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Title: Drugs%20Affecting%20Autonomic%20Nervous%20System%201

Drugs Affecting Autonomic Nervous System 1
Lecture objectives
  • Identify the anatomy of nervous system.
  • Identify the drugs that effect ANS

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Nervous System Divisions
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Nervous System Overview
  • Nervous System
  • Brain
  • Spinal cord
  • Nerves
  • Functions of nervous system
  • Regulates and coordinates all body activities
  • Center of all mental activity, including thought,
    learning, and memory

Nervous System Divisions
  • Central Nervous System (CNS)
  • Brain
  • Spinal Cord
  • Processes and stores sensory and motor
  • Controls consciousness
  • Peripheral Nervous System (PNS)
  • 12 Pairs of Cranial Nerves
  • 31 Pairs of Spinal Nerves
  • Transmits sensory and motor impulses back and
    forth between CNS and rest of body

