Chapter 5

Autonomic Drugs

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Autonomic Pharmacology

Autonomic Nervous System

This system is divided into two separate

systems.
These systems are called the parasympathetic
nervous system and the sympathetic nervous
system.
These systems often produce opposite effects.
Drugs in this group are designed to either
enhance or mimic the autonomic nervous system
or to block the effects of the neurotransmitters at
their receptor sites.
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Autonomic Nervous System

Parasympathetic Nervous System

This system is concerned with the

conservation of the body processes.
Its main neurotransmitter is acetylcholine.
Its receptors are muscarinic, nicotinic, and the
somatic-skeletal muscles.

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Autonomic Nervous System

Sympathetic Nervous System

This nervous system is designed to cope with

emergency situations.
This is commonly known as the fright or flight
response.
Its neurotransmitters are epinephrine and
norepinephrine.
Its receptors are the and receptors.

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Autonomic Pharmacology

Cholinergic or Parasympathomimetic Drugs

These drugs are classified as either direct or indirect
acting agents.
Direct acting drugs act directly on the
parasympathetic receptors.
Indirect acting drugs work by either of two methods.
They can cause the release of the neurotransmitter
which then goes to the receptor site or they inhibit the
enzyme cholinesterase.

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Autonomic Pharmacology

Cholinergic Pharmacology

Cardiovascular
Direct effects include negative chronotropic and

inotropic actions.
Relaxation of smooth muscles causes a decrease in
total peripheral resistance.
Indirect effects include increased heart rate and
cardiac output.
The resulting effect depends upon the dose used.
Usually, the patient experiences bradycardia and a
decrease in blood pressure and cardiac output.

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Autonomic Pharmacology

Cholinergic Pharmacology

Gastrointestinal
These drugs excite the smooth muscle of the
gastrointestinal tract and cause an increase in
activity, motility, and secretion.

Eye
These drugs cause miosis and cycloplegia.
They cause a decrease in intraocular pressure.

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Autonomic Pharmacology

Adverse Reactions

Adverse reactions are an extension of the

drugs pharmacologic effects.
They include:
Salivation
Lacrimation
Urination
Defecation
Paralysis
Overdose

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Cholinergic Pharmacology

Contraindications

The contraindications and relative cautions are

a result of the drugs pharmacologic and
adverse effects.
They include:
Bronchial asthma
Hyperthyroidism
Gastrointestinal or urinary tract obstruction
Myasthenia gravis treated with neostigmine
Peptic ulcer disease
Severe cardiac disease
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Cholinergic Drugs

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Anticholinergic Drugs

These drugs prevent the action of

acetylcholine at postganglionic
parasympathetic endings.
Acetylcholine is released but its receptor site
is completely blocked by anticholinergic
drugs.
These drugs only block muscarinic receptors.

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Anticholinergic Drugs

Pharmacology

Central Nervous System

Depending on the dose, these drugs can cause
stimulation or depression.

Exocrine Glands
They reduce the flow and volume of secretions in the
respiratory, gastrointestinal, and genitourinary tracts.

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Anticholinergic Drugs

Pharmacology

Smooth Muscle
Relax smooth muscles in the respiratory and
gastrointestinal tracts.
They delay gastric emptying and decrease
esophageal and gastric emptying.
These drugs also cause bronchial dilation.

Eye
These drugs cause mydriasis and cycloplegia.

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Anticholinergic Drugs

Pharmacology

Cardiovascular
With large doses, these drugs produce vagal
blocking which results in tachycardia.
Bradycardia can occur with low doses.

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Anticholinergic Drugs

Adverse Reactions

The adverse reactions are an extension of the

drugs pharmacologic effects.
They include:
Xerostomia
Constipation
Urinary retention
Blurred vision
Hyperpyrexia
Hallucinations
Photophobia
Tachycardia
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Anticholinergic Drugs

Contraindications

Contraindications are usually due to the drugs

pharmacologic and adverse effects.
They include:
Glaucoma
Prostatic hypertrophy
Intestinal or urinary obstruction or retention
Cardiovascular disease

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Anticholinergic Drugs

Uses

Preoperative Medication
They inhibit salivary and bronchial secretions.
They block the vagal slowing of the heart that can
occur with general anesthesia.

Gastrointestinal Disorders
They decrease gastrointestinal motility and can be
used to treat ulcers, diarrhea, and hypermotility.

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Anticholinergic Drugs

Uses

Ophthalmologic Examinations
Topical use can cause mydriasis which causes a full
visualization of the retina.
Cycloplegia relaxes the lens so that proper
prescriptions for glasses can be determined.

Parkinson Disease
They reduce the tremors and rigidity associated with
Parkinson and drug-induced Parkinson disease.

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Anticholinergic Drugs

Uses

Motion Sickness
These drugs are used to treat or prevent motion
sickness because of their central nervous system
depressant action.

Dentistry
These drugs are used to create a dry, oral field.

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Adrenergic Drugs

Adrenergic drugs can be classified as having direct

action, indirect action, or mixed action.
These drugs stimulate and receptors throughout
the body.
Drugs with direct action (epinephrine, norepinephrine,
isoproterenol) produce their effect by directly
stimulating the receptor site.
Drugs with indirect action (amphetamine) release
endogenous norepinephrine which then stimulates
the receptor.
Drugs with mixed action (ephedrine) either directly
stimulate the receptor or release endogenous
norepinephrine.
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Adrenergic Drugs

Pharmacology

Central Nervous System (CNS)

These drugs produce CNS excitation or alertness.
Higher doses produce anxiety, apprehension,
restlessness, and tremors.

Cardiovascular System
These drugs increase the force and rate of
contraction of the heart.
Blood pressure is also increased.
Total peripheral resistance is also increased.

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Adrenergic Drugs

Pharmacology

Eye

These drugs lower intraocular pressure and can cause

mydriasis.

Respiratory System

These drugs cause a relaxation of bronchiole smooth

muscles.

Metabolic Effects

Increased glycogenolysis from -receptor stimulation

causes hyperglycemia.

Salivary Glands

These drugs produce vasoconstriction of the salivary

glands which leads to decreased salivary flow which
results in xerostomia.
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Adrenergic Drugs

Adverse Reactions

The adverse reactions associated with these

drugs are an extension of the drugs
pharmacologic effects.
They include:
Anxiety
Tremors
Tachycardia
Increased blood pressure
Arrhythmias

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Adrenergic Drugs

Uses

Vasoconstriction
These drugs are used in dentistry because of their

vasoconstrictive actions on blood vessels. They are

added to local anesthetics because they prolong the
action of the local anesthetic, reduce the risk for
systemic toxicity, and help to create a dry field.

Cardiac Effects
These drugs are used to raise blood pressure and to
treat cardiac arrest.

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Adrenergic Drugs

Uses

Bronchodilation
These drugs are used to treat asthma, emphysema,
and allergic reaction.

Central Nervous System Stimulation

These medications are used for the treatment of
attention deficit hyperactivity disorder, narcolepsy,
and as diet aids.

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Adrenergic Blocking Drugs

These drugs competitively inhibit and

receptor sites.
One group of drugs is specific for
receptors.
One group of drugs is specific for both 1
and 2 receptors.
One group is specific for 2 receptors.
One group is specific for both and
receptors.
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Antiadrenergic Drugs

Pharmacology

These drugs reduce sympathetic tone in the

blood vessels and decrease total peripheral
resistance.
This results in a reduction in blood pressure.

Uses

These drugs are used to treat hypertension,

peripheral vascular disease (i.e., Raynaud
syndrome) and benign prostatic hypertrophy.

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