Autonomic Nervous System

Fall 2013 Chapter 4 - Havales Part 1

Autonomic Nervous System

Autonomic Nervous System
This system is divided into two separate systems. These systems are called the parasympathetic nervous system and the sympathetic nervous system. These systems often produce opposite effects. Drugs in this group are designed to either enhance or mimic the autonomic nervous system or to block the effects of the neurotransmitters at their receptor sites.

Autonomic Nervous System

Regulates bodily functions Heart Rate GI Motility Salivary Gland Secretions Bronchial Smooth Muscle
Stomach, intestines, bladder Muscle - iris eye Around blood vessels In the skin around hair follicles

Autonomic Nervous System

THERE ARE TWO TYPES OF AUTONOMIC NERVE FIBERS

parasympathetic and sympathetic

Middleton, Jim Kellogg CC

AUTONOMIC NERVOUS SYSTEM

1. those leaving the brain stem (Cranial nerves: III, VII, IX, X) and the sacral portion (2 4th segment) of the spinal cord are of the parasympathetic division 2. those nerve fibers leaving the spinal cord from T1 thoracic to L2 lumbar portions of spinal cord are of the sympathetic division

Divisions of the ANS

Two Divisions
Sympathetic Autonomic Nervous System
SANS

Parasympathetic Autonomic Nervous System

PANS

Produce opposite effects of each other

PANS Conserve: Rest and Digest

Parasympathetic Autonomic Nervous System

Preganglionic fibers In the nuclei Cranial Nerves: III, VII, IX, X and the second through the fourth sacral segments (S2 S4) Preganglionic fibers are LONG Extend near/into innervated organ Post ganglionic fibers are SHORT Originate in the ganglia Terminate on innervated tissue

Parasympathetic Nervous System

Parasympathetic Nervous System
This system is concerned with the conservation of body processes. Both digestion and intestinal tract motility are greatly influenced by the PANS Its main neurotransmitter is acetylcholine. Its receptors are muscarinic, nicotinic, and the somatic-skeletal muscles

Parasympathetic Autonomic Nervous System

Smooth muscle Cardiac muscle Glands

receptor receptor

Parasympathetic Receptors
Three types of receptors in the parasympathetic system a. muscarinic b. nicotinic C. somatic-skeletal muscle

Neurohormonal Transmitters Chemical mediators

Parasympathetic system: acetylcholine therefore, --the parasympathetic system is also known as the cholinergic system --drugs that imitate acetylcholine are known as parasympathomimetic or cholinergic drugs or P+ --drugs that block or inhibit acetylcholine are known as parasympatholytic, cholinergic blockers, anticholinergic or P- drugs

PANS
Action potential travels along the nerve
Causes release of Ach

Note: Atropine can block the action of acetylcholine at the post gang endings but not at the neuromuscular junction this is part of the ANS but not what we are concerned with.

Cholinergic agents
Cardiovascular effects
Direct effect
Decrease in cardiac output. Negative chronotropic and inotropic effect
Chronotropic effect = rate Inotropic effect = force of contractility of the heart muscle

Smooth muscle around the blood vessels results in relaxation and vasodilation Decrease in total peripheral resistance

Indirect effect
Increase in heart rate and cardiac output Positive chronotropic and inotropic effect

Depends on concentration of the drug

Cardiovascular Effects Generally - PANS

Bradycardia Decrease in blood pressure and cardiac output

Gastrointestinal Effects PANS Eye - PANS

Cholinergic agents excite the smooth muscle of the GI tract
Increase in activity, motility and secretion

Eye
Cholinergic agents
Cause cycloplegia - paralysis of the ciliary muscle of the eye so that it results in loss of visual accommodation Effect - Miosis
Constricted pupil

Intraocular pressure is decreased

USED TO TREAT GLAUCOMA

Parasympathetic Autonomic Nervous System

Cholinergic agents
Direct acting
Acts on the receptor
Choline derivatives and pilocarpine

Indirect acting
Causes release of neurotransmitter
Cholinesterase inhibitors (inhibit that exzyme) Reversible cholinesterase inhibitors Used to treat glaucoma and myasthenia gravis Rate of reversibility is based on the enzyme binding Concentration of acetylcholine builds up = P stimulation Irreversible cholinesterase inhibitors Developed for chemical warfare and pesticides

Meds used to treat Glaucoma

acetacholine (Miochol) carbachol (IsoptoCarpine ) pilocarpine (Salagen)

Med used to treat urinary retention

An oral cholinergic-type drug
bethanechol (Urecholine)

pilocarpine - Salagen
Cholinergic agent Treatment of xerostomia Side effects
Sweating Nausea Chills, flushing Rhinitis

Usual dose: 5mg tab t.i.d.

