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Basic & Clinical Pharmacology, 12e
Chapter 6. Introduction to Autonomic Pharmacology
Sections: Case Study, Introduction to Autonomic Pharmacology, Anatomy of the Autonomic Nervous System, Neurotransmitter Chemistry of the Autonomic Nervous System, Autonomic Receptors, Nonadrenergic, Noncholinergic (NANC) Neurons, Functional Organization of Autonomic Activity, Pharmacologic Modification of Autonomic Function, References, Case Study Answer.
Topics Discussed: autonomic agents; autonomic nervous system; drugs affecting neurotransmission; sympathomimetics; adrenergic antagonists; cholinergics; anticholinergics.
Excerpt:"A teenage boy is seen at the office of a dental surgeon for extraction of an impacted wisdom tooth. He is so nervous that the dentist decides to administer a sedative to calm the boy. After intravenous administration of the sedative (promethazine), the boy relaxes and the extraction is accomplished with no complications. However, when the boy stands up from the dental chair, he turns very pale and faints. Lying on the floor, he rapidly regains consciousness, but has a rapid heart rate of 120 bpm and a blood pressure of only 110/70 mm Hg. When he sits up, his heart rate increases to 140 bpm, his pressure drops to 80/40 mm Hg, and he complains of faintness. He is helped to a couch in the reception area, where he rests for 30 minutes. At the end of this time the boy is able to sit up without symptoms and, after an additional 15 minutes, is able to stand without difficulty. What autonomic effects might promethazine have that would explain the patient's signs and symptoms? Why did his heart rate increase when his blood pressure dropped?..."
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