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Autonomic Nervous System. Cholinergic – Blocking Drugs. Cholinergic-Blocking Drugs. Describe the cholinergic-blocking drug effects on major body systems.

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autonomic nervous system

Autonomic Nervous System

Cholinergic – Blocking Drugs

cholinergic blocking drugs
Cholinergic-Blocking Drugs
  • Describe the cholinergic-blocking drug effects on major body systems.
  • Discuss the nursing process in the care of patients receiving cholinergic-blocking drugs for cardiovascular, respiratory, gastrointestinal, and genitourinary system problems.
cholinergic blocking drugs mechanism of action
Cholinergic-Blocking DrugsMechanism of Action

Drugs that block or inhibit the actions of acetylcholine (ACh) in the parasympathetic nervous system (PSNS)

  • anticholinergics
  • Compete with Ach & block ACh at the muscarinic receptors in the PSNS
    • ACh is unable to bind to the receptor site and cause a cholinergic effect

Once these drugs bind to receptors, they inhibit nerve transmission at these receptors

cholinergic blocking drugs chemical class
Cholinergic-Blocking DrugsChemical Class

Natural Synthetic/ Semisynthetic

atropinebenztropine (Cogentin)

Belladonnadicyclomine (Bentyl) glycopyrrolate

Robinul)

Hyoscyamine homatropine ipratropium

Scopolamine isopropamide methscopolamine

oxybutynin (Ditropan) propantheline

tolterodine (Detrol)

solifenacin (Vesicare)

cholinergic blocking drugs drugs
Cholinergic-Blocking DrugsDrugs
  • Atropine – preop; bradycardia;
  • Dicyclomine (Bentyl) – irritable bowel syndrome
  • glycopyrrolate (Robinul) – intraop to control secretions; PUD (peptic ulcer disease), reversal of neuromuscular blockers
  • Oxybutynin (Ditropan) – antispasmodic for neurogenic bladder; overactive bladder; spinal cord injury
  • Scopolamine (Transderm-Scop) – control of secretions; motion sickness
  • Tolterodine (Detrol) – overactive bladder
cholinergic blocking drugs drug effects
Cholinergic-Blocking DrugsDrug Effects
  • Cardiovascular
    • Small doses: decrease heart rate
    • Large doses: increase heart rate
  • CNS
    • Small doses: decrease muscle rigidity and tremors
    • Large doses: drowsiness, disorientation, hallucinations
  • Respiratory
    • Decreased bronchial secretions
    • Dilated bronchial airways
cholinergic blocking drugs drug effects1
Cholinergic-Blocking DrugsDrug Effects
  • Eye
    • Dilated pupils (mydriasis)
    • Decreased accommodation due to paralysis of ciliary muscles (cycloplegia)
  • Gastrointestinal
    • Relax smooth muscle tone of GI tract
    • Decrease intestinal and gastric secretions
    • Decrease motility and peristalsis
cholinergic blocking drugs drug effects2
Cholinergic-Blocking DrugsDrug Effects
  • Genitourinary
    • Relaxed detrusor muscle
    • Increased constriction of internal sphincter
    • Result: urinary retention
  • Glandular
    • Decreased bronchial secretions, salivation, sweating
cholinergic blocking drugs indications cns
Cholinergic-Blocking DrugsIndications - CNS
  • To decrease muscle rigidity and muscle tremors
    • Parkinson’s disease
    • Drug-induced extrapyramidal reactions
cholinergic blocking drugs indications cardiovascular
Cholinergic-Blocking DrugsIndications - Cardiovascular

Affect the heart’s conduction system

  • Low doses: slow the heart rate
  • Appropiate doses: block inhibitory vagal effects on the SA and AV node pacemaker cells
    • Intended Effect: increased heart rate
  • Uses:
    • Diagnosis of sinus node dysfunction
    • Symptomatic second-degree heart block
    • Severe sinus bradycardia with hemodynamic compromise (advanced life support)
cholinergic blocking drugs indications respiratory
Cholinergic-Blocking DrugsIndications – Respiratory
  • Blocking the cholinergic stimulation of the PSNS allows unopposed action of the SNS
  • Results
    • Decreased secretions from nose, mouth, pharynx, bronchi
    • Relaxed smooth muscles in bronchi and bronchioles
      • Bronchodilation
    • Decreased airway resistance
cholinergic blocking drugs indications respiratory1
Cholinergic-Blocking DrugsIndications - Respiratory