Adverse Reactions Extensions of their pharmacologic effects

Salivation Lacrimation Urination Defecation

Paralysis can occur as a result of larger doses and confusion

Seen with much larger doses

Indirect-acting cholinergic agents

Rapidly reversible
Edrophonium

Slowly reversible
Physostigmine and neostigmine

Treat myasthenia gravis and glaucoma

Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. Glaucoma is an increase in intraocular pressure
Cause blindness

Irreversible Cholinesterase Inhibitors

Insecticides
Insecticides inhibit cholinesterase, an enzyme that metabolizes acetylcholine i.e. Parathion and Malathion Insecticides are not so much cholinergic agents as they are drugs that slow down the metabolism of acetylcholine; the net effect is to increase the levels of acetylcholine and bring on the SLUD response

Sarin (used to poison subway riders in Japan. Used for chemical warfare.

Drugs used to treat acute toxicity

pysostigmne (Antilirium)
Treat acute toxicity from the anticholinergic agents (atropine), phenothiazines, tricyclic antidepressants an anthihistamines Overdose from cholinergic agents causing toxicity is treated with
pralidoxime (2-PAM, Protopam) atropine

Parasympatholytic/Anticholinergic Agents
Anticholinergic Drugs
blocks receptor site for acetylcholine Causes a decrease salivary flow and respiratory secretions during surgery Aka: antimuscarinic agents

Parasympatholytic/Anticholinergic Agents
CNS
Depending on dose can stimulate/depress
Pg. 41

Exocrine glands
Reduce flow and volume of secretions Used therapeutically in dentistry to decrease salivation

Smooth muscle
Relax smooth mus. in respiratory and GI tract
Meds are also called, spasmolytic agents Used to slow down the GI tract Used to treat asthma

Parasympatholytic/Anticholinergic Agents
Eye
Mydriasis
Dilation of pupil

Cyclopegia
Paralysis of the eye that results in the loss of visual accommodation

Used in eye examinations

Used to make proper measurements to make glasses

Parasympatholytic/Anticholinergic Agents
Cardiovascular
Large doses
Tachycardia
Used to prevent cardiac slowing during general anesthesia Produces vagal blockade = tachycardia

Small doses
Bradycardia predominates

Heart rate is a function of both direct and indirect effects

That is why you get different effects based on dosage

Parasympatholytic/Anticholinergic Agents
Adverse Reactions
Extensions of their pharmacologic effects
Xerostomia Blurred vision and photophobia (sens to light) Tachycardia GI stasis and Urinary tract stasis
Peristalsis and urination stops Constipation

Elevated temperature Toxicity

Hallucinations, delirium, convulsions, respiratory depression

Parasympatholytic/Anticholinergic Agents
Contraindications
Glaucoma
Can cause acute rise in intraocular pressure

Prostatic hypertrophy
Men who have difficulty urinating already should not be given drug, may need catheter

Intestinal/Urinary blockage
People already constipated/urinary tract retention

CV Disease
Why? Because anticholinergic agents can block the vagus nerve and result in tachycardia

Parasympatholytic/Anticholinergic Agents
Uses
Preoperative medication
Reduce saliva Ability to block the vagal slowing of the heart that results from general anesthesia

Treatment for GI disorders

Diarrhea, hypermotility of the colon Gastric ulcers

Parasympatholytic/Anticholinergic Agents
Uses
Eye exam
Mydriasis and cyclopegia (relax the lens of eye)

Reduction of Parkinson-like movements

Reduce tremors

Motion Sickness
Scopolamine
CNS depression

Parasympatholytic/Anticholinergic Agents
Atropine a. decreases secretions and salivation b. adverse reactions --increase heart rate without increased cardiac output --red, mad, hot c. dose range in 0.2 to l.0mg --usually ranges from 0.4 to 0.6mg d. contraindicated in glaucoma and, over long term, among patients with prostatic hypertrophy

