Developed

by Greg Cook

1987 (revised 2011)

PHARMACOLOGY / PHYSIOLOGY REVIEW

A review of certain terms and physiological principles is essential to understand the effects pharmacological agents have on the cardiovascular system, DRUGS THAT AFFECT THE HEART Autonomic drugs mimic or block the action of the autonomic (sympathetic and parasympathetic) nervous system. These drugs affect the vasculature, bronchial, and alter the rate, force, of myocardial contraction. Terms that describe some of these autonomic actions include: inotropic, chronotropic, dromotropic, and pressor effect. 1. Inotropic Effect: Drugs with an inotropic action affect myocardial contractility. a). A positive inotropic action increases myocardial contractility, e.g. epinephrine. b). A negative inotropic action decreases myocardial contractility, e.g. propranolol. 2. Chronotropic Effect: Drugs with a chronotropic action affect the rate of the heart. The ancient Greek God Chronos personified time. a). A positive chronotropic increases heart rate by increasing the rate of impulse formation in the SA node, e.g., epinephrine. b). A negative chronotropic decreases heart rate by slowing the rate of impulse formation in the SA node, e.g. propranolol. 3. Dromotropic Effect: Dromotropic drugs affect conduction velocity through specialized conducting tissue. a). A positive dromotropic drug speeds conduction, e.g. epinephrine. b). A negative dromotropic action slows conduction, e.g., digitalis. 4. Pressor Effect: Pressor drugs cause vasoconstriction and increase peripheral vascular resistance, e.g., epinephrine. THE AUTONOMIC NERVOUS SYSTEM Nerves transmit impulses across synapses via chemical called neurohormonal transmitters. Autonomic drugs affect smooth muscle, cardiac muscle, and gland cells by mimicking or modifying the actions of the neurohormonal transmitters. For the most part, the neurohormonal transmitters associated with the sympathetic fibers are the catecholamines (dopamine, norepinephrine, and epinephrine) while acetylcholine (ACh) effects the parasympathetic fibers. Fibers that release ACh are called cholinergic fibers. Fibers that release catecholamines (i.e., norepinephrine) are called adrenergic fibers. In most instances the sympathetic and parasympathetic systems can be viewed as antagonists. One system augments a function (i.e., the sympathetic fight or flight response) while the other inhibits that function and restores homeostasis (the parasympathetic response). 1. The Sympathetic System: The sympathetic terminals make contact with a large number of postganglionic nerves. Some ratios may be as high as 1:20 or more. Therefore, a diffuse discharge of the sympathetic system is possible. - The sympathetic system is associated with the "Fight or Flight" mechanism. a). Increases heart rate and blood pressure, b). Dilatation of pupils and bronchioles. c). Increases glucose levels, and shunts blood from the skin and splanchnic regions to the skeletal muscles. d). Effects on blood pressure are mostly due to sympathetic control of arteriolar resistance.

Developed by Greg Cook

1987 (revised 2011) 2. The Parasympathetic System: The parasympathetic system is organized for discrete and localized discharge which is concerned with conservation of energy, maintenance of the body during periods of normal activity, and the restoration of homeostasis. The parasympathetic system has its terminal ganglia very near to or within the organs innervated; the ratio of pre-ganglion to post-ganglion neurons is often 1:1. - The parasympathetic functions are summarized as follows: a). Decreases heart rate and blood pressure. b). Increases GI movement and secretions. c). Increased the guts absorption of nutrients, urinary bladder and rectal emptying, and protection of the retina from excessive light. d). No useful purpose would be served in the body if the parasympathetic nerves were to discharge all at once. THE AUTONOMIC DRUGS Autonomic drugs mimic, intensify, or block the effects of the sympathetic / parasympathetic systems. They are divided into the following groups: 1. CHOLINERGIC (parasympathomimetic or sympatholytic): Drugs that mimic or intensify the parasympathetic response. 2. CHOLINERGIC BLOCKING (parasympatholytic or sympathomimetic): Drugs that block/counteract the parasympathetic response. 3. ADRENERGIC (sympathomimetic or parasympatholytic): Drugs that mimic or intensify the sympathetic response. 4. ADRENERGIC BLOCKING (Sympatholytic) drugs which block the action of the sympathetic system. ADRENERGIC RECEPTORS Adrenergic drugs directly act on three types of adrenergic receptors: alpha-adrenergic (alpha-1 and alpha-2), beta-adrenergic (beta-1 and beta-2), and dopaminergic. 1. Stimulation of alpha-1 receptors causes smooth muscle contraction (arteriole vasoconstriction in the skin, skeletal, and splanchnic area producing a rise in blood pressure). 2. Stimulation of the alpha-2 receptors inhibits the release of norepinephrine, which decreases alphaadrenergic activity. 3. Stimulation of beta-1 receptors increases heart (positive chronotropic effect) rate and increases the force of myocardial contractility (positive inotropic effect). 4. Stimulation of beta-2 receptors causes vasodilatation and relaxation of bronchial, uterine, and gastrointestinal smooth muscle.

PUTTING IT TOGETHER
Prefixes (tell the system involved) sympatho... parasympatho... SYNONYMS Sympathetic: Adrenergic, Catecholamine Parasympathetic: Cholinergic, Vagal ALPHA: Vasoconstriction BETA 1: You have 1 heart (Beta 1 = increased contractility) BETA 2: You have 2 lungs ( Beta 2 = bronchodilatation) Chronos (time/heart rate) Inotropic (force of myocardial contraction) Suffices (tell action) mimetic (mimic) lytic (block)