Pharmacology

of

Autonomic Nervous
System
urdu Mnemonics

Easy
are given in
Green Font to remember difficult names of drugs.

Cholinomimetics
Parasympathomimitics
cholinesterase inhibitors

1.. Direct acting

Mnemonics in Green Fonts
a. muscuric
choline esters MBC (methanicoline, ACH, bethanicol, carbacol)
Alkaloids PILLOW (Pilocarpine, nicotine, Lobeline)
b. nicotinic
2.. Indirect acting
a. short acting (edrophonium)
b. long acting [carbamates] (neostigmine, pyridostigmine, physiostigmine)
c. very long acting [organophosphates] Maleha serial (parathion,
malathion, serin, tubun)

Reversible indirect acting (Ambenomium,

Neostigmine, Physostigmine, pyridostigmine)
Irreversible indirect acting aik he
(echothiophate)
Indirect acting for Alzhemers disease
Riva gentleman ha, Done kr du osay
(Rivastigmine, galantamine, donepezil, tacrine)

Imp points
Methacoline act mainly on the M2 receptor and also stimulate the M3
receptor. It is use for the diagnostic purpose of the reactive reaction
inside the trachea .
Carbacol use in the glaucoma and the cycloplegia.
Pilocarpine is used in the open and close angle glaucoma and to clear
the adhesions in the eye. Also use in the sjogren syndrome.

Imp points with Pneumonic .

Bathenicol.
Pilocarpine.
tear production).
Carbacol.
Methacoline
Neostigmine
Pyridostigmine
Edrophonium
Donepzol

B for bathenicol, B for ball, B for bladder

You cry, you sweat on your pillow. (Pilocarpine control
Carbacol is a carbon copy of ACH. (glaucoma)
asthma
Neo=NO cns entry
gets rid of myasthenia gravis
diagnosis of myasthenia gravis
treat alzhemer.

All cholimitics MAO point

INC ACH

Cholinergic transmission
1. Synthesis of Ach ( transport of choline is inhibitid by
Hemicholinium)
2. Uptake into storage vesicles
3. Release of neurotransmitter (release is blocked by Botulium
toxins)
4. Binding to the receptor (postsynaptic receptors activated by
binding of neurotransmitors)
5. Recycling of choline (choline is taken up by neuron)
6. Degradation of Ach (Ach rapidly hydrolyzed by enzyme acetyle
cholinestrase)

Cholinergic receptors
Muscurinic receptors

Gq

1. M1 (stomach Glands, secretions)

2. M2 (SA node, AV node dec heart rate, dec conduction velocity) Gi

3. M3 (eye sphincter and ciliary muscle, lungs, bladder, sphinctors, blood
vessels)

Gq

Nicotinic receptors
1. Nn (adrenal medulla , autonomic ganglia) no 2nd messenger
2. Nm (Neuromuscular junction)
no 2nd messenger

Imp points::
Muscurinic
Pralidoxine is use in Reactivation of acetylcholinesterase.
Ach has short half life, dec HR and BP.
Bathanecol use inc intestinal motility, inc urination.
Carbacol use to treat glaucoma
Pilocarpine does contraction of pupil (Miosis) {atropine does mydriasis}

Indirect acting Nicotinic

Edrophonium is short acting and use in Myasthenia
Neostigmine and pyridostigmine not enter in CNS and use in urinary retention
and myasthenia.
Rivostagmine and donepezil enter in CNS and use in Alzheimer disease.
Physiostigmine enter in CNS and use in glaucoma. It is an antidote in atropine
overdose.

Anti-cholergic
Parasympatholitics
cholinesterase Regenerators

1.. Anti-muscurinic
a. M1 selective (PIR, TEL, DARI, SOLI) (pirenzipine, telenzepine,
darifenacin, fesoterodine, solifenacin, tolterodine)
b. Non selective (atropine, scopolamine, ipratropium)

2.. Anti-nicotinic
a. ganglion blockers Mika ko methi khany ki vaja sy heza ho gia
(hexamethonium, Trimethaphan, Mecamylamine)
b. neuromuscular blockers (toba ki athara sal ki dosheza)
(tubocurarine, atracurium, Doxacurium)

3.. Cholinestrase Regenrators

a. oximes (pralidoxime)

Imp points::
Antimuscurinic
Atropine is protype drug in this class.
Can enter in CNS.
It is spamodytic, dec secretions, do mydriasis, cycloplegia, hyperthermia,
tachycardia, sedation, urinary retention and constipation.
Atropine excite the behavior.
AntiNicotinic
Others antimuscurinic
Hyptention
Scopolamine (motion sickness,cause sedation)
Mydriasis
Tropicamide (opthalmology)
Cycloplegia
Xerostomia
Ipratropium,Tiotropium (asthma and COPD)
Anhydrosis

Sympathomimetic
Adrenomimitics

1.. Direct acting

Alpha agonist (No Priyanka Chopra)
a. Non-selective (norepinephrine)
b. alpha1 agonist (phenylpherine)
3.. Mixing acting
c. alpha2 agonist (clonidine)
a) Ephedrine
Beta agonist (IdeA)
b) Pseudoepherine
a. non-selective (isoproterenol)
c) Metaraminol
b. beta 1 agonist (dobutamine)
c. beta 2 agonist (albuterol)