Nicotinic Agonists and Antagonists

Nicotine
Present in cigarettes Very toxic in high doses Peripherally
Increases GI motility, b.p., reduces blood flow and constricts blood vessels

Addicting, can cause withdrawal Used as insecticide too

ANS Part 2

Two Divisions of the ANS

SYMPATHETIC
adrenergic fight or flight mediator:
adrenalin/epinephrine

PARASYMPATHETIC
cholinergic the body at ease mediator:
acetylcholine

the "mediator" listed above refers to that magic neurotransmitter at the synapse

SANS Fight or Flight

Sympathetic Autonomic Nervous System Sympathetic Nervous System

This nervous system is designed to cope with emergency situations. This is commonly known as the fright or flight or flight or fight response. Stimulate SANS = release of Epinephrine from adrenal medulla
Goes throughout the body via the bloodstream

Its neurotransmitters are epinephrine and norepinephrine. Dopamine receptors in the brain, splanchnic (viscera-i.e.-abdominal organs) and renal vasculature are important

Sympathetic Autonomic Nervous System

Sympathetic Nervous System
Catechol
Chemical structure NH2

Catecholamines are endogenous SANS neurotransmitters

NE Epi Dopamine

Sympathetic Autonomic Nervous System

Preganglionic fibers
short

originate from
Thoracic (T1) to the lumbar (L2) Produces a more diffuse effect Fibers exit the cord, enter the sympathetic chain, form multiple synaptic connections

Post gang. fibers terminate at the effector organ/tissue

Long

SANS
Pre

Heart Skeletal muscle Blood Vessels

Receptors alpha and beta (a and b)

Neurohormonal Transmitters Chemical mediators

Sympathetic system: epinephrine or "adrenalin" therefore, --the sympathetic system is also known as the adrenergic system --drugs that imitate epinephrine are known as sympathomimetic or adrenergic drugs --drugs that block or inhibit epinephrine are known as sympatholytic or anti-adrenergic drugs

Sympathetic Nervous System

Major neurotransmitters
NE and epinephrine NE released at the terminal nerve endings of the SANS Drugs classified by action
Direct action
Epi, NE and isoproterenol (exogenous) produce their effects directly on the receptor site by stimulating the receptor Its receptors are the and receptors

Indirect action
Amphetamine, release endogenous NE = response

Mixed action
Agents such as ephedrine, stimulate the receptor directly to release endogenous NE to cause a response

Sympathetic Nervous System

Note:
Monoamine Oxidase (MAO) and catechol-Omethyltransferase (COMT) are involved in the metabolism of a portion of both epinephrine and NE.

Sympathetic/Adrenergic System Receptors

TWO TYPES: alpha and beta --located in effector tissues (sites of action) activated by the sympathetic system --one type (either alpha or beta) tends to predominate a. alpha tend to be excitatory b. beta tend to be inhibitory

SANS Receptors
Alpha receptors
Stimulation
Results in smooth muscle excitation or contraction
Causes vasoconstriction Drugs that block the alpha receptors are called a-adrenergic blocking agents

SANS Receptors
Beta receptors
Two types
Beta 1 Beta 2

SANS Receptors
Beta 1 receptor
Controls the heart
(you have only 1 heart)

Metabolic effects on glycogen formation

increased

SANS Receptors
Beta 2
Stimulation
Smooth-muscle inhibition or relaxation
Relaxation of bronchioles with beta2 receptors

Skeletal muscle = vasodilation Bronchodilation of lungs/controls the lungs

Beta 2, think two lungs

Use drugs to treat asthma

SANS Receptors
Agents that block the effects
Beta-adrenergic blocking agents Some drugs will block both beta 1 and beta 2 receptors
i.e. propranolol

Others may only block beta 2 receptors

Tissue effects and drug effects of beta receptors

a. in blood vessels --both alpha and beta are present --alpha predominates i. alpha: contraction of smooth muscle vasoconstriction ii. beta: inhibits contraction, causing vasodilation

Tissue effects, drug effects of beta receptors

b. in the heart
i. beta stimulation results in a POSITIVE CHONOTROPIC (rate) ACTION and POSITIVE INOTROPIC (force) ACTION

Chronotropic and Inotropic Actions

Definition time:

