AUTONOMIC PHARMACOLOGY

Regarding the sympathetic division of the autonomic nervous system:

a) acetylcholine is secreted by some sympathetic postganglionic fibers. b) most sympathetic preganglionic fibers secrete norepinephrine (noradrenaline). c) sympathetic postganglionic neurons are found in spinal segments from T1 to L2. d) the sympathetic chain extends from the thoracic to the sacral regions of the spinal cord.

ANSWER
a.
Most sympathetic postganglionic fibers secrete norepinephrine (noradrenaline) but some secrete acetylcholine (e.g those supplying the piloerector muscles). Sympathetic preganglionic fibers secrete acetylcholine. Although the sympathetic preganglionic neurons are found in the thoracic and upper lumbar spinal segments, paired sympathetic ganglia are found on both sides of the spinal cord from the cervical region to the sacral region. In the cervical region, only three pairs of ganglia are found (superior, middle and inferior cervical ganglia) while from T1 to L3 there is a pair of ganglia for each spinal segment. The postganglionic neurons are found in the sympathetic ganglia.

 Regarding the parasympathetic division of the autonomic nervous system:

a) parasympathetic preganglionic fibers are found in all cranial nerves. b) parasympathetic vasoconstrictor fibers are present in the salivary glands. c) paraympathetic postganglionic neurons are found in spinal ganglia from T1 to L2. d) parasympathetic postganglionic fibers secrete acetylcholine onto their target organs.

ANSWER: D
d. Parasympathetic preganglionic fibers are found in cranial nerves III, VII, IX and X. The salivary glands are innervated by parasympathetic vasodilator fibers (parasympathetic stimulation promotes salivary secretion). Parasympathetic post ganglionic neurons are located close to or embedded within the organs they innervate. Both parasympathetic preganglionic and parasympathetic postganglionic fibers secrete acetylcholine.

 Regarding the role of the autonomic innervation:

a) stimulation of the sympathetic nerves to the eyes causes pupillary constriction. b) activation of the sympathetic system causes vasodilatation in the skin. c) activation of the sympathetic system causes vasoconstriction in the viscera and vasodilatation in skeletal muscle. d) stimulation of the vagus nerves speed up the heart.

ANSWER C

c. Stimulation of the sympathetic nerves to the eyes

results in dilation of the pupils. Although activation of the sympathetic nerves results in generalized vasoconstriction, epinephrine (adrenaline) secreted by the adrenal medulla acts on the -adrenoceptors of the blood vessels of skeletal muscle to cause vasodilatation. Vagal stimulation slows the heart.

 Regarding synaptic transmission in the autonomic nervous system:

a) The acetylcholine receptors in both parasympathetic and sympathetic ganglia are predominantly muscarinic. b) Norepinephrine (noradrenaline) secreted by sympathetic postganglionic fibers acts preferentially on adrenoceptors. c) The adrenal medulla secretes epinephrine (adrenaline) in response to activation of muscarinic sympathetic postganglionic fibers in the splanchnic nerves. d) Acetylcholine secreted by parasympathetic postganglionic fibers acts on muscarinic receptors.

ANSWER: D Norepinephrine acts preferentially on adrenoceptors, while epinephrine acts preferentially on -adrenoceptors. It is, however, important to realize that norepinephrine and epinephrine will activate both types of adrenoceptor. Epinephrine and norepinephrine are secreted by the adrenal medulla in response to stimulation of sympathetic preganglionic fibers traveling in the splanchnic nerves which release acetylcholine and activate nicotinic receptors. Thus, the chromaffin cells of the adrenal medulla are homologous with sympathetic post-ganglionic neurons.

