Drugs Acting on Autonomic Nervous System (ANS)

A. Drugs for Cholinergic System:

1. Cholinergic agents:
   • Directly acting:
     • Choline esters: Acetylcholine, bethanechol, carbachol
     • Alkaloids: Pilocarpine, muscarine
   • Indirectly acting: (Anticholinesterases)
     • Reversible:
       • Carbamates: Physostigmine, Neostigmine, Pyridostigmine, Rivastigmine
       • Alcohols: Edrophonium
       • Others: Donepezil, galantamine, tacrine
     • Irreversible:
       • Organophosphorous compounds: Parathion, Malathion, Sarin, soman, tabun (nerve gases), Dyflos, Echothiophat
       • Carbamates: Propoxur, carbaryl
2. Anticholinergic agents:
   • Natural alkaloids:
     Atropine, hyoscine (scopolamine)
   • Semisynthetic derivatives:
     Atropine methonitrate, homatropine, hyoscine butylbromide, Ipratropium bromide, tiotropium bromide
   • Synthetic compounds:
     • Antisecretory-antispasmodics:
       • Quaternary compounds: Propantheline, oxyphenonium, clidinium, pipenzolate methyl bromide, isopropamide
       • Teritiary amines: Dicyclomine, valethamate, pirenzepine
     • Mydriactics: Cyclopentolate, tropicamide
     • Vasicoselective: Oxybutynin, flavoxate, tolterodine
     • Antiparkinsonian: Trihexyphenidyl (Benzhexol), procyclidine, biperidin

B. Drugs for Adrenergic System:

1. Adrenergic Agonists: (sympathomimetics)
   • Pressor agents: Noradrenaline(Norepinephrine), Ephedrine, Dopamine, Phenylephrine, Methoxamine, Mephentermine
   • Bronchodilators: Isoprenaline, Salbutamol (Albuterol), Terbutaline, Salmeterol, Formoterol, Bambuterol
   • CNS stimulants: Amphetamine, Dexamphetamine, Methamphetamine, Methylphenidate
   • Uterine relaxants: Ritodrine, Isoxsuprine Salbutamol, Terbutaline
   • Cardiac stimulants: Adrenaline, Isoprenaline, Dobutamine
   • Nasal decongesants: Xylometazoline, Oxymetazoline, Naphazoline, Phenylephrine, Phenylpropanolamine, Pseudoephedrine
   • Anorectics:
     Amphetamine, Fenfluramine, sibutramine
2. Adrenergic receptor blockers:
   • α Adrenergic blocking drugs:
     • Non equilibrium type:
       • β-haloalkylamine: Phenoxybezamine
     • Equilibrium type:
       • Non selective:
         • Ergot alkaloids: Ergotamine, Ergotoxine
         • Imidazoline: Phentolamine
         • Hydrogenated ergot alkaloids: Dihydroergotamine (DHE), Dihydroergotoxine (Codergocrine)
         • Miscellaneous: Chlorpromazine
       • α₁ Selective: Prazosin, Terazosin, Doxazosin, Alfuzosin, Tamsulosin
       • α₂ Selective: Yohimbine
   • β Adrenergic blocking drugs:
     • First Classification:
       • Non selective (β₁ + β₂):
         • With Intrinsic sympathetomimetic activity (ISA): Pindolol
         • Without ISA: Propranolol, Sotalol, Timolol
         • With α blocking property: Labetalol, Carvedilol
       • Cardioselective (β₁): Metoprolol, Atenolol, Acebutolol, Bisoprolol, Esmolol, Betaxolol, Celiprolol, Nebivolol
     • Second Classification:
       • First generation:

         (Older, nonselective)

         Timolol, Betaxolol, Levobunolol, Carteolol
       • Second generation:

         (β₁ or cardioselective)

         Metoprolol, Atenolol, Acebutolol, Bisoprolol, Esmolol
       • Third generation:

         (With α blocking and or vasodilator property)

         Labetalol, Carvedilol, Celiprolol, Nebivolol, Betaxolol

1. β-Adrenergic agonists: Timolol, Betaxolol, Levobunolol, Carteolol
2. α-Adrenergic agonists: Dipivefrine, Apraclonidine, Brimonidine
3. prostaglandin analogues: Latanoprost, Travoprost, Bimatoprost
4. Carbomic anhydrase inhibitors: Dorzolamide, Brinzolamide
5. Miotics: Pilocarpine, Physostigmine, Echothiophate