Autonomic Nervous System
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Transcript Autonomic Nervous System
Autonomic Nervous System
Chapter 16, 17, 18, 19, 20
Clinical Drug Therapy
Nervous System
Two main divisions
Central Nervous System or CNS
Peripheral Nervous System or PNS
Central Nervous System or CNS
Brain and spinal cord: receives and
processes incoming sensory information and
responds by sending out signals that initiate
or modify a process.
Peripheral Nervous System or PNS
Includes all the neurons and ganglia found
outside the CNS
Afferent (sensory): modify motor output
Efferent:
Afferent Neurons
Afferent neurons carry sensory input from the
periphery to the CNS and modify motor
output through the reflex arc.
Efferent Neurons
Efferent neurons carry motor signals from the
CNS to the peripheral areas of the body.
ANS / SNS
Autonomic nervous system controls
involuntary activities of smooth muscle,
secretory glands and the visceral organs of
the body such as the heart (involuntary
activities of smooth muscle)
Somatic nervous system innervates the
skeletal muscles and controls voluntary
movement
Autonomic Nervous System
Sympathetic Nervous System
Para sympathetic System
Enteric System
The Race Horse and the Cow
Sympathetic Nervous System
Sympathetic System
Fight or Flight – stimulated by physical or
emotional stress (exercise or work), pain,
hemorrhage, intense emotions, temperature
extremes
Sympathetic Nervous System
Protective mechanisms designed to help
person cope with the stress or get away from
it.
Neurotransmitters
Neurotransmitters
Acetylcholine: skeletal muscle
Norepinepherine: stress response
Norepinephrine and epinephrine
Both always present in the blood.
Norepinephrine varies according to the
amount of stress present and will cause
transient changes in heart rate and systemic
arteries and veins.
Epinephrine is a constant in regulating heart
rate, vasoconstriction in systemic arteries and
veins and vasodilation of muscles and liver.
Dopamine
Adrenergic neurotransmitter – essential for
normal brain function.
Studies focus on connection between dopamine
malfunction in schizophrenia and Parkinson’s
Disease.
Role of dopamine in drug addition to drugs:
stimulants and depressants.
Protective Mechanisms
Intensity of response depends on
Norepinephrine and epinephrine
Fight or flight
Body Responses
Increase in blood pressure and cardiac
output.
Increase blood flow to brain, heart and
skeletal muscles.
Decrease blood flow to skin and organs not
needed for “flight”.
Increase in glycogen for energy, mental
activity, muscle strength, blood coagulation,
respiratory rate, pupil dilation to aid vision,
and increase in sweating.
Fight of Flight Response
Can be a problem if the body stay in the “fight
or flight” mode.
Type A personalities?
High stress environment?
Medications may be needed reduce the
physiologic body responses.
Parasympathetic Nervous System
Rest and Digest
Save energy
Decreased heart rate
Adrenergic Receptors
Norepinephrine and epinephrine interact with
two adrenergic receptors
Alpha and beta
Alpha 1
Alpha 2
Beta 1
Beta 2
Alpha 1
Alpha 1 receptors allows calcium ions to
move into the cell and produce muscle
contraction.
Alpha 1
Location
Blood vessels
Kidney
Intestinal smooth muscles
Genitourinary
Eyes = blinking
Pregnant uterus =
contractions
Male sexual organs =
sexual function
Effects of stimulation
Vasoconstriction
Release of renin (kidney)
Relaxation
Alpha 2
Location
Nerve endings
Vascular smooth
muscles
Pancreatic beta cells
Platelets
Effects of stimulation
Inhibits release of
Norepinephrine
Vasoconstriction
Inhibit insulin secretion
Aggregation or clotting
Beta 1
Location
Heart
Kidneys
Effects of stimulation
Increase heart rate,
force of contraction,
automaticity and rate of
atrial-ventricular
function
Increased renin release
Beta 2
Location
Bronchioles
Blood vessels
Gastrointestinal tract
Liver
Urinary bladder
Pregnant uterus
Effects of stimulation
Vasodilation
Decreased motility and
tone
Glycogenolysis
Relaxed detrusor
muscle (bladder
muscle)
Relaxation of uterus
Dopamine
Location
Blood vessels of
kidney, heart, and other
viscera
Effects of stimulation
Vasodilation
Parasympathetic Nervous System
Functions stimulated by PNS: Resting,
reparative, or vegetative function
Body Responses
Dilation of blood vessels in skin
Decrease heart rate (bradycardia)
Increase secretion of digestive enzymes
Constriction of smooth muscle of bronchi
Increase in sweat glands
Contraction of smooth muscles of urinary
bladder
Contraction of smooth muscle of skeletal
system
Neurotransmitter
Acetylcholine
Two types of cholinergic receptors
Nicotinic: located in motor nerves and skeletal
muscles
Muscarinic: located in internal organs,
cardiovascular, respiratory, GI and GU
Autonomic Drugs
Drugs used due to their ability to stimulate or
block activity of the sympathetic or
parasympathetic nervous system.
