AUTONOMIC

DRUGS
GROUP 3:
FRENZY REGIS
DARREN BABIA
PHILLIAN MABULAC
KRESHA LAMPARAS
KRISTIANA GUERRERO
 CASE STUDY1
A 15-year-old girl presents to the clinic with a sore throat
and fever. She is diagnosed with pharyngitis caused by
group A β-hemolytic Streptococcus. She is given an IM
injection of penicillin. Approximately 5 minutes later, she is
found to be in respiratory distress and audibly wheezing. Her
skin is mottled and cool, she is tachycardic (rapid heart rate),
and her blood pressure has fallen to 70/20 mm Hg. You
immediately diagnose her as having an anaphylactic reaction
to the penicillin and give an SC injection of epinephrine.
 CASE STUDY1
A 15-year-old girl presents to the clinic with a sore throat
and fever. She is diagnosed with pharyngitis caused by
group A β-hemolytic Streptococcus. She is given an IM
injection of penicillin. Approximately 5 minutes later, she is
found to be in respiratory distress and audibly wheezing. Her
skin is mottled and cool, she is tachycardic (rapid heart rate),
and her blood pressure has fallen to 70/20 mm Hg. You
immediately diagnose her as having an anaphylactic reaction
to the penicillin and give an SC injection of epinephrine.
 Anaphylactic reaction
A common medical emergency and a life-threatening
acute hypersensitivity reaction. It can be defined as a
rapidly evolving, generalized, multi-system allergic
reaction. Without treatment, this condition can be fatal
due to its rapid progression to respiratory collapse
 CASE STUDY1
A 15-year-old girl presents to the clinic with a sore throat
and fever. She is diagnosed with pharyngitis caused by
group A β-hemolytic Streptococcus. She is given an IM
injection of penicillin. Approximately 5 minutes later, she is
found to be in respiratory distress and audibly wheezing. Her
skin is mottled and cool, she is tachycardic (rapid heart rate),
and her blood pressure has fallen to 70/20 mm Hg. You
immediately diagnose her as having an anaphylactic reaction
to the penicillin and give an SC injection of epinephrine.
ALSO KNOWN AS LIVEDO
RETICULARIS
 Epinephrine
Epinephrine is a non selective
adrenergic agonist that targets
alpha 1, beta 1, and beta 2
receptors.
It is a potent vasoconstrictor and a
cardiac stimulant
Which adrenoceptor primarily mediates
the vascular response?

Jhfhgx h
Which adrenoceptor primarily mediates
the vascular response?

Jhfhgx h
What effect will epinephrine have on this
patient’s vascular system?
Raises blood pressure
Normalize heart rate
Allow normal flow of oxygenated
blood to alleviate mottled skin
Which adrenoceptor primarily mediates
the respiratory system response?
What effect will epinephrine have on her
respiratory system?

Decrease respiratory distress

by dilating airways
Erradication of audible
wheezing
 CASE STUDY 4.2
A 61-year-old man is noted to have increased intraocular pressure on a
routine eye examination. The visual acuity is normal in both eyes. The
dilated eye examination reveals no evidence of optic nerve damage.
Visual field testing shows mild loss of peripheral vision. He is diagnosed
with primary open-angle glaucoma and is started on pilocarpine
ophthalmic drops.
Primary open-angle glaucoma is the most common type of glaucoma
and is characterized by increased resistance to drainage in the
trabecular meshwork, even though the drainage angle between the
cornea and iris remains open. Due to this blockage, the pressure in
the eye gradually increases, resulting in damage to the optic nerve
and progressive visual loss.
Source: National Library of Medicine
 What is the action of pilocarpine on the muscles of the iris and cilia?

Muscarinic stimulants and cholinesterase inhibitors reduce intraocular

pressure by causing contraction of the ciliary body so as to facilitate
outflow of aqueous humor and perhaps also by diminishing the rate of its
secretion.

What receptor mediates this action?

Muscarinic (M3) receptor
Is pilocarpine the appropriate first- line drug for the treatment of
primary open- angle glaucoma?

In the past, glaucoma was treated with either direct agonists

(Pilocarpine, Methacholine, and Carbachol) or cholinesterase
inhibitors (Physostigmine, Demecarium, Echiophate, and
Isoflurophate).

For chronic glaucoma, these drugs have been largely replaced by

prostaglandin analogs (Latanoprost) and topical Beta-adrenoceptor
antagonists.
 CASE STUDY 3
A 53-year-old woman comes to see you for a consultation.
She is scheduled to take a Caribbean cruise in 2 weeks but is
concerned about sea sickness. She has been on boats before
and is very sensitive to motion sickness. A friend mentioned
to her that there is a patch that is effective for this problem.
She is in good health and takes no medications regularly. Her
examination is normal. A scopolamine transdermal patch is
prescribed for her.
 WHAT IS THE MECHANISM OF
ACTION OF SCOPOLAMINE?

Scopolamine (hyoscine) is an alkaloid substance that

competitively antagonizes ACh's actions at both central and
peripheral muscarinic receptors. It is selective to muscarinic
receptors but is non-selective between the muscarinic receptor
subtypes (M1 thru M5). Since ACh is the primary neurotransmitter
of the parasympathetic nervous system, scopolamine has
parasympatholytic effects.
 WHAT ARE THE COMMON SIDE
EFFECTS OF THIS MEDICATION?

Scopolamine commonly causes dry mouth, constipation, blurred

vision, mydriasis, urinary retention, and tachycardia. As an
antimuscarinic medication, scopolamine has the potential to cause
excitement, agitation, hallucinations, drowsiness, and coma.
 WHAT ARE SOME RELATIVE
CONTRAINDICATIONS TO ITS USE?

