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Important points about ANS phamacology

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By Dr. Ahmed
  • Atenolol is not lipid soluble therefore it has longer half life than Metaprolol which is lipid soluble.
  • Carvedilol blocks both alpha and beta receptors and is the most common beta blocker used in chronic congestive heart failure because it has Antioxidant and Antimitogenic properties in addition.
  • Esmolol has the shortest and Nadolol has the longest half life among all beta blockers.
  • Beta Blockers must not be used in compensated (i.e) acute heart failure.
  • Beta blockers that are excreted in kidneys (lipid insoluble): Nadalol, Satolol, Atenolol, Acebutalol, Bisprolol, Betaxolol, Celioprolol- Should be avoided in renal failure.
  • Endogenous Norepinephrine is metabolized by COMT and MAO. Exogenous Norepinephrin is metabolized by reuptake.
  • Hemicholimium- Blocks the reuptake of Choline
  • Vesamicol- prevents entry of choline into storage vesicles.
  • Glucagon is DOC in beta blockers overdose. Other drugs that are used- Norepinephrine and Calcium chloride.
  • Cardioselective Beta Blocker used in Glaucoma treatment- Betaxolol.
  • Beta Blockers having local anaesthetic activity- Propranolol, Metaprolol, Labetolol, Acebutolol, Pindolol- These drugs must not be used for treatment of glaucoma (more risk of corneal ulcer formation)
  • Longest acting ocular beta blokcer- Betaxolol.
  • Latanoprost- It is a PGF2alpha derivative used in Glaucoma.
  • Intramuscular injection of Atropine causes an initial Bradycardia- due to inhibition of M1 receptors (which normally decrease Ach release).
  • Hyoscine (scopolamine) is a CNS depressor in low doses. Atropine is a CNS elevator in low dose and depressor in high dose.
  • Glycopyrrolate is an anticholinergic drug that is used in pre anaesthetic medications and also during surgeries- to decrease secretions and avoid reflex bronchospasm.
  • Tropicamide- fastest mydriatic (antimuscuranic with shortest half lie).
  • Rate limiting enzyme in the synthesis of Catecholamines- Tyrosine hydroxylase.
  • Vasomotor reversal of Dale is seen in case of Epinephrine because it has both alpha and beta2 agonist activity.
  • Vasoconstrictors must not be used in secondary shock
  • Adrenergic neuron blocking drugs have no action on exogenous (injected) adrenaline. They only block the release of adrenaline from nerve endings.
  • Ergot alkaloids are the alpha blockers that can cause vasoconstriction.
  • Aplha1 inhibitors cause faster and greater symptomatic relief but do not affect the disease progression. 5 alpha reductase inhibitors (Finasteride) slows disease progression.
  • Most dangerous effect of belladona in very young children- Hyperthermia (not dehydration)
  • Cocaine inhibits the re-uptake of Dopamine and Noradrenaline in CNS.
  • The effect of parasympathetic system (and atropine) is of longest duration in Eye.
  • Adrenaline in anaphylaxis- If used IM, dose is 1:1000; If used IV, dose is 1:10,000
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