Autonomic nervous system Drugs, action

We will conclude this chapter by referring to a term often used for those symptomatic drugs inhibiting the action of the autonomic nervous system by interfering with the effect of the chemical mediators involved. There are two groups. (1) Para-sympatholytic drugs block the action of acetylcholine. These are included within the wider class of spasmolytics which, as the name suggests, check or eliminate spasms. (2) Sympatholytics inhibit the action of adrenaline, noradrenaline and the sympathetic nervous system. 

In the sympathetic part of the peripheral autonomic nervous system the simation is less complicated since only the sympathetically innervated visceral organs have receptors sensitive to the transmitter of the postganglionic sympathetic neuron noradrenaline. However, the noradrenaline sensitive receptors, which all belong to the G-protein coupled receptor superfamily, can be subdivided in at least three subtypes ai-, a - and jSi-adrenoceptors. These receptors are to a similar extent sensitive to adrenaline, a humoral transmitter which is released under sympathetic control from the adrenal medulla. Adrenaline, in contrast to noradrenaline has affinity to a forth type, the /32-adrenoceptor. In general drug interacting with the autonomous nervous system can be subdivided according to their mechanism of action. 

Erection involves a coordinated action of the autonomic nervous system, and certain drugs may interfere with either the sympathetic division (e.g., aj- receptors) or the parasympathetic division (e.g., noncholinergic neurotransmitters). 

Other classes of drugs not included in Figure 22-3 that may exert sedative effects include most antipsychotic and many antidepressant drugs and certain antihistaminic agents (eg, hydroxyzine, promethazine). As discussed in other chapters, these agents differ from conventional sedative-hypnotics in both their effects and their major therapeutic uses. Since they commonly exert marked effects on the peripheral autonomic nervous system, they are sometimes referred to as "sedative-autonomic" drugs. Certain antihistaminics with sedative effects are available in over-the-counter sleep aids. Their autonomic properties and their long durations of action can result in adverse effects. 

Unlike antipsychotic or antidepressant drugs, which exert several actions on the central or autonomic nervous system, lithium ion at therapeutic concentrations is devoid of autonomic blocking effects and of activating or sedating effects, though it can produce nausea and tremor. 

This section provides a review of the anatomy and physiology of the autonomic nervous system (ANS) accompanied by a brief description of some of the important drugs which modify its actions. A summary of the interaction between the immune system and the ANS is also included. An extensive discussion of the anatomy and physiology of the ANS can be found in the Primer on the Autonomic Nervous System (Robertson, 2004). Detailed information on the pharmacology of the ANS can be found in Goodman Gilman s The Pharmacological Basis of Therapeutics (Brunton et al., 2006). 

Cardiovascular system. Both caffeine and theophylline directly stimulate the myocardium and cause increased cardiac output, tachycardia and sometimes ectopic beats and palpitations. This effect occurs almost at once after i.v. injection and lasts half an hour. Theophylline contributes usefuUy to the relief of acute left ventricular failure. There is peripheral (but not cerebral) vasodilatation due to a direct action of the drugs on the blood vessels, but stimulation of the vasomotor centre tends to counter this. Changes in the blood pressure are therefore somewhat unpredictable, but caffeine 250 mg (single dose) usually causes a transient rise of blood pressure of about 14/10 mmHg in occasional coffee drinkers (but has no additional effect in habitual drinkers) this effect can be used advantageously in patients with autonomic nervous system failure who experience postprandial hypotension (2 cups of coffee with breakfast may suffice for the day). In occasional coffee drinkers 2 cups of coffee (about 160 mg caffeine) per day raise blood pressure by 5/4 mmHg. Increased coronary artery blood flow may occur but increased cardiac work counterbalances this in angina pectoris. 

Some drugs used for arrhythmias exert their actions through the autonomic nervous system by mimicking or antagonising the effects of the sympathetic or... 

The definition of receptors as specific sites for drug action owes much to the work of John Newton Langley [ 1852-1925 ] and Paul Ehrlich [ 1854-1915 ]. Their separate work on the autonomic nervous system and toxins and chemotherapeutic agents led to the concept of a receptor that possesses both recognition and transduction components and of chemotherapeutic molecules possessing discrete molecular features subserving specific functions ... 

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