Chronotropic means rate of contraction Inotropic means force of contraction

A positive effect on these two actions would mean: increase rate of contraction (positive chronotropic) and increase force of contraction (positive inotropic) A negative effect on these two actions would mean: decrease in rate of contraction (negative chronotropic) and decrease in force of contraction (negative inotropic)

Beta Receptors
Drugs that block -receptor effects are called adrenergic blocking agents
Some are nonspecific, blocking both 1- and 2-receptors Others are more selective, blocking primarily 2-receptors

Adrenergic (Sympathomimetic) Agents

Play important role in treating anaphylaxis and asthma Added to local anesthetics
vasoconstrictors

Adrenergic (Sympathomimetic) Agents

Pharmcologic Effects
Epinephrine
Has both alpha and beta activity

NE
Primarily stimulates alpha receptors

Isoproterenol
Acts mainly on beta receptors

Adrenergic (Sympathomimetic) Agents

CNS
Produce excitement, alertness Higher doses
Anxiety Apprehension Restlessness Tremors

Adrenergic (Sympathomimetic) Agents

Cardiovascular
General effect
Increase its force and strength of contraction Final effect on B.P. is the direct and indirect effects

Vessels
Depends on location
Innervated by alpha or beta or both Alpha = vasoconstriction in skin and mucosa Beta = vasodilation of skeletal muscle

Adrenergic (Sympathomimetic) Agents

Cardiovascular
Blood Pressure
General increase Epinephrine
Rise in systolic Decrease in diastolic

NE
Rise in both systolic and diastolic pressures

Isoproterenol
Little change in systolic, decrease in diastolic

Adrenergic (Sympathomimetic) Agents

Blood Pressure
NE, primarily an -agonist, produces vasoconstriction, increasing peripheral resistance, resulting in an increase in BP
With an increase in BP, the vagal reflex decreases heart rate

Epinephrine, an - and -agonist, constricts -receptors and dilates -receptors

This widens pulse pressure with an increase in systolic and a decrease in diastolic BP

Isoproterenol, primarily a -agonist, produces vasodilation that triggers an increase in heart rate (vagal reflex)

Adrenergic (Sympathomimetic) Agents

Eye
Decrease in intraocular pressure
Treat glaucoma

Mydriasis

Respiratory
Relax the bronchiole smooth muscle
Useful in treating asthma

Metabolic rate
Increases basal metabolic rate

Adrenergic (Sympathomimetic) Agents

Salivary glands
Stimulate the mucous secreting cells of the submaxillary and sublingual glands = thick, viscous saliva Parotid gland has no sympathetic innervation
Sympathomimetics will produce vasoconstriction Flow of saliva is often reduces Results in xerostomia

Adrenergic (Sympathomimetic) Agents

Uses
Vasoconstriction
Prolonged action

Hemostasis
Stops bleeding, infiltrate locally
In retraction cord

Decongestion
In nose drops
Constrict vessels, reduce swelling of mucous membranes of nose. Repeated use? Rebound congestion will occur Symptoms greater than before

Adrenergic (Sympathomimetic) Agents

Uses
Cardiac effects
Treatment of shock
Contraversial use Elevate a lowered b.p. However, need to correct the cause of shock

Treat cardiac arrest

Epinephrine

Adrenergic (Sympathomimetic) Agents

Bronchodilation
Asthma Anaphylaxis
Use epinephrine is DOC

Emphysema

CNS Stimulation
Amphetamine-like agents
Diet

ADD and narcolepsy

pg. 45

Specific Adrenergic Agents

epinephrine (Adrenalin)
Acute asthma attacks and anaphylaxis
Store epi in amber colored containers sunlight will destroy effectiveness pink then brown in color as it deteriorates

phenylephrine (Neo-Synephrine) a. stimulates alpha receptors b. similar to epinephrine without cardiac effects c. has been used with local anesthetics d. in eye, for dilation of pupil for examination (pupil dilation--MYDRIASIS) e. main claim to fame: nasal decongestant, drops or spray, 0.25-1% solution, or as a jelly for small children

Specific Adrenergic Agents

levonordefrin (Neo-Cobefrin)
Derivative of NE Vasconstrictor in LA
Less CNS stimulation Dose required for vasocons. is higher

Specific Adrenergic Agents

ephedrine and pseudoephedrine (Sudafed)
(Sudafed) mechanism of action is mixed Meth folks like to cook the pseudoephedrine to produce methamphetamine Now kept behind the counter Must be 18 to purchase Must sign a log in most states Limit per monthly purchase