Respiratory drugs are used to treat:

  • Exercise-induced bronchospasms
  • Chronic bronchitis
  • Asthma
  • Chronic obstructive pulmonary disease
cholinergic blocking drugs indications gastrointestinal
Cholinergic-Blocking DrugsIndications - Gastrointestinal
  • PSNS controls gastric secretions and smooth muscles that produce gastric motility
  • Blockade of PSNS results in:
    • Decreased secretions
    • Relaxation of smooth muscle
    • Decreased GI motility and peristalsis

Gastrointestinal drugs are used to treat:

  • Irritable bowel disease
  • GI hypersecretory states
  • Acute pancreatitis (reduces gastric and pancreatic secretions)
cholinergic blocking drugs indications genitourinary
Cholinergic-Blocking DrugsIndications - Genitourinary
  • Reflex neurogenic bladder
  • Incontinence
cholinergic blocking drugs other indications
Cholinergic-Blocking DrugsOther Indications

Preoperatively

to reduce salivary secretions

cholinergic blocking drugs adverse effects
Cholinergic-Blocking DrugsAdverse Effects

Body SystemAdverse Effects

Cardiovascular Increased heart rate, dysrhythmias

CNS Excitation, restlessness, irritability, disorientation, hallucinations, delirium

Eye Dilated pupils, decreased visual accommodation, increased intraocular pressure

GastrointestinalDecreased salivation, decreased gastric secretions, decreased motility

Genitourinary Urinary retention

Glandular Decreased sweating

Respiratory Decreased bronchial secretions

cholinergic blocking drugs interactions
Cholinergic-Blocking DrugsInteractions
  • Antihistamines
  • phenothiazines
  • tricyclic antidepressants
  • MAOIs
  • When given with cholinergic blocking drugs, cause additive effects, resulting in increased effects
cholinergic blocking drugs nursing implications
Cholinergic-Blocking DrugsNursing Implications
  • These drugs will block the action of ACh in the PSNS
  • Assess for allergies, presence of BPH, glaucoma, tachycardia, MI, HF, hiatal hernia, and GI or GU obstruction
  • Perform baseline assessment of vital signs and systems overview
  • Medications should be taken exactly as prescribed to have the maximum therapeutic effect
  • Overdosing can cause life-threatening problems
  • Blurred vision may cause problems with driving or operating machinery
cholinergic blocking drugs nursing implications1
Cholinergic-Blocking DrugsNursing Implications
  • Patients may experience sensitivity to light – sun glasses
  • When giving ophthalmic solutions, apply pressure to the inner canthus to prevent systemic absorption
  • Dry mouth may occur: chewing gum, frequent mouth care, and hard candy
  • Check with physician before taking any other medication, including OTC medications
  • Antidote for atropine overdose is physostigmine
cholinergic blocking drugs nursing implications patient ed
Cholinergic-Blocking DrugsNursing Implications – Patient Ed
  • Anticholinergics taken by the elderly patient may lead to higher risk for heatstroke due to effects on heat-regulating mechanisms
  • Teach patients to limit physical exertion and avoid high temperatures and strenuous exercise
  • Emphasize the importance of adequate fluid and salt intake
cholinergic blocking drugs patient education
Cholinergic-Blocking DrugsPatient Education

Patients should report the following to their physician:

  • Urinary hesitancy and/or retention
  • Constipation
  • Palpitations
  • Tremors, confusion, sedation or amnesia,
  • Excessive dry mouth
    • especially if pt. chronic lung infections or disease
  • Fever
cholinergic blocking drugs nursing implications2
Cholinergic-Blocking DrugsNursing Implications

Monitor for therapeutic effects

  • For patients with Parkinson’s disease: fewer tremors and decreased salivation and drooling
  • For urologic problems: improved urinary patterns, less hypermotility, increased time between voiding

Monitor for adverse effects