Pharmacology

• Autonomic nervous system

Lecture No.-03 Dr Ankit Kumar (MD, DM)

1 Cholinergic drugs: Directly acting

2 Smoking cessation, Mushroom poisoning

3 Cholinergic drugs: Indirectly acting

 Cholinergic drugs: Continued
HARD

Q: In which scenario action of Pilocarpine on iris will not occur ? (AIIMS 2019)
Directly Acting

A. Edinger Westphal nucleus damage

B. Uncal herniation
M on IRIS
C. Adie tonic pupil +

D. Pharmacological block by atropine

MIOSIS
 Edinger Westphal nucleus
c
PILOCARPINE
Cilla my ganglion

iris 193 + : MIOSIS

EDIN
H PSNS Post G.
A Etch
C-.
3: oculomotor Ach

"73 ④ : Miosis

Atropine Blocks M3 ins

D
 SMOKING
DE-
ADDICTION
v. Imp

* Pleasure: t Anxiety
: Pleasure/Reward

> cycle c inves

Dependance L
DRUG Tolerance TAPER.
conc.

MNely/ IRRITATED
> * Withdrawal: l
CRAVING
 Smoking deaddiction /CESSATION

v.up

First line drugs 3

C) I
never
transdermal patch.
Nicotine: NICOTINE : Route
• MI/Angina ? CVS Db
Chewings Gums * sublingual •.
BUCCAL strips - vasopasm (Raynaud's)
* oral
LOZENGES • HTM
sudden Absorptionth 5
NASAL S pray.
• SEIZURES

ORAL Also approved

¥- CVS Dis
Very : VARENICLINE - PARTIAL Agonist for Tobacco
seizures
@ Nicotinic Receptor
Lewing suicide (depression)

A
Norepi Dopamine ⇐ CVS Dis
: Antidepressant → NDRI
Bad. 8 BUPROPION. reuptake inhibitor SEIZURES ✓

ORAL }
+ Nicotinic receptor
 when cannot give 1st Line DRUG.
2nd Line DRUGS

seizure patient !
> safe in CVS Dis and
• CLONIDINE

: Antidepressant (Tricyclic Antidepressant

2. NORTRYPTILINE
Second Line Drugs → Clonidine, Nor tryptiline

was for: Anti-obesity Also

Anti-smoking

Banned: Suicides
(depression)
: Not approved but found to be effective
Off Label Use 2 RIMONA BAUT
① MECANYLAMINE
(not Important Blocks CBI (Cannabinoid)
[Ganglionic Blocker]

Most Effective Psychological Counselling:

From now I will not

smoke
Treatment
COLD TURKEY Technique

Most Effective Drug > Transdermal nicotine> Varenidine

Combination is even better

MUSHROOM
POISONING
A Theory exam
 Mushroom poisoning :3 types.

EARLY type LATE Type Hallucinogenic type

4s PHALLOIDIM type kS MUSCARIA type

KE/MUSCARINE type
-
Amanita MUSCARIA
Amanita phalloides.
species: Inocybe

I BOTENIC acid
MUSCINOL E
MUSCARINE AMATOXIN
Toxin:
Most dangerous)

Hallucination, SEIZURES.
DUMBBELSS HEPATOTOXICITY
¥: Diazepam
i
pinpoint pupi
- No speape Antidote
HEPATO PROTECTIVES.

T/t: ATROPINE
• Thioctic AUDO Atrooine is contraindicated

is Antidote • Sili BININ-Q Itself causes: Hathanahan/seizin

 Indirectly Acting Cholinergic

¥ Anti-Choline Esterase

ACHE enzyme
PACHE So
inhibit

Increase endogenous Acetylcholine

 Anti-choline Esterase

• suicide inhibitor

• HIT & RUN DRUGS

Irreversible inhibitor
Reversible inhibitor: ✓ clinically
✓ ←
used
Poisons
• CARBAMATES
• CARBAMATES (anent)

• TACRINE • Organophosphates.