Specific Adrenergic Agents

dopamine (Intropin)
A and B agonist Primarily used to treat shock

dipivefrin (Propine)
Used to tx glaucoma

Adrenergic Blocking Agents

Alpha adrenergic blocking agents Competitively inhibit vasoconstricting effects of adrenergic agents Reduces tone in blood vessels which produces a decrease in the total peripheral resistance = decrease in blood pressure but then stimulates the vagus, causing reflex tachycardia pg. 46 Meds: Minipress, Hytrin, Regitine, Cardura, Priscoline -used to tx hbp

Beta-Adrenergic Blocking Drugs

Completely block the beta receptors in the adrenergic nervous system Generic names end in: olol Produce
Bronchoconstriction Bradycardia

Beta-Adrenergic Blocking Drugs

Specific beta blocker
atenolol (Tenormin)
More activity on heart, blood vessels,

Nonspecific beta blocker

propranolol (Inderal)
Depresses the heart (neg. chronotropic/ionotropic) Bronchoconstriction Used to treat arrhythmias, angina, hypertension and migraine headache prophylaxis

Alpha and Beta Blocking Agents

labetalol (Normodyne, Trandate)
Blocks both alpha and beta Remember - Beta blockers have suffix: olol A/B blockers have suffix: alol Used for treatment of hypertension, produces a fall in blood pressure without reflex tachycardia

REVIEW!!!!!

 Autonomic Nervous System

This system is divided into two separate systems. These systems are called the parasympathetic nervous system and the sympathetic nervous system. These systems often produce opposite effects. Drugs in this group are designed to either enhance or mimic the autonomic nervous system or to block the effects of the neurotransmitters at their receptor sites.

 Parasympathetic Nervous System

This system is concerned with the conservation of the body processes. Its main neurotransmitter is acetylcholine. Its receptors are muscarinic, nicotinic, and the somatic-skeletal muscles.

 Sympathetic Nervous System

This nervous system is designed to cope with emergency situations. This is commonly known as the fight or flight response. Its neurotransmitters are epinephrine and norepinephrine. Its receptors are the and receptors.

 Cholinergic or Parasympathomimetic Drugs

These drugs are classified as either direct or indirect acting agents. Direct acting drugs act directly on the parasympathetic receptors. Indirect acting drugs work by either of two methods. They can cause the release of the neurotransmitter which then goes to the receptor site or they inhibit the enzyme cholinesterase.

Cholinergic Pharmacology
Cholinergic Pharmacology
Cardiovascular
Direct effects include negative chronotropic and inotropic actions. Relaxation of smooth muscles causes a decrease in total peripheral resistance. Indirect effects include increased heart rate and cardiac output. The resulting effect depends upon the dose used. Usually, the patient experiences bradycardia and a decrease in blood pressure and cardiac output.

Cholinergic Pharmacology
Cholinergic Pharmacology
Gastrointestinal
These drugs excite the smooth muscle of the gastrointestinal tract and cause an increase in activity, motility, and secretion.

Eye
These drugs cause miosis and cycloplegia. They cause a decrease in intraocular pressure.

Cholinergic Pharmacology
Adverse Reactions
Adverse reactions are an extension of the drugs pharmacologic effects. They include:
Salivation Lacrimation Urination Defecation Paralysis Overdose

Cholinergic Pharmacology
Contraindications
The contraindications and relative cautions are a result of the drugs pharmacologic and adverse effects. They include:
Bronchial asthma Hyperthyroidism Gastrointestinal or urinary tract obstruction Myasthenia gravis treated with neostigmine Peptic ulcer disease Severe cardiac disease

Anticholinergic Drugs
These drugs prevent the action of acetylcholine at postganglionic parasympathetic endings. Acetylcholine is released but its receptor site is completely blocked by anticholinergic drugs. These drugs only block muscarinic receptors

Anticholinergic Drugs
Pharmacology
Central Nervous System
Depending on the dose, these drugs can cause stimulation or depression.

Exocrine Glands
They reduce the flow and volume of secretions in the respiratory, gastrointestinal, and genitourinary tracts.

Anticholinergic Drugs
Pharmacology
Central Nervous System
Depending on the dose, these drugs can cause stimulation or depression.

