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2005Pharm501AutonomicsPDF

2005Pharm501AutonomicsPDF - Pharmacology 501 January 10 12...

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Pharmacology 501 January 10 & 12, 2005 David Robertson, M.D. Page 1 Pharmacology of the Autonomic Nervous System Lecture Outline I. Introduction II. Anatomy III. Biochemistry A. Neurotransmitters B. Nonclassical Neurotransmitters C. Synthesis and Metabolism of Acetylcholine D. Synthesis and Metabolism of Catecholamines E. Summary of Intervention Mechanisms IV. Norepinephrine, Epinephrine and Dopamine A. Adrenoreceptors B. Alpha 1 Agonists C. Alpha 1 Antagonists D. Alpha 2 Agonists E. Alpha 2 Antagonists F. Beta Agonists G. Beta Antagonists H. Dopamine Agonists and Antagonists I. Indirectly Acting Phenylethylamines V. Acetylcholine A. Acetylcholine Receptors B. Muscarinic Agonists C. Muscarinic Antagonists D. Nicotinic Agonists E. Nicotinic Antagonists (Ganglionic Blockers) F. Cholinesterase Inhibitors G. War Gases VI. Skeletal Muscle Relaxants VII. Bibliography
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Pharmacology 501 January 10 & 12, 2005 David Robertson, M.D. Page 2 Learning Objectives: Autonomic and Neuromuscular Pharmacology 1) An understanding of the clinical physiology of the autonomic nervous system a) Key structures in central cardiovascular control b) Neurotransmitters involved in major central and peripheral neuronal pathways c) Synthesis and metabolism of norepinephrine (NE) and acetylcholine (Ach) 2) An understanding of a and b adrenoreceptors, their subtypes and the clinical spectrum of their general and selective stimulation and blockade a) Key uses and side effects of major drugs in each category b) Clinical circumstances where these agents may be beneficial 3) An understanding of muscarinic agonists and antagonists, and cholinesterase inhibitors 4) An understanding of agents that stimulate or relax skeletal muscle, including the cholinergic neuromuscular agonists and antagonists as well as the neuromuscular agents acting at noncholinergic sites.
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Pharmacology 501 January 10 & 12, 2005 David Robertson, M.D. Page 3 I. Introduction The CNS receives diverse internal and external stimuli. These are integrated and expressed subconsciously through the autonomic nervous system to modulate the involuntary functions of the body. This overlies a strong circadian rhythm of autonomic function. The somatic nerves that innervate voluntary skeletal muscle are not part of the autonomic system, but will be discussed in the final lecture. The autonomic nervous system consists of two large divisions (Figure 1): sympathetic (thoracolumbar) outflow, and parasympathetic (craniosacral) outflow. The two divisions are defined by their anatomic origin rather than by their physiological characteristics. Figure 1: Schematic diagram of the sympathetic and parasympathetic divisions of the peripheral autonomic nervous system. The paravertebral chain of the sympathetic division is illustrated on both sides of the spinal outflow in order to demonstrate the full range of target structures innervated. Although the innervation pattern is diagrammatically illustrated to be direct connects between preganglionic outflow and postganglionic neurons, there is overlap of innervation such that more than one spinal segment provides innervation to neurons within the ganglia .
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