Tertiary Amine Quarter nary Amine

+
NHz NHy
 Water soluble
Lipid soluble

- ionic
non- ionic

cross
NO
* BBB

* cross
No.
Comea

(eye drops)
 Reversible Anti-CHE

Quaternary Amine
Tertiary Amine

Physostigmine
l NEOSTIGMINE

AMBENOMIUM

TACRINE
2
7ft Alzheimer's
"RIDOSTIG mine
DONE PEZIL

GALANTAMINE DROP HOMIUM (ENSILON)

RIVA STIGMINE
 Tertiary amines

Peysostig mine

Belladonna)
ATROPINE poisoning (14s
DOC
* poisonin

Atropine
Ach 1^9
Miotic Agent
/comp. * Topical eye drops ⇒

Blocker.
+ -
in Glaucoma

8 DUMBBELSS

¥
 Drugs for Alzheimer’s disease IF

Cholinergic neurons
→ neurodegenerative Disease:

Hippocampus (nucleus)
Pressure Atrophy.
of

^
^ Mey nest
l

: Dementia
symptoms
31 Amyloid

deposition •
main
(memory loss

cognition

Insomnia.

Depression
DRUGI → Approved one

99 memory
9 Ach in Brain
- Anti-choline Esterase: 30 Amine →
1
1st

Banned Hepatotoxic, short acting

. ACRINE

Longest ORAL DRUG: once/day → Most effective &

✓ DONE PEZIL Doc for Alzheimer

✓ GALANTA MINE

Rivas Tig mime Transdermal patch/now Also of Donepezily

no significant improvement

i MMSE questionnaire

(Mini mental status examination

 Add

⇒ 9 MEMORY
2 HEMANTINE NMDA Antagonist

glutamate)

MEM any Alzheimer

Removes
ADU CANUMAB → Monoclonal against 31 Amyloid
3
Antibody

Alzheimer

NEIN
Disease

underlying cause
4 LECANEMAB T
 IF - BEL DRUGS for Alzheimers
Quaternary amines
Reference

PIRACETAM
l NOO TROPHIC DRUGS → 9 Memory

ERGONOVINE

T → failed to produce significant effect

Gingko Biloba

Nicotine.

2 ASPIRIN

3 STATINS

ESTROGEN
4
 Quaternary Amines

Additionally: Nicotinic receptor Agonist

eostigmine

Direct Action ✓ ORAL, Ving

Mused
Ambenonium

ORAL only
→ longest
TYRIDOS Tigmine

ing.
DROPHONIUM → Shortest

(1¥ Tension)
USES

: Resp. Muscle
Venom → Blocks Nm
1 COBRA BITE Poisoning
paralysis
+

S : Mach overcome
NEO

Postoperative
CURARE reversal SMR → Block Nm
2
reversal
e. g TUBOW RARE, ATRA WRIUM

( Skeletor muscle Relaxant)

: symptomatic
Antibodies → Block Nm
MY AESTHENIA GRAVIS
3
Muscle

weakness
I Precaution e Neostigmine

want
④ Nicotinic

19 Ach
NEO S

Side effects
Muscarinic →
+

Always Combine

E Q E DUMBBELLS
S

ATROPINE
Bradycardia

Blocks Muscarinic

receptors only
 Myasthenia gravis
WAKE BITE

VENOM.

HEMATOTOXIC
NEUROTOXI

→ Hemolysis &
→ Block NM

Bleeding
* Muscle paralysis

MOST: VEI
I , ELAPIDS
MOST: COBRA, KRAIT
 DOC Pou VALENT Antivenom
¥

Any snake Bite

If neurotoxic: symptoms of

Muscle paralysis

Add: ing. NEOSTIG mine + ATROPINE

(ing-EDROphonium
Thankyou

Always
r

Read your notes tonight