Autonomic Nervous System (ANS) Lecture SANS2 PDF

Climate-resilient Autonomic Nervous System Public Infrastructure (ANS) Lecture SANS2 Thesis Defense Doaa Zaghloul Mohammad Shebl Doaa Zaghloul mohammad Shebl * Lecturer, Clinical * Lecturer, Pharmacology Clinical...

Climate-resilient Autonomic Nervous System Public Infrastructure (ANS) Lecture SANS2 Thesis Defense Doaa Zaghloul Mohammad Shebl Doaa Zaghloul mohammad Shebl * Lecturer, Clinical * Lecturer, Pharmacology Clinical Department, Pharmacology Department, Faculty of Medicine, Menoufia University, Faculty of Medicine, Menoufia University, Egypt Egypt. ILOS ( Lecture 2) Purpose Statement Methodology 01 You can describe the topic 04 You can describe the topic 01 Introduction to ANS of the section here of the section here ✓ Anatomy of the ANS. Neurotransmitters of the ANS. ✓Hypothesis Analysis 02 ✓ Receptors of the ANS. 05 You can describe the topic ✓You can describe Distribution the and topic of the ANS. Function of the section here of the section here 02 Sympathetic nervous system Objectives Conclusions 03 You can describe the topic ✓ Adrenergic 06 You can describe the topic neurotransmitters & receptors. ✓ Sympathomimetics. of the section here of the section here ✓ Sympatholytics. 01  Sympathetic nervous system Purpose 01 03 statement You can describe the topic of the section here ✓ Sympathomimetics  Sympathomimetic (Adrenergic Agonists) Classification: Chemical Chemical /mechanism of action Classification Non-catecholamines 01 Catecholamines e.g. Phenylephrine, (5 drugs) ephedrine Natural Synthetic e.g. Adrenaline, NA, e.g. Isoprenaline, dopamine dobutamine  Sympathomimetic (Adrenergic Agonists) Catecholamines Non-Catecholamines (Adrenaline) (ephedrine) 1- GIT Not absorbed Absorbed 01 ( x Oral ) ( Effective Orally ) 2- BBB Don’t pass BBB Pass BBB → Produce CNS stimulation Water soluble 3- COMT / MAO Destroyed by COMT / MAO Not destroyed by COMT / MAO 4- Onset-duration Rapid onset, short duration Slow onset, long duration  Sympathomimetic (Adrenergic Agonists) Classification according to mechanism of action Direct acting e.g. 01 Adrenaline, noradrenaline, Indirect acting e.g. Amphetamine. isoprenaline, dopamine, Dual acting e.g. Ephedrine dobutamine. (↑release/ ↓reuptake of NE All cat drugs (5) from nerve endings)  Catecholamines 1- Adrenaline Catecholamines. Direct mechanism. 01 Pharmacological actions: (alpha + beta).  Catecholamines 1- Adrenaline Indications (Uses): Anaphylactic shock Physiological antagonist (drug of choice). of histamine. (α1/ β2) Acute bronchial asthma. β2 5A Cardiac Arrest. β1 Arrest of bleeding (Topical in epistaxis). α1 Added to local Anesthetics.  Catecholamines 1- Adrenaline Give a reason 01  Catecholamines 1- Adrenaline Q1) Use of adrenaline in anaphylactic shock ? 01 Acute anaphylactic shock is a life-threatening condition results from massive release of histamine in response to exposure to allergic substance e.g. penicillin. (Histamine causes sever hypotension and bronchoconstriction by its effect on histamine ( H1) receptors.  Catecholamines 1- Adrenaline 01  Catecholamines 1- Adrenaline Q1) Use of adrenaline in anaphylactic shock ? 1- Injection of epinephrine immediately dilates the bronchi (ꞵ2), decreases bronchial secretions and elevates BP (VC) (α1). 01 So, epinephrine is considered the (physiological antidote) of histamine as it can reverse all its effects by actions on different receptors. 2- ↓ Histamine release from mast cell (stabilize membrane).  Catecholamines 1- Adrenaline Q2) Combination of adrenaline with local anesthetics? Adrenaline constrict B.Vs (α1) in the tissue resulting in : 1. Slow the absorption of the anesthetic agent → ↑ duration of action of local anesthetics. 