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2. Cholinergic pharmacology: Indirectly acting Reversible anti Cholinesterases (ANS Pharmacology)

Autonomic pharmacology is the study of how drugs interact with the autonomic nervous system. The autonomic nervous system plays an important role in the control of the internal organs including the heart, lungs, gastrointestinal tract, and vasculature. Drugs that target the autonomic nervous system are, therefore, useful in the treatment of a range of conditions such as hypertension; gastrointestinal disturbances, and asthma. An understanding of how drugs can interact with the autonomic nervous system allows us to appreciate the therapeutic uses of these drugs, and to predict their likely adverse effects.

Anatomy of the ANS

The parasympathetic and sympathetic nervous systems each consist of two nerves – a preganglionic nerve which has its cell body within the CNS; and a postganglionic nerve which innervates the effector tissue.

Preganglionic nerves of the sympathetic nervous system leave the CNS in the thoracolumbar regions of the spinal cord and synapse with the postganglionic fibres in prevertebral and paravertebral ganglia adjacent to the spinal cord. The long postganglionic fibres run from these ganglia to the effector organs.

The parasympathetic preganglionic nerve fibres exit the spinal cord via the cranial nerves and the sacral regions of the spinal cord. The parasympathetic ganglia are located within the effector organs and the postganglionic fibres of the parasympathetic nervous system are, therefore, much shorter than those of the sympathetic system.

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