 Which of the following is the 1 drug of choice (DOC) for retinal exams and surgery, giving mydiasis (dilation of iris)? a) Ephedrine b) Epinepherine c) Oymetazoline d) Isoproterenol e) Phenylephrine

EFFECTS OF AUTONOMIC DRUGS ON THE FUNCTIONS OF THE EYE

Control of pupil size: The pupil in the eye is controlled by both sympathetic and parasympathetic neurons The sympathetic system dilates the pupil by stimulating the contraction of radial muscle in the iris of the eye

The parasympathetic system constricts the pupil by causing contraction of circular muscle in the eye.

EFFECTS OF AUTONOMIC DRUGS ON THE FUNCTIONS OF THE EYE

Control of pupil size: The circular muscle (sphincter pupillae) is innervated by the parasympathetic system M3 agonists (acetylcholine, pilocarpine, anticholinesterase drugs e.g. physiostigmine) & bright light constrict the pupil (miosis) to reduce the amount of light reaching the retina

M3 antagonists (atropine, homatropine, tropicamide) inhibit pupil constriction leading to dilation; these drugs are used to facilitate eye exam

EFFECTS OF AUTONOMIC DRUGS ON THE FUNCTIONS OF THE EYE

Control of pupil size: The radial muscle of the Iris (dilator pupillae) is innervated by the sympathetic system Agonists of 1 receptors (epinephrine, phenylephrine) & dim light relax the radial muscle leading to dilation of the pupil (mydriasis). These agonists may be used to facilitate eye examination

Note that light entering one eye causes the other to constrict (called consensual pupil response); this is used as diagnostic tool to assess brain damage in comatose & unconscious patients

 Which of the following -blockers is used for decreasing aqueous humor secretions from the ciliary body? a) Propranolol b) Nadolol c) Carvedilol d) Timolol e) Metoprolol

CONTROL OF INTRAOCULAR PRESSURE

Intraocular pressure is determined by the net effect of the rate of production of aqueous humor from the ciliary body and the rate of outflow of aqueous humor from the anterior chamber of the eye.

Agonists of receptors increase the rate of production of aqueous humor, but these are not used clinically Instead, the antagonists (timolol, betaxolol) are used to reduce intraocular pressure in glaucoma (block beta receptors on the ciliary epithelium)

CONTROL OF INTRAOCULAR PRESSURE CONTINUED

Agonists of 1 receptors (epinephrine)* decrease the rate of production of aqueous humor by constricting arteries and reducing blood flow to the ciliary body; this effect is exploited for the treatment of glaucoma

M3 agonists (pilocarpine, antcholinesterase drugs) increase the rate of outflow of aqueous humor and reduce intraocular pressure. These drugs are used to treat glaucoma

MECHANISMS OF M3 AGONISTS ON OUTFLOW OF AQUEOUS HUMOR

Pilocarpine acts on a (M3) found on the circular muscles of the iris causing the muscle to contract and engage in miosis Pilocarpine also acts on M3 receptors on the ciliary muscle and causes it to contract When the ciliary muscle contracts, it opens the trabecular meshwork through increased tension on the scleral spur

*leading to increase in the filtration angle and the patency of the trabecular meshwork at the entrance of the Canal of Schlemm Facilitate the outflow of aqueous humor into the episcleral vein canal of schlemm bloodstream

FUNCTIONAL UNITS OF THE EYE

 Which of the following agonists would be used for asthma patients or to delay premature labor?

a) 2-agonist b) 1-agonist c) 3-agonist d) 2-agonist e) 1-agonist

EFFECTS OF 2 AGONISTS ON THE UTERUS

The nerves to the uterus include the sympathetic nerve fibres, which produce contraction of uterine muscle and constriction of vessels, and parasympathetic (sacral) fibres, which inhibit muscle activity and cause dilation of blood vessels.

Examples of 2 agonists: (salbutamol, ritodrine). These drugs cause relaxation of the uterine muscle. This effect is exploited for prevention of premature labour during pregnancy

PROPANOLOL
HOW DOES IT TREAT HIGH BLOOD PRESSURE

PRAZOSIN
HOW DOES IT TREAT HIGH BLOOD PRESSURE WHAT IS THE OTHER INDICATION