2.. Indirect acting

Releasers (amphetamine) {use of
methylphenidate in narcolepsy and
ADHD}
Reuptake inhibitors (cocaine, tricyclic
antidepressant)

Adenergic transmission
1. Syn of norepinephrine (Hydroxylation of tyrosine is rate limiting step)
2. Uptake into storage vesicles (dopamine enters a vesicle and is converted to
norepinephrine, it is protected from degradation . Transport into vesicle is
inhibited by Reserpine)
3. Release of neurotransmitter (influx of calcium is causes fusion of vesicle
with the cell membrane in a process known as exocytosis. Release is blocked
by Guanethidine and bretylium)
4. Binding to receptor (postsynaptic receptor is activated by binding of
neurotransmitter.)
5. Removal of norepinephrine (released norepinephrine is rapidly taken into
neuron, reuptake is inhibited by Cocaine and Imipramine)
6. Metabolism (norepinephrine is methylated by COMT and oxidized by MAO)

Adrenoceptors
Alpha 1 (vasoconstriction, inc peripheral resistance, inc BP, mydriasis, inc
closure of internal sphincter of Bladder){vascular smooth muscles, Liver}
Alpha 2 (Inhibition of norepinephrine release, inhibition of Ach release,
Inhibition of insulin){Adenergic and cholinergic nerve terminals,
platelets, fat cells , pancreatic B cells}
Beta 1 (Tachycardia, Inc lipolysis, Inc myocardial contractility, inc release
of renin){heart , Juxtaglomerular cells of kidney}
Beta 2 (vasodilation, dec peripheral resistance, bronchodialation, inc
release of glucagon, Relaxed uterine smooth muscle){airways, uterine
vasculature, liver, Pancreatic B cells, Heart}
Beta 3 (stimulate lipolysis) {Fat cells}
D1 (dilates){renal and other splanchnic blood vessels}
D2 (inhibit adenyl cyclase) {nerve terminals}

Imp points
Dopamine use in shock (D1>B1>A1)
Fenoldopam is a D1 agonist used for hypertension.
Alpha1 agonist inc mean blood pressure via vasoconstriction .
Phenylephrine is nasal decongestant and do mydriasis without cycloplegia.
Alpha 2 agonist stimulate prejunctional receptors in CNS, and use
hypertension.
Beta agonist Dec mean BP via vasodilation (B2) and inc HR (B1).
Salmeterol, albuterol and terbutaline used in asthma.
Terbutalin used in Premature labor.
Epinephrine act both on alpha and beta receptors. This is demonstrated by
Dale and so known as Dales phenomenon.
Nor-epinephrine have more effect on alpha-receptors , slight on B1, not on
B2. It causes inc BP, inc peripheral resistance, and cause reflex bradycardia.

Epinephrine in low dose stimulate B1 & B2

Epinephrine in high dose stimulate A1 , B1 (B2)
Epinephrine Reversal.
Use of A1 blocker to reverse hypertension to hypotension in a patient receiving
too much epinephrine.
Hypertension was due to predominant A1 tone on the vasculature.
Hypotension results from unmasking of B2 receptors.
Uses of epinephrine and norepinephrine
Cardiac arrest
Adjunct to local anesthesia
Hypotension
Uses of only epinephrine
Anaphylaxis
Asthma

Sympatholytic
Adrenolytic

1.. Alpha blockers

a. Non selective
reversible (phentolamine)
irreversible (phenoxybenzamine)
b. alpha 1 blockers (prazosin, doxazosin, terazosin, tamsulosin)
c. alpha 2 blockers (yohimbine)

2.. Beta blockers

a. Non selective (propranolol, timolol, pindolol, nadolol)
b. B1 blockers (atenolol, esmolol, metoprolol, nebvilol)
c. B2 blockers (butoxamine)

3.. Alpha & Beta blockers

a. Labetalol
b. Carvedilol

Imp points
Common uses of alpha blockers is Hypertension
uses of non selective A blocker is pheocromocytoma.
Use of A1 blocker is Bening prostatic hyperplasia.
Use of B1 blockers is Dec HR, SV, CO and renin release.
Use of B2 blockers is vasospasm and bronchospasm in asthma.
Uses of all B blockers is angina, hypertension, Post MI.
___
Timolol = glaucoma
Propranolol = migraine , antiarrhtymia

Past paper Questions asked from ANS

(only DPT).

Name acetyl cholinesterase inhibitors used clinically.

Write therapeutic uses of Neostigmine.
Write clinical uses of sympathomimetic drugs?
By what mechanism do beta blockers decrease the blood pressure in hypertensive?
Write contraindications for the use of beta blockers.
Enumerate Six clinical uses of Beliadona alkaloids?
Classify anticholinesterases?
By what mechanism do beta blockers decrease the blood pressure in hypertension.?
Write down the interactions of atropine on heart and eye.
Give therapeutic classification of anti-muscurinics.
Give an account of epinephrine reversal, also enlist important clinical uses of epinephrine.
Enumerate muscarinic drugs.
Clinical uses of cholinergic drugs.
Name four B1 blockers.
Name the renin inhibitor
Write stepped care therapy in hypertension.
How can you diffentiate b/w cholinergic crises and myasthenic crisis.

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