Effect of Drugs
Drugs that act of ANS usually affect the entire
body.
Effects depend on whether you are trying to
stimulate or inhibit function.
Receptor Activity
Drugs are developed to stimulate or inhibit
particular subtypes of receptors.
More selective on particular body tissues.
Decrease adverse effects on other body
tissues – side effects.
Simulation of SNS
Stimulation of sympathetic nervous system
can be divided into drug classifications:
Adrenergic
Sympathomimetic
Alpha and beta adrenergic agonists
Agonist
In pharmacology an agonist is a substance
that binds to a specific receptor and triggers a
response in the cell.
Blockage of SNS
Drugs that inhibit sympathetic nervous
system are classified as
Antiadrenergic
Sympatholytic anticholinergic
Stimulation of PNS
Parasympathetic nervous system stimulation
drug classifications
Cholinergic
Parasympathomimenic
Cholinomimetic
Blocking of PNS
Drugs that inhibit parasympathetic stimulation
are classified as:
Anticholinergic
Parasympatholytic
Cholenergic blocking drugs
Classifications: SNS
Sympathetic nervous system drug
classifications
Adrenergic - stimulating
Antiadrenergic - blocking
Classifications: PNS
Parasympathetic
nervous system drugs
Cholinergic
Anticholinergic
Adrenergic Drugs
Chapter 17
Adrenergic Drugs
What do they do?
Stimulation of the sympathetic nervous
system.
Mechanism of Action
Three mechanisms:
Directly with alpha 1 or beta-adrenergic receptors
on surface membrane.
Indirect effects of postsynaptic adrenergic
receptors.
Mixed action – combination of action on direct and
indirect receptor.
Heart
Direct stimulation of receptors
Alpha 1 - Vasoconstriction of blood vessels which
increases blood pressure – pressor or
vasopressor effect.
Beta 2 - increased force of myocardial contraction
- Increased speed of electrical conduction in the
heart.
Lungs
Asthma and COPD (Chronic Obstructive
Pulmonary Disease): Beta 2 drugs or
bronchodilators are used to relieve bronchoconstriction and broncho-spasm.
Pregnancy
Adrenergic drugs used to relax uterine
muscles in preterm labor.
OTC Adrenergic Drugs
Common cold: anti-histamines
Allergy: nasal or oral to relieve nasal
congestion
Adrenergic Drugs
Epinephrine
Pseudoephedrine – Sudafed
Isoproterenol (Isuprel)
Phenylephrine (Neo-Synephrine)
Clonidine (antihypertensive)
How does one choose a drug?
How emergent is the situation
PO or IM or IV
Allergic Response
Runny nose, itchy eyes, cough
Asthma: Cough with bronchospasms,
difficulty breathing or SOB (shortness of
breath)
Anaphylactic shock – edema of airway
Allergy Response
Nasal congestion, itchy eyes, non-productive
cough
Seasonal response to environmental causes
Commonly mixed with other drugs in cold
medications
Pseudoephedrine
Therapeutic classification: allergy, cold, and cough
remedies, nasal drying, and decongestants.
Indications: symptomatic management of nasal
congestion associated with acute viral upper
respiratory tract infection. Most often used in
combination with other drugs.