Antimuscarinic drugs such as scopolamine are contraindicated in

patients with glaucoma, especially angle-closure glaucoma. It
should also be avoided in patients with a history of prostatic
hyperplasia. Because antimuscarinic drugs slow gastric emptying, it
is contraindicated in patients who have gastric ulcers.
 CASE STUDY 4
A healthy 25-year-old man is undergoing a brief surgical procedure
requiring general anesthesia. He underwent an unremarkable intubation
and induction of anesthesia using IV succinylcholine and inhaled
halothane. During the surgery the patient develops muscle rigidity and
tachycardia, and his temperature rapidly rises.
 What is the mechanism of action of
succinylcholine?
Succinylcholine is a depolarizing neuromuscular blocker. As does
acetylcholine, it combines with the cholinergic receptors of the motor end
plate to produce depolarization. This depolarization may be observed as
fasciculations.
 What reaction is occurring in the patient?

The reaction that is occurring in the patient is malignant hyperthermia.

Early signs of malignant hyperthermia:

Unexplained increase in heart rate (tachycardia).

Unexplained increase in carbon dioxide produced by
your body.
Rapid breathing
Muscle rigidity.
Rapid elevation in temperature.
MALIGNANT HYPERTHERMIA
It is associated with an uncontrolled increase in
myoplasmic calcium in skeletal muscle. This is a severe
reaction to an individual exposed to volatile anesthetic
while undergoing general anesthesia. A depolarizing muscle
relaxant, succinylcholine, may also trigger this reaction.
What drug should immediately be given to the patient
and what is its mechanism of action?
Treatment: Dantrolene

MOA: inhibits the release of calcium from the sarcoplasmic reticulum

during muscle contraction.
A 65-year-old woman is
admitted to the intensive care
unit (ICU) of the hospital with
sepsis caused by a urinary tract
infection.

She is HYPOTENSIVE, with a

blood pressure of 80/40 mm Hg
CASE
and has an elevated heart rate STUDY

5
(tachycardia) and decreased
urine output (oliguria).

Along with the institution of

appropriate antibiotic therapy
and IV fluids, a decision is made
to start her on an IV infusion of
DOPAMINE to attempt to raise
her blood pressure.
A 65-year-old woman is
admitted to the intensive care
unit (ICU) of the hospital with
sepsis caused by a urinary tract UROSEPSIS
infection.

She is HYPOTENSIVE, with a IT HAPPENS WHEN

blood pressure of 80/40 mm Hg A URINARY TRACT
and has an elevated heart rate
(tachycardia) and decreased INFECTION (UTI)
urine output (oliguria). GOES UNTREATED
Along with the institution of
AND SPREADS TO
appropriate antibiotic therapy YOUR KIDNEYS.
and IV fluids, a decision is made
to start her on an IV infusion of
DOPAMINE to attempt to raise
her blood pressure.
Antibiotics
first line of defense for urosepsis
Get rid of the bacteria causing the infection.

IV fluids
Second treatment for sepsis.
These fluids contain minerals like sodium
Keep your blood pressure from dropping too low
and can help treat organ damage from urosepsis.
INFORMATION ABOUT

DOPAMINE
Intravenous dopamine infusion is one of the most commonly employed drugs in
intensive care units.

The cardiovascular and renal effects of dopamine result from its direct action on
alpha and beta adrenoceptors as well as dopamine receptors.

Appreciation of the dose-dependent effects of dopamine is essential for its optimum

and safe therapeutic use.
QUESTIONS
What effects can be expected with low- dose
dopamine and which receptors mediate
these effects?

What effects can be expected with high- dose

dopamine and which receptors mediate
these effects?
NO. 1
What effects can be expected with low- dose dopamine and
which receptors mediate these effects?

DOSE: 0.5 to 2 micrograms/kg/min

EFFECTS:
Increase in renal blood flow and sodium excretion

RECEPTOR:
D1 Receptors
NO. 2
What effects can be expected with high-dose dopamine and
which receptors mediate these effects?
The PERIPHERAL DOPAMINE SYSTEM
is an important regulator of renal function,
sodium excretion and blood pressure
 CASE STUDY 6
A 70-year-old man is seen in follow-up at the clinic after he has
been hospitalized for a myocardial infarction (MI). He underwent
successful angioplasty and is currently asymptomatic. Prior to his
MI, he was not on medications. He is not a smoker and is not
diabetic. During his hospitalization, he was noted to have
persistently elevated blood pressure readings. He had asthma as
a child, but has not had any recent wheezing episodes. While in
the hospital, he was started on oral metoprolol.
NO. 1
Metoprolol is selective for which adrenoceptor?

Metoprolol is a beta1-selective (cardioselective) adrenergic

receptor-blocking agent.
NO. 2
What effects do agents such as metoprolol have on the
cardiovascular system?
EFFECTS:

Reduction of sympathetic-stimulated increases in heart rate,

contractility, and cardiac output;
lower blood pressure as a result of effects on the heart, renin-
angiotensin system, and CNS;
increased atrioventricular (AV) conduction time and
refractoriness.
NO. 3
In which organ is metoprolol primarily metabolized?

Metoprolol is metabolized in the liver via the cytochrome P450

(CYP2D6).
NO. 4
Why must B- adrenergic antagonists be used with caution in asthmatics?

The b-adrenergic antagonist can block the b-2 receptors,

leading to an increase in airway resistance.
THANK
YOU!