cholinergic receptors and its modulators(agonists, antagonists etc)
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Dr. Asif HussainJNMCHA.M.U, Aligarh
Cholinergic receptors and modulators
Autonomic nervous system◦ Afferent neurons◦ Efferent neurons◦ Preganglionic and post ganglionic neurons◦ Involuntary in nature
1) Parasympathetic nervous system2) Sympathetic nervous system
Introduction
Somatic nervous system
◦ Sensory neurons◦ Motor neurons◦ Voluntary in nature◦ Somatic motor neurons are myelinated◦ Somatic motor neurons are cholinergic
Parasympathetic System
Ganglia close to or on target organs
Parasympathetic Innervation of Visceral Targets
• Preganglionic neurons - long
• Post ganglionic neurons - short
Acetic acid ester of choline Synthesis, storage , release and
degradation
Acetylcholine
Types of Cholinergic Receptors
1. Nicotine = agonist
2. Directly opens a Na+ Ca + K+ channels
3. Curare = antagonist
4. NM : Skeletal muscle endplate
5. NN : Ganglionic cells, adrenal medulla, CNS
(1) Nicotinic cholinergic receptor
Ionotropic Receptors
1. Work very fast; important role in fast neurotransmission
2. Each is made of several subunits (together form the complete receptor)
3. At center of receptors is channel or pore to allow flow of neurotransmitter
4. At rest - receptor channels is closed5. When neurotransmitter bind -- channel immediately opens6. When ligand leaves binding site -- channel quickly closes
Nicotinic Receptor signal transduction pathway
Ionotropic : ligand gated ion channel
Composed of 5 subunits
ACh binds to extracellular domains of α subunits
Receptor opens a central transmembrane ion channelChanges in membrane potential or ionic concentration within cell
Selectively stimulated by muscarine and blocked by atropine.
Located primarily on autonomic effector cells of heart, smooth muscles, respiratory tract etc and CNS.
Subtypes are M1 ,M2, M3, M4 & M5
(2) Muscarinic receptors
NH3
COOH
Gq
Phospho-lipase C
(+)
PIP2
IP3 Diacylglycerol
Increase Ca2+ Activate ProteinKinase C
Response
Muscarinic Receptor signal transduction pathways
M3 muscarinic receptor
C O
O
CH2 CH2 N
CH3
CH3
CH3
CH3
Acetylcholine
General Effects of Acetylcholine
Choline esters ◦ Acetylcholine◦ Methacholine◦ Carbachol◦ Bethanechol
AlkaloidsMuscarinePilocarpineArecoline
Cholinergic agonists
Blocks action of Ach on autonomic effectors and in CNS exerts through muscarinic rceptors.
Atropine is prototype drug of this class is highly selective for muscarinic receptors.
All anticholinergics are competitive antagonists.
Cholinergic antagonists
Natural alkaloid◦ Atropine◦ Hyoscine
Semisynthetic derivatives◦ Homatropine◦ Ipratropium bromide◦ Tiotropium bromide
Classification
Synthetic compoundsMydriatics: cyclopentolate, tropicamideAntisecretory-antispasmodics:
◦ Propantheline◦ Oxyphenonium◦ Glycopyrrolate◦ Dicyclomine◦ PirenzepineVesicoselective :oxybutynin, flavoxate, tolterodineAntiparkinsonian: trihexyphenidyl, biperiden
Therapeutic Uses : Cholinergic Antagonists
CVS Affect heart’s conduction system
Low Doses High Doses
Slows heart rate
↓ ↓Block inhibitory vagal effects on SA & AV Nodes
1. Sinus Bradycardia2. Sympatomatic 2nd degree heart
block
Atropine (0.05 – 1 mg/ml injection)
Therapeutic uses Continued…
CNS
1.Parkinson’s Disease
3.Motion Sickness
Parkinsonian tremor & rigidity results from Relative Excess of Cholinergic activity
Deficiency in the Dopaminergic activity in Basal ganglia-Striatum system
This vestibular disturbance involve muscarinic cholinergic transmission
Centrally acting Antimuscarinic Agents
2.Drug induced extra-pyramidal symptoms
Benzhexol, Benztropine
Scopolamine
Respiratory system
Both smooth muscle & secretory glands of Airway receive Vagal innervation & contain Muscarinic receptors
Decreased secretions from pharynx ,bronchi & bronchioles
Relaxes smooth muscles in bronchi & bronchioles
1. Asthma2. COPD3. Exercise-induced
bronchospasm
Ipratropium, Tiotropium
Gastrointestinal System
Blockade of muscarinic receptors affect motility & secretory functions of the gut
1.Decreased secretions2. Relaxation of smooth muscle3. Decreased tone & peristalsis
1.To facilitate endoscopy & GI radiology by relaxing smooth muscles ( Hyoscine)
2. As an antispasmodic in IBS & colonic divericula ( Dicyclomine)
3. Peptic ulcer disease ( Pirenzepine – selective M1
antagonist)
4. Traveler's diarrhea (atropine + diphenoxylate, Lomotil)
Genitourinary system
Relaxes smooth muscles of ureters & bladder wall
1.Bladder spasm after urologic surgery
2. Reduces involuntary voiding in neurological disorder
-Oxybutinin-Derifenacin -Solifenacin -Toltrodine
Eye
Constrictor papillae muscle is blocked by Atropine
Pupillary constrictor mucle depends on muscarinic cholinoceptor activation
Results in unopposed sympathetic dilator activity
1
2 Weaken the contraction of ciliary muscle ( Cycloplegia)
1.Referactive error measurement2. Fundoscopic examination3. To prevent synechia(adhesion) formation in uveitis & iritis
Atropine,homatropine, tropicamide,cyclopentolate
Cholinergic poisoning
- Cholinesterase inhibitors insecticide in rural communities- Consumption of wild mushrooms
1.Antimuscarinic therapy
1-2 mg Atropine sulphate i/v every 5-15 minutes until signs (dry mouth, reversal of miosis) appears
2.Cholinisterase regenerator compounds
Pralidoxime (PAM) & Diacetylmonoxime(DAM)(1-2 gm i/v infusion over 15-30 mins)
Body System Side/Adverse Effects
Cardiovascular Increased heart rate, dysrhythmias
CNS CNS excitation, restlessness, irritability, disorientation, hallucinations, delirium
Cholinergic Blocking Agents: Side Effects
Body System Side/Adverse Effects
Eye Decreased visual accommodation, increased intraocular pressure
Gastrointestinal Decreased salivation, decreased gastric secretions,
decreased motility
Genitourinary Urinary retention
Cholinergic Blocking Agents: Side Effects
Antihistamines, phenothiazines, tricyclic antidepressants, MAOIs
When given with cholinergic blocking agents, cause ADDITIVE anticholinergic effects, resulting in increased effects
Cholinergic Blocking Agents: Interactions
Ganglion blocking drugsCompetitively block action of Acetylcholine & similar agonist at nicotinic receptors of both parasympathetic & sympathetic ganglia
Effects are numerous & complex as both divisions of ANS are blocked indiscriminately
Hexamethonium –historically 1st effective antihypertensive agent
Mecamylamine ---reducing nicotine craving in patients quitting smoking
Trimethaphan ---occasionally used in hypertensive emergency & dissecting aortic aneurysm---to produce controlled hypotension
Thank You
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