Action: stimulates Alpha and beta-adrenergic
receptors – vasoconstriction in respiratory tract
mucosa – possible bronchodilation
Therapeutic effects: reduction of nasal congestion,
and swelling of nasal passages.
Forms and Dosage
How supplied: tabs, chew tabs, extended
release tabs, liquid or drops
Dosing: 30 to 60 mg / dose q 6-8 hours PO
Maximum dose 240 mg/24 hours
Sustained release: 120 mg PO q 12 hours
Contraindications
Severe Hypertension
Severe CAD / coronary artery disease
Use with caution in pregnancy, breast feeding
and renal failure
Use with caution!
Mild or moderate hypertension,
hyperglycemia, hyperthyroidism, and cardiac
disease.
Side Effects
Dizziness, nervousness, restlessness,
insomnia and arrhythmias
Seizures
Cardiovascular collapse
Additional Information
OTC used in combination with antihistamines
Primarily excreted renally – adjust in patients
with renal impairment
May cause false-positive for amphetamines –
athletes
Currently need to ask pharmacist for Sudafed
– OTC has been limited due to abuse
Nursing Implications
Assess for congestion
Monitor pulse and blood pressure before
beginning therapy
Assess lung sound for signs of bronchial
secretions
Severe Anaphylactic Shock
Usually involving the airways
Some thing as simple as food allergy can
trigger it
Peanuts, shell fish, legumes, bee sting,
medications
Symptoms usually starts with numbness and
tingling of lips and leads to swelling of the
glottis or epiglottis – this can result in closure
of the airway.
How Do You Treat It?
Epinephrine would be the drug of choice
Classification: adrenergic
Action: affects both the beta (cardiac) and
beta (pulmonary) receptors – produces
bronchodilation – inhibits hypersensitivity
reaction of mast cells.
Epinephrine
Therapeutic Effects:
Bronchodilation
Maintenance of heart rate and blood pressure
Adverse Side Effects:
Nervousness, restlessness, tremors, angina,
arrhythmias, hypertension, tachycardia
How it is given?
Sub-Q or IV or inhaled
The subcutaneous or intramuscular
administration will help it to get into the blood
stream quicker – epi-pen is given to clients
with severe allergy reactions
Not given by mouth because drug is
inactivated by gastric juices
Can be inhaled in asthma attack
CAUTION!
Check dose, concentration, and route of
administration – fatalities have occurred from
medication errors – us TB syringe for
subcutaneous administration
Inhaled provided as metered dose inhaler
160 to 250 mcg – broncho-constriction is
asthma
IV would be 0.1 to 0.25 mg (cardiopulmonary
resuscitation)
Precautions with Use
Tachyarrhythmia's (fast irregular heart rate),
headache, nausea, and palpitations
Short acting so more definitive treatment
needs to be initiated
Need cardio-respiratory monitoring
Pulse oximetry
Cardiac monitor
Cardiac Arrest
Epinephrine is the best studied and most
widely administered adrenergic agonist used
for the treatment of cardiac arrest.
Used to jump start the heart.
Vasopressor / Inotropic Drugs
Used extensively along with Dopamine to
maintain myocardial and cerebral perfusion
post cardiac arrest.
Administered in small, consistent amounts
intravenous.
Antiadrenergic Drugs
Chapter 18
Clinical Drug Therapy
Antiadrenergic Drugs
Blocks the effects of the sympathetic nerve
stimulation, endogenous catecholamine and
adrenergic drugs.
Mechanism of Action
Act on alpha or beta receptors
Receptors are blocked by adrenergic
antagonists or pre-synaptic alpha 2 receptors
are stimulated.
When Used?
To manage hypertension and a number of
cardiovascular disorders.
Anti – hypertensive Medication
Clonidine: Catapres, Catapres TTS, Dixarit,
Duracion
Pharmacologic classification: adrenergic
(centrally acting)
Therapeutic classification: antihypertensive
Clonidine
Action: Stimulates the alpha-adrenergic
receptors in the CNS which results in
decreased sympathetic outflow inhibiting
cardioacceleration and vasoconstriction
centers. Prevents pain signal transmission to
the CNS by stimulating alpha-adrenergic
receptors in the spinal cord.