2. ↓ Systemic toxicity of local anesthetics. 3. ↓ bleeding.  Catecholamines 1- Adrenaline Pharmacological Adverse effects Contraindications actions: (alpha + beta) 1.Tachycardia, palpitation. 1. Angina (Ischemic heart β1 ( Heart → ) 01 2. Angina, Arrthysmias and Anxiety. disease). 2. Arrhythmia. 3. Hyperthyroidism. 3. Hypertension. α1 4. Hypertension. 4. Gangrene of fingers and toes.  Catecholamines 2- Noradrenaline Catecholamines. Direct mechanism. 01 Pharmacological actions: (alpha + weak β1).  Catecholamines 2- Noradrenaline Pharmacological actions: Indications (Uses): (alpha + weak β1) 01 α1 (BVs → VC) Acute hypotensive state Weak β1 ( Heart → )  Catecholamines 3- Isoprenaline Catecholamines. Direct mechanism. 01 Pharmacological actions: (β receptors: β1 and β2).  Catecholamines 3- Isoprenaline Pharmacological actions: Indications (Uses): (2 B) β receptors ( β1 and β2) Heart block. β1 ( Heart → ) 01 β2 (Bronchi → BD) Acute bronchial asthma.  Catecholamines 4- Dopamine Catecholamines. Direct mechanism. 01 Pharmacological actions: - Its action is dose dependent D1 β1 α1 Increasing doses of dopamine  Catecholamines 4- Dopamine Receptor stimulated Effect Lower rate of infusion D1 (renal, coronary, - VD and decrease PR cerebral, mesenteric blood - Increase renal blood flow and vessels). renal output. 01 Moderate rate D1 & β 1 increase COP, systolic BP. High rate α1 Generalized VC and increase PR.  Catecholamines 4- Dopamine Indications (Uses): (1) Shock: (Cardiogenic), hemorrhagic and endotoxic (The best drug for shock)………….? 01 1. VD and decrease peripheral resistance which help tissue perfusion. (increase renal blood flow and urine output). 2. Increase cardiac output and increase blood pressure. (2) Heart failure: Especially if accompanied with hypotension.  Catecholamines 4- Dopamine Tissue D1→ VD & ↓PR Tissue perfusion 01 perfusion Shock Dopamine BP BP β 1→ ↑ COP  Catecholamines 5- Dobutamine Dopamine Dobutamine 1- Source Natural catecholamine Synthetic catecholamine 01 2- Actions Stimulates D 1˃ β 1˃ α1 Stimulates β 1 only 3- Uses TTT of most cases of shock TTT of cardiogenic shock  Catecholamines (5 drugs) Adrenaline Noradrenaline Isoprenaline Dopamine Dobutamine Alpha + weak β1 (2 B) Dose dependent. (Alpha + beta) -Synthetic. (Stimulates D 1˃ β 1˃ α1) 01 Uses: (5A) Uses: Acute Actions: β1 and β2 - Stimulates β 1 hypotensive state Uses: Uses: only Give reasons: -- Heart block. - Shock - Anaphlactic shock (The best drug for - TTT of -with local anathetic -- Acute bronchial asthma. shock) cardiogenic A/E and CI: - Heart failure shock -----β1 and α1 01 Let us practice  Let us practice Q1) Which of the following drugs is the drug of choice for anaphylactic shock? 01 a) Phenylephrine. b) Terbutaline. c) Ritodrine. d) Adrenaline. e) Isoprenaline.  Let us practice Q2) Which one of the followings is a contraindication of adrenaline use ? a) Acute bronchial asthma. 01 b) Anaphylactic shock. c) Hypertension. d) Cardiac arrest. e) Epistaxis.  Let us practice Q3) Which receptor/s does isoprenaline act on? a) Beta1 and alpha1. 01 b) alpha1 and alpha 2. c) Beta2 and beta3. d) Dopamine and beta1. e) Beta1 and beta2.  Let us practice Q4) Which one of the following conditions is treated by IV infusion of dopamine? 01 a) Acute bronchial asthma. b) Hemorrhagic shock. c) Hypertension. d) Vomiting. e) Pheochromocytoma.  Let us practice Q5) Dobutamine is best indicated for management of which the following shock? 01 a) Septic shock. b) Hypovolemic shock. c) Anaphylactic shock. d) Neurogenic shock. e) Cardiogenic shock. THANKS!