathetic response).1.
The Sympathetic System
: The sympathetic terminals make contact with a large number of postganglionic nerves. Some ratios may be as high as 1:20 or more. Therefore, a diffuse discharge of the sympathetic system is possible.- The sympathetic system is associated with the "
Fight or Flight
" mechanism.a). Increases heart rate and blood pressure,b). Dilatation of pupils and bronchioles.c). Increases glucose levels, and shunts blood from the skin and splanchnic regions to the skeletalmuscles.d). Effects on blood pressure are mostly due to sympathetic control of arteriolar resistance.