This effect is carried out by the reflex way because the definite skin areas are connected with definite inner organs through the corresponding segments of the spinal cord.

Indications 3 - 6

Effect in the site of drug application:

- vasodilation (with hyperemia of skin etc.)

Indication 1

- vasoconstriction (with whiteness of skin etc.)

Indication 2

Indications:

1/ Prophylaxy of bedsore: camphor, turpentine oil, ammonium liniment (main effect – prevention of pus inflammation due to local intensification of blood circulation; apply onto the skin with risk of bedsore formation).

2. Rhinitis: menthol (main effect – decreasing of running nose due to vasoconstriction; apply by drops in the nose).

3. Joint pain, neuralgia, myositis: camphor, turpentine oil, ammonium liniment (main effect – decreasing of pain; apply onto the skin above the injured joint, nerve or muscle).

4. Respiratory organs diseases, for example pneumonia, bronchitis: camphor, turpentine oil, ammonium liniment (main effect – decreasing of inflammation; apply onto the skin of the back)

5. Stenocardia (angina pectoris): validolum (main effect – decreasing of cardiac pain due to relaxation of coronary arteries and increasing of blood supply to the heart).

6. Fainting (syncope): ammonium solution (main effect – restoration of consciousness; give it to breath in for patient during syncope).

Some aspects of physiology. VERY IMPORTANT!!!

Cholinergic synapses (most of them are parasympathetic synapses), as any another synapses in the organism, consist of two parts: presynaps and postsynaps. Presynaps releases acetylcholine, which activates Muscarinic (M) or Nicotinic (N) cholinoreceptors on the postsynaptic membrane. Thereafter acetylcholine is destroyed by specific enzyme – acetylcholinesterase, which is located on the postsynaptic membrane.

Acetylcholine produces next effects (see and study the table):

Type of receptors	Organ	Effect
Stimulation of M-cholinoreceptors	Eye	Constriction of pupil (miosis)
	Salivary glands	Increasing of saliva secretion
	Heart	Decreasing of heart rate, heart contractility, heart conductance and heart excitability
	Bronchi	Constriction (due to contraction of smooth muscles of bronchi)
	Gastro-intestinal tract (GIT) organs: stomach, small intestine, gall bladder etc.	Increasing of motility (due to contraction of smooth muscles of GIT organs)
	Urinary bladder	Constriction (due to contraction of smooth muscles of urinary bladder)
Stimulation of N-cholinoreceptors	Skeletal muscles	Increasing of contractility
	Autonomic ganglions	Constriction of blood vessels Increasing of uterus contractility

1. (CholinOnegative drugs)

1. Anticholinesterases

List of drugs

Reversible anticholinesterases: Neostigmine bromide, Pyridostigmine bromide

Irreversible anticholinesterases: Arminum, Echothiophate

Mechanism of action

These drugs produce inhibition of acetylcholinesterase that results in accu­mulation of acetylcholine in the synaptic cleft.

Neostigmine and pyridostigmine produce reversible inhibition of acetylcholinesterase, arminum and echothiophate produce irreversible inhibition of acetylcholinesterase

Pharmacological effects

These drugs produce inhibition of acetylcholinesterase that results in accu­mulation of acetylcholine in the synaptic cleft. In this situation acetylcholine more stronger activates M- and N-cholinergic receptors and, therefore, induces aforementioned effects:

Type of receptors	Organ	Effect
Stimulation of M-cholinoreceptors	Eye	Constriction of pupil (miosis)
	Salivary glands	Increasing of saliva secretion
	Heart	Decreasing of heart rate, heart contractility, heart conductance and heart excitability
	Bronchi	Constriction (due to contraction of smooth muscles of bronchi)
	Gastro-intestinal tract (GIT) organs: stomach, small intestine, gall bladder etc.	Increasing of motility (due to contraction of smooth muscles of GIT organs)
	Urinary bladder	Constriction (due to contraction of smooth muscles of urinary bladder)
Stimulation of N-cholinoreceptors	Skeletal muscles	Increasing of contractility
	Autonomic ganglions	Constriction of blood vessels Increasing of uterus contractility

Indications

1. Glaucoma (increasing of intraocular pressure)

Neostigmine, Pyridostigmine, Arminum, Echothiophate → constriction of pupil → decreasing of intraocular pressure → treating of glaucoma. This effect depends on M-cholinoreceptors.

2. Atony of GIT organs and urinary bladder

Neostigmine, Pyridostigmine → increasing of motility of GIT organs and urinary bladder → treating of atony. This effect depends on M-cholinoreceptors.

3. Poor uterine contraction strength

Neostigmine, Pyridostigmine → increasing of uterus contractility → inducing of labor (delivery).

This effect depends on N-cholinoreceptors.

4. Myasthenia gravis (weakness of skeletal muscles)

Neostigmine, Pyridostigmine → increasing of contractility of skeletal muscles → treating of myasthenia gravis This effect depends on N-cholinoreceptors.