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DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM

DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM. 1. Nicotinic - skeletal Muscarinic - organ. Peripheral Nervous System. Somatic: Voluntary Innervates skeletal muscles Controlled through conscious thought Neurotransmitter Acetylcholine. Autonomic Nervous System.

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DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM

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  1. DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM 1 Winter 2013

  2. Nicotinic - skeletal Muscarinic - organ Winter 2013

  3. Winter 2013

  4. Peripheral Nervous System • Somatic: Voluntary • Innervates skeletal muscles • Controlled through conscious thought • Neurotransmitter • Acetylcholine Winter 2013

  5. Autonomic Nervous System • Autonomic or visceral division – not controlled by conscious • Controls • Blood pressure • Heart rate • Gastrointestinal activity • Glandular secretions Winter 2013

  6. SUBDIVISIONS OF THE AUTONOMIC NERVOUS SYSTEM • Sympathetic nervous system • Fight or Flight • Useful in highly stressful or emergency situations • Parasympathetic nervous system • Maintains homeostasis • Works in “opposition” of the Sympathetic nervous system • “Rest and Digest” Winter 2013

  7. VOCABULARY“SYNONYMOUS” TERMS • SYMPATHETIC • AKA ADRENERGIC • SYMPATHOMEMETIC • MIMICS THE SYMPATHETIC SYSTEM • PARASYMPATHETIC • AKA CHOLINERGIC • PARASYMPATHOMEMETIC • MIMICS THE PARASYMPATHETIC NERVOUS SYSTEM Winter 2013

  8. Adrenergic/SympatheticNEUROTRANSMITTERS(neurohormones) CATECHOLAMINES • Epinephrine (prototype) – secreted by Adrenal gland, direct response at nerve ending • Norepinephrine – secreted by Adrenal gland. Stored in the axon, direct response at the nerve ending RECEPTORS / RECEPTOR SITES ALPHA 1 ALPHA 2 BETA 1 BETA 2 Winter 2013

  9. Winter 2013

  10. RECEPTOR Responses to Stimulation • ALPHA I (located on the target cells) • Blood vessels Constriction • Pupils Dilation • Penis Ejaculation • Uterus Contraction • Sphincters Constriction

  11. Alpha-1 Adrenergic drugs • Isuprel (isoproterenol) • Used for shock • Adrenalin (epinephrine) • Cardiac arrest • Anaphylactic shock • Nasal decongestants (phenylephrine – Neo-Synephrine) • Pseudoephedrine (Sudafed) Winter 2013

  12. RECEPTOR Responses to Stimulation • ALPHA 2 (located on presynaptic terminal) • Control the release of norepinephrine Winter 2013

  13. ALPHA 2 Adrenergic Drugs • CLONIDINE (Catepres) • Decrease blood pressure • Management of Opioid withdrawal • METHYLDOPA • Decrease blood pressure Winter 2013

  14. RECEPTOR Responses to Stimulation • DOPAMINE RECEPTORS • Located in various tissues and organs • Cause dilation of renal, mesenteric, coronary and cerebral arteries Winter 2013

  15. Adrenergic drugs (Alpha 1) • ADVERSE EFFECTS V. THERAPEUTIC EFFECTS • Increased HR (tachycardia) • Increased Blood pressure • Decreased Gastric motility • Restlessness, irritability, anxiety, pallor • Increased Alertness Winter 2013

  16. Adrenergic blocking drugs • Alpha and BETA blocking drugs • Uses (Beta1 receptors are located primarily on cardiac tissues - cardioselective) • Cardiac dysrhythmias • Angina • Hypertension • Congestive heart failure • Prostate hypertrophy (alpha blocker) Winter 2013

  17. Winter 2013

  18. Adrenergic (beta-1) blocking drugs • Beta-adrenergic blocking drugs • Propranolol (Inderal) • Nadolol (Corgard) • Atenolol (Tenormin) • Timolol (Timoptic) Winter 2013

  19. ADRENERGIC BLOCKING DRUGS • Adverse reactions • Drowsiness, fatigue • Bradycardia • Hypotension • Orthostatic hypotension • Diarrhea Winter 2013

  20. Adrenergic blocking drugs • Nursing considerations • Patient teaching • Postural hypotension • Signs and symptoms of Heart Failure • Monitor blood pressure • Taking their own pulse Winter 2013

  21. Winter 2013

  22. Parasympathetic (Cholinergic)Nervous System • NEUROTRANSMITTER (neurohormone) • Acetylcholine – Produced and stored in nerve endings • Acetylcholine (ACh) binds to Cholinergic receptor sites and causes a response • Stimulation results in “rest and digest’ Winter 2013

  23. Acetylcholinesterase(aka:cholinesterase) • Breaks down Acetylcholine or limits response • Maintains the balance between acetylcholine and dopamine Winter 2013

  24. Uses – only four for cholinergic drugs:Drugs that increase Acetylcholine in the Synapse • Glaucoma – Reduce intraocular pressure • Myasthenia gravis – Disease caused by the lack of ACh at the synapse • Relief of urinary retention • Increase GI motility Winter 2013

  25. Indirect acting Cholinergic drugs • Neostigmine (Prostigmine) (anticholinesterase) prototype • Primarily used to treat Myasthenia Gravis • Pyridostimine (Mestinon) • Myasthenia Gravis • Donepezil (Aricept) • Works in the CNS to inhibit synthesis of Acetylcholinesterase • Used to treat Alzheimer’s disease Winter 2013

  26. Cholinergic drugs • Direct acting Cholinergic drugs • Directly stimulates the nerve ending to secrete acetylcholine • Bethanechol (Urecholine) • Used to treat urinary retention Winter 2013

  27. ADVERSE REACTIONS CHOLINERGIC DRUGS • Bradycardia • Hypotension • Headache, dizziness • Increased secretions • Abdominal cramping • Increased respiratory secretions and possibly bronchospasms Winter 2013

  28. Anticholinergic Medication • Competitive antagonists • Compete with ACh • Inhibit nerve transmission • Sites of action • All systems except musculo-skeletal Winter 2013

  29. Anticholinergic Medication • EXAMPLES • Bentyl (dicyclomine HCL) • Antispasmotic used to decrease intestinal cramping in IBS • Atropine (Prototype) • Acetylcholine antagonist • Antidysrhythmic • Antispasmotic • Antisecretory Winter 2013

  30. Anticholinergic Medication • USES • Dry oral secretions • Increase heart rate • Treat ureteral colic • Decrease GI motility • Parkinson’s disease • Decrease upper respiratory secretions Winter 2013

  31. Urinary antispasmodics AKA anticholinergics • OXYBUTYNIN (DITROPAN) • Synthetic antimuscarinic • INCREASES BLADDER CAPACITY • DECREASES FREQUENCY OF VOIDING • TOLTERODINE (DETROL, DETROL LA) • Synthetic antimuscarinic • DELAYS THE URGE TO VOID • INHIBITS BLADDER CONTRACTIONS Winter 2013

  32. Anticholinergic Medication • Adverse reactions / Side effects • Dry mouth • Blurred vision • Photophobia • Urinary retention • Constipation • Tachycardia • Drowsiness Winter 2013

  33. Nursing Interventions Monitor for signs of anticholinergic crisis Report changes in heart rate, blood pressure, or development of dysrhythmias Provide comfort measures for dryness of mucous membranes Minimize exposure to heat or cold or strenuous exercise Monitor I&O Monitor patient for abdominal distension, and auscultate for bowel sounds Winter 2013

  34. Anticholinergic Crisis Winter 2013

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