Semester 2: Weeks 2 and 3

PARAsympathetic SYMPathetic
OVERVIEW: (cholinergic) (adrenergic)
G-protein Coupled Receptors: muscarinic (M1, M2, M3), Alpha receptors (⍺), Preganglionic neurons ACh ACh
Beta receptors (β)
Postganglionic neurons ACh ACh, NE
Ion Gated Receptors: nicotinic (Nm and Nn)
Muscarinic Alpha receptors (⍺)
Receptors involved
Nicotinic Beta receptors (β)
Cholinergic and Anticholinergic
Drugs
 refers to drugs that manipulate acetylcholine at muscarinic or
nicotinic receptors; they are active at:
o Parasympathetic nervous system
o Sympathetic nervous system sweat glands
o Skeletal muscle motor nerves
Hot as a hare: no sweating
Dry as a bone: dry eyes/mouth
Blind as a bat: eye dilation
Red as a beet: flushing
DRUG Mad as a hatter: confusion; delirium
Used for tx of

Mnemonics

-suffix

Effects

Contraindications

Acetylcholine Related

Catecholamine Related
Semester 2: Weeks 2 and 3

Side Effects: “DUMBBELSS”

• Diarrhea, defection
• Urination
• Miosis
• Bronchospasm
• Bradycardia
• Emesis
• Lacrimation
• Salivation
• Sweating

Succinylcholine is not cholinergic or anticholinergic, but rather the ONLY depolarizing agent in clinical use
• Binds to nicotinic receptors in skeletal muscle; Mimics ACh, but resistant to acetylcholinesterase so causes persistent depolarization
• used for intubation
 Semester 2: Weeks 2 and 3

SYMPATHETIC NERVOUS SYSTEM ADRENERGIC AGONISTS/ANTAGONISTS

AGONISTS (SYMPATHOMIMETICS) ANTAGONISTS (SYMPATHOLYTICS)
PHENYLEPHRINE Non-Selective α Agonist: PRAZOSIN
HTN
Alpha1 (⍺1)

Nasal decongestant
-drine PHENOXYBENZAMINE and
DOXAZOSIN
The police department
PHENTOLAMINE TERAZOSIN
MIDODRINE gives me HTN when I sin
 ⍺1= ⍺2
Orthostatic hypotension
 pheochromocytoma -sin
TAMSULOSIN BPH
ALFUZOSIN Tammy the TA
SILODOSIN stimulates prostates;
this is a sin
METHYLDOPA: HTN in PREGNANT women N/A
GUANFACINE
Alpha2 (⍺2)

HTN; ADHD
CLONIDINE
TIZANIDINE: Muscle relaxant
BRIMONIDINE
Glaucoma
APRACLONIDINE

-nidine
 Semester 2: Weeks 2 and 3
DOBUTAMINE (β1 >β2>>>>⍺) Non-Selective β Agonist: ACEBUTOLOL Nonselective β blockers:
↑ cardiac output PROPRANOLOL HTN;
Beta1 (β1)
acute heart failure ISOPROTERENOL BISOPROLOL Stage fright
Angina do NOT use in
cardiogenic shock β1=β2 (little effect on ⍺) ESMOLOL Arrhythmias Migraine prophylaxis and tx airway disease
AV Block Heart Failure Essential tremor
or diabetes
ATENOLOL Esophageal Varices
HTN
Infantile Hemangioma puppies never
METOPROLOL NADOLOL stop playing
ABEAM
-lol SOTALOL toys, and they
PINDOLOL are not
TIMOLOL selective
β2 >>β1>>>>⍺ N/A about them
Beta2 (β2)

Short-acting: ALBUTEROL acute asthma

Nonselective β with ⍺1 (β > ⍺1) Blockers:
Long-acting (only in combination with CARVEDILOL heart failure
steroids): FORMOTEROL and SALMETEROL LABETALOL HTN emergency
asthma

-rol -lol

Non-Selective Catecholamines:
EPINEPHRINE: DRUG
 ⍺1= ⍺2 = β1 = β2
 anaphylactic shock
 vasoconstriction added to local anesthetic Used for tx of
NOREPINEPHRINE:
 ⍺1= ⍺2; β1>> β2 Mnemonics
 septic and cardiogenic shock

Indirect Acting Sympathomimetics: -suffix

COCAINE;
AMPHETAMINE ADHD
Side effects/Contraindications
Mixed Acting Sympathomimetics:
PSEUDOPHEDRINE nasal decongestion
Semester 2: Weeks 2 and 3