Exocrine Glands
They reduce the flow and volume of secretions in the respiratory, gastrointestinal, and genitourinary tracts

Anticholinergic Drugs
Pharmacology
Cardiovascular
With large doses, these drugs produce vagal blocking which results in tachycardia. Bradycardia can occur with low doses.

Anticholinergic Drugs
Adverse Reactions
The adverse reactions are an extension of the drugs pharmacologic effects. They include:
Xerostomia Constipation Urinary retention Blurred vision Hyperpyrexia Hallucinations Photophobia Tachycardia

Anticholinergic Drugs
Contraindications
Contraindications are usually due to the drugs pharmacologic and adverse effects. They include:
Glaucoma Prostatic hypertrophy Intestinal or urinary obstruction or retention Cardiovascular disease

Anticholinergic Drugs
Uses
Preoperative Medication
They inhibit salivary and bronchial secretions. They block the vagal slowing of the heart that can occur with general anesthesia.

Gastrointestinal Disorders
They decrease gastrointestinal motility and can be used to treat ulcers, diarrhea, and hypermotility.

Anticholinergic Drugs
Uses
Ophthalmologic Examinations
Topical use can cause mydriasis which causes a full visualization of the retina. Cycloplegia relaxes the lens so that proper prescriptions for glasses can be determined.

Parkinson Disease
They reduce the tremors and rigidity associated with Parkinson and drug-induced Parkinson disease.

Anticholinergic Drugs
Uses
Motion Sickness
These drugs are used to treat or prevent motion sickness because of their central nervous system depressant action.

Dentistry
These drugs are used to create a dry, oral field.

Please! NO MORE!

Adrenergic Drugs
Adrenergic drugs can be classified as having direct action, indirect action, or mixed action. These drugs stimulate and receptors throughout the body. Drugs with direct action (epinephrine, norepinephrine, isoproterenol) produce their effect by directly stimulating the receptor site. Drugs with indirect action (amphetamine) release endogenous norepinephrine which then stimulates the receptor. Drugs with mixed action (ephedrine) either directly stimulate the receptor or release endogenous norepinephrine.
20

Adrenergic Drugs
Pharmacology
Central Nervous System (CNS)
These drugs produce CNS excitation or alertness. Higher doses produce anxiety, apprehension, restlessness, and tremors.

Cardiovascular System
These drugs increase the force and rate of contraction of the heart. Blood pressure is also increased. Total peripheral resistance is also increased.
21

Adrenergic Drugs
Pharmacology
Eye
These drugs lower intraocular pressure and can cause mydriasis.

Respiratory System
These drugs cause a relaxation of bronchiole smooth muscles.

Metabolic Effects
Increased glycogenolysis from -receptor stimulation causes hyperglycemia.

Salivary Glands
These drugs produce vasoconstriction of the salivary glands which leads to decreased salivary flow which results in xerostomia.
22

Adrenergic Drugs
Adverse Reactions
The adverse reactions associated with these drugs are an extension of the drugs pharmacologic effects. They include:
Anxiety Tremors Tachycardia Increased blood pressure Arrhythmias
23

Adrenergic Drugs
Uses
Vasoconstriction
These drugs are used in dentistry because of their vasoconstrictive actions on blood vessels. They are added to local anesthetics because they prolong the action of the local anesthetic, reduce the risk for systemic toxicity, and help to create a dry field.

Cardiac Effects
These drugs are used to raise blood pressure and to treat cardiac arrest.
24

Adrenergic Drugs
Uses
Bronchodilation
These drugs are used to treat asthma, emphysema, and allergic reaction.

Central Nervous System Stimulation

These medications are used for the treatment of attention deficit hyperactivity disorder, narcolepsy, and as diet aids.

25

Adrenergic Blocking Drugs

These drugs competitively inhibit and receptor sites. One group of drugs is specific for receptors. One group of drugs is specific for both 1 and 2 receptors. One group is specific for 2 receptors. One group is specific for both and receptors.
26

Antiadrenergic Drugs
Pharmacology
These drugs reduce sympathetic tone in the blood vessels and decrease total peripheral resistance. This results in a reduction in blood pressure.

Uses
These drugs are used to treat hypertension, peripheral vascular disease (i.e., Raynaud syndrome) and benign prostatic hypertrophy.
27