Hypotensive

emergency

Phenylephrine
Mitodrine
Clonidine
Apraclonidine
Brimonidine

More prominent
inotropic (FOC) then
chronotropic (HR)
effect on heart
For cardiogenic
shock
For patient with Low
CO

Methacholine
Carbachol

2 agonist
Direct Acting

Dobutamine

1 agonist

Bethanecol

Selective
Pilocarpine

Xamoterol
Bronchial Asthma Salbutamol
Terbutaline
Salmeterol 2 agonist
Formoterol
Ritodrine
Bromocriptine D2 agonist
oxymetazoline 1 and 2
Isoprenaline
Bronchial Asthma
1 & 2
(Isoproterenol)
Acute anaphylactic
Shock
Adjunct with local
anaesthetics
Haemostatic agent
control superficial
beeding
Provide inotrophic
Adrenaline (given
support (influence
1 2 1 2
IM/SC)
force of muscular
contractions)
Epistaxis nasal
packs
(vasoconstriction)
Bronchial Asthma
Treat CARDIAC
ARREST
In vivo Reflex
bradycardia
In vitro
tachycardia
Restore BP in acute
hypotensive states
In states whr thr is
severe hypotension
and vasodilation of
peripheral blood
vessels

Cannot use clinically

coz very short
acting

Acetylcholine
1 agonist

Direct Acting

Reversible ACHe
Inhibitor (3-4 Hr)

Sympathomimetic

Non-Selective

postoperative
abdominal
distension ; gastric
atony and retention;
gastroparesis
Urinary retention;
gastroparesis
Xerostomia
Opthalmological
diseases, eg
glaucomaa

Parasympathomime
tic

Indirect Acting
(inhibit ACHe)

Noradrenaline

Can pass BBB Has CNS Effect

Treat Atropine
poisoning
(parenterally)
Eye drops; produce
Physostigmine
Miosis; contract
ciliary muscle;
reduce IOP
Antidote to
competitive NMBA
Cannot pass BBB
Act on NMJ nd GIT
treat Myasthenia
Gravis
Neostigmine
Stimulate bowels
and bladders after
surgery
Antidote to
competitive NMBA
Diagnosse
Myasthenia Gravis;
Treat myasthenic
Edrophonium (5
crisis (weakness
min)
due to inadequate
anticholinesterase
treatment
Ecothiophate
Highly lipid soluble
(except
echothiophate)
3 phases: acute
choinergic
phase>>
intermediate
syndrome>>
organophosphate-i
nduced
polyneuropathy

1 2 1

Dopamine D
Amphetamine
Methamphetamine
Releasing agent
Ephedrine
Tyramine
Indirect Acting
Cocaine
Uptake inhibitor
Tricyclic
antidepressants
Pargyline
MAO/ COMT
inhibitor
Entacapone
Ephedrine MIxed Acting
Pupil dilation; IOP
increase; HR, BP
increase;
vasoconstriction;
skeletal muscle
Effects
vessels
vasodilation;
ejaculation; increase
blood glucose,
bronchodilation (2)
Prazosin
Terazosin
Doxazoxin
1 Selective
antagonist
Trimazosin
Tamsulosin
(uroselective)
Tolazoline
Non Selective
Phentolamine
Blocker (1, 2)
Phenoxybenzamine
Systemic
Hypertension
Congestive heart
failure
Therapeutic uses
Pheochromocytoma
Raynauds disease
Benign prostatic
hyperplasia
Propranolol
Non Selective
Timolol
Blocker (1st Gen)
Nadolol
Acebutolol
Atenolol
1 selective (2nd
Bisoprolol
Gen)
Esmolol
Metoprolol
Non Selective
Carteolol
blockers with
Carvedilol
additional actions
Labetalol
(3rd Gen)
1 selective blocker
Betaxolol
with additional
Celiprolol
actions (4th Gen)
Arrhythmia
Angina
Hypertension
Myocardial
infarction
Hyperthyroidism
Anxiety
Alcohol/ Opioid
Therapeutic uses
withdrawal
symptoms
Glaucoma
Benign essential
tremor
Pheochromocytoma
Hepatic portal
hypertension

Irreversible ACHe
Inhibitor (form
covalent bond with
enzyme)

Organophosphorous
compounds cause
poisoning

Trearment:
Cholinesterase
regenerators:
Pralidoxime
reactivate
phosphorylated
enzymes (within first
few hours of
poisoning)

Sympathetic

ANS
Pharmacology

Diazepam: control
convulsion
Pupil constriction
(miosis); IOP, HR,
BP decrease;
vasodilation;
Effects
bronchoconsriction;
GI motility increase;
uterine contraction;
erection
Ganglion Blocking
Acting at
Agent
Nicotinic
Neuromuscular
Receptor
Blocking Agent

Parasympathetic

adrenoceptor
antagonist

Acting at Muscarinic
Receptor
Sympatholytic

adrenoceptor
antagonist

D-tubocurarine
Non- Depolarizing (
Gallamine
competitive)
Atracurium
Succinylcholin
Depolarizing
Metabolised by
e
(Non-competitive;
pseudocholine
(Suxamethoni
Depolarize plasma
esterase in plasma
um)
membrane of
skeletal m. fiber)
Decamethonium
Competitive: by
neostigmine,
physostigmine
Termination of
Non-competitive
Action
(depolarizing):
Cannot be reversed
by
anticholinesterase

Parasympatholytic
(competitive
antagonist of Ach)

NMBA

Treatment: Atropine
in high doses until
signs of atropine
poisoning appear

Hexamethonium

D- Tubocurarine
Succinylcholine
Dilate Pupil
Anaesthetic
premedication dry
secretions
Decrease
pancreatic
Atropine
secretions in acute
pancreatitis
Organophosphorous
poisoning treatment
Natural
(block muscarinic
action)
Antiemetic (prevent
motion sickness)
Anaesthetic
Hyoscine
premedication dry
(scopolamine)
secretions
Relax GI smooth m.
fascilitate
endoscopy
Semi-synthetic Homatropine Dilate Pupil
Bronchial asthma
Ipratopium Bromide
COPD
Oxyphencyclimine
Cyclopentolate Eye drops
Synthetic
Eye drops
Tropicamide
Congeners
mydriasis
Antispasmodic in
Dicyclomine
irritable bowel
syndrome
Benztropine

Effects:
Mydriasis;IOP
increase; MODEST
Tachycardia; block
all secretions
excepet milk; Inhibit
GI motility; relax
bronchial, biliary,
urinary tract smooth
m; CNS effect: mild
restlessness,
hallucination;
antiemetic action
Dry mouth; blurred
vision; dizziness;
fatigue; urinary
retention in old men;
coonstipation;
cyclopegia;
increased IOP
Toxicity: Hot as a
Adverse Effects hare, Blind as a Bat,
Dry as a bone, Red
as Beet, Mad as
Hatter
Gastric lavage, Ice
bags,
Physostigmine, dark
comfortable
room, gastric lavage