Therapeutic Effects: decreased blood
pressure. Decreased pain.
Cholinergic Drugs
Chapter 19
Clinical Drug Therapy
Cholinergic Drugs
Cholinergic drugs stimulate the
parasympathetic nervous system.
Mechanism of Action
Direct acting cholinergic drugs are synthetic
derivative of choline.
Effects of drug
Decrease heart rate, vasodilation, and changes in
BP
Increase tone and contractibility of smooth muscle
Increase tone and contractibility of bronchial
smooth muscles
Increased respiratory secretions
Indications for Use
Urinary retention without obstruction
Postoperative abdominal distention due to
paralytic ileus
Myasthenia gravis – muscle weakness
During surgery to reverse the effects of
muscle relaxants used during surgery
Nursing Assessment: urine retention
Urinary retention
Bladder distention
Fluid intake
Time of last void
How do you know drug is working?
Fluid intake equal to urine output
Patient has voided within the last 8 hours
Nursing Assessment: paralytic ileus
Paralytic ileus
Hypo-peristalsis
Decreased bowel sounds
No gas or bowel movement
How do you know drug is working?
Bowel sounds heart in all four quadrants
Client states has passes gas
Client states has had a bowel movement
Nursing Assessment: Myasthenia Gravis
Signs and symptoms: muscle weakness,
ptosis (droopy eye lid), diplopia (double
vision), difficulty chewing and swallowing,
decreased activity intolerance.
How do you know medication is working?
Increased muscle tone, no droopy eye lid or
double vision, increased activity tolerance.
Nursing Assessment: Alzheimer
Signs and symptoms: loss of memory,
cognitive function and decreased self-care
Signs medication is working: increase
memory and cognitive function and increase
interest in activities of daily living
Use in Older Adults
May be used in myasthenia gravis or
Alzheimer’s disease
Contraindications
Renal obstruction
Liver disease
Anticholinergic Drugs
Chapter 20
Clinical Drug Therapy
Anticholinergic Drugs
Anticholinergics are a class of medications
that inhibit parasympathetic nerve impulses
by selectively blocking the binding of the
neurotransmitter acetylcholine to its receptor
in nerve cells.
Mechanism of Action
Drugs act by occupying receptor sites on
target organs innervated by parasympathetic
nervous system leaving fewer receptor sites
free to respond to acetylcholine.
Parasympathetic response is absent or
decreased depending on number of receptors
blocked.
Effects of Anticholinergic Drugs
CNS stimulation followed by depression
Decreased cardiovascular response to
parasympathetic (vagal) stimulation that
slows heart rate
Bronchodilation and decrease respiratory
secretions
Antispasmodic effects in GI system
Change in intra-ocular pressure in patients
with glaucoma
Uses
GI disorders – peptic ulcer disease, gastritis,
increased gastric acid secretion – relax gastric
smooth muscle (replaced by newer drugs)
Genitourinary – anti-spasmodic – urgency
Excessive secretions
Ophthalmology – relax eye for exam
Respiratory disorder – asthma or bronchitis –
inhaled form only
Cardiac disorders – bradycardia or heart block
Parkinson’s disease
Side Effects
Hyperthermia, hot, dry flushed skin, dry
mouth, tachycardia, delirium, paralytic ileus
and urinary retention
Atropine
Pharmacological classification:
anticholinergic
Therapeutic classification: antiarrhythmic
Action: Inhibits the action of acetylcholine at
postganglionic sites located in the smooth
muscle, secretory glands, CNS. Low doses
decrease: sweating, salivation and
respiratory secretions.
Atropine
Therapeutic effects:
Increased heart rate
Decreased GI and respiratory secretions
Reversal of muscarinic effects
May have spasmodic action on the biliary and
genitourinary tracts.
Atropine
Side effects: drowsiness, blurred vision,
tachycardia, dry mouth, urinary hesitancy.
Atropine
Prototype of anticholineric drugs – atropine
sulfate
Therapeutic
Previously used in preoperative patients to
reduce secretions – other newer drugs have
replaced