By Pharmacist Salwan Salem

 -Central nervous system (CNS)  - Peripheral nervous system (PNS)  *CNS: spinal cord and brain  *The PNS consists of:  sensory neurons running from stimulus receptors that inform the CNS of the stimuli  motor neurons running from the CNS to the muscles and glands - called effectors - that take action.

 * PNS subdivided into :  Autonomic, and somatic  Autonomic NS :  - sympathatic neurons (thorasic and lumbar part of spinal cord)  - Parasympathatic neurons (cranial and sacral part of spinal cord)

1.Cardiovascular system : -ve chronotropic effect -ve inotropic effect.Decrease SA and AV conductivity.Increase IC Ca by phosphatidy inositol system.Production of NO from arginine in endothelial cells

2. GIT: Increase peristalsis, tone,circulation, increase secretion, nausea and vomiting 3.Urinary tract : Increase contraction of detrusor muscle of bladder

4. Eye miosis, and decrease IOP 5.Exocrine glands : Increase secretion of lacrimal, salivary,and digestive. 6.Respiratory system : Bronchial constriction, tracheobronchial secretion

The Cranial Nerves

 slowing down of the heartbeat  lowering of blood pressure  constriction of the pupils  increased blood flow to the skin and viscera  peristalsis of the GI tract

are neuron receptor that signal for muscular contractions. They are cholinergic receptors. -NR found in : 1-NMJ 2-Autonomic ganglia 3-Adrenal medulla 4-ligand gated ion receptor Nicotinic receptor agonist is nicotine. NR Blocked by tubocurarine and doxacurium.

Types of MR: M1 : in CNS, Gastric parietal cells M2: heart M3: exocrine gland, smooth muscle, bronchia,bladder, sweat and salivary glands. M4 and M5 : in CNS, but function not fully understood.

1.Cardiovascular system : -ve chronotropic effect -ve inotropic effect.Decrease SA and AV conductivity.Low dose … V.D and tachycardia.Increase IC Ca by phosphatidy inositol system Production of NO from arginine in endothelial cells

2. GIT: Increase perstalsis, tone,circulation, increase secretion, nausea and vomiting 3.Urinary tract : Increase contraction of detrusor muscle of bladder

4. Eye miosis, and decrease IOP 5.Exocrine glands : Increase secretion of lacrimal, salivary,and digestive. 6.Respiratory system : Bronchial constriction, tracheobronchial secretion

. Direct acting. Indirect acting A -Direct acting :  Cholinesters (esters of Ach ) carbacol, bethanicol.  Alkaloids

-rarely used - S/E : produce miosis and decrease IOP - Has profound effect on CVS and GIT due to ganglionic stimulating activity. - Activate N receptors in adrenal medulla.

 not Hydrolysed by AchE, while hydrolyzed by other esterases.  Used for treatment of bladder and GIT atony.

 Alkaloids  Is Muscarinic agonist  Mainly used in opthalmology, caused miosis  S/E : sweating and salivation because enter CNS

Reversible AchE inhibitors and irreversible AchE inhibitors. Reversible : 1- Physostigmine : -Act on MR, N gang, and N NMJ -uses : GIT, bladder atonty, and glucoma. - S/E : bradycardia, convulsions.

2-Neostigmine -Polar, so doesn’t pass BBB -effect on skeletal muscle is greater than that of pysostigmine. - used for Mysthemia Gravis, and antidote for tubocurarine.

3- Pyridostigmine : -for long term management of M.G because of longer duration of action. 4- Edrophomium : Used for diagnosis of M.G -Has duration min

- organophosphorous cpds / insectsides - Isoflurophate -Echothiophate - clinically used for glucoma

Atropine -causes : eye medryasis, and cycloplagia -in low dose block M1R, cause bradycardia -in high dose (>1 mg ) block M2R, cause tachycardia. - dilate cutaneous vasculature

-No effect on arterial blood pressure. -GIT: decrease motility and secretion -urinary tract : reduce hyper motility of bladder -secretions: decrease salivation, sweating, and lacrimal secretion.

-antispasmodic, antidote for anticholinergic, reduce secretion prior to surgery, and cause medriasis in ophthalmology. -other anti Muscarinic :  Scopolamine : motion sickness  Pirenzepine : gastric ulcer reduce HCL  Ipratropium : bronchodilator used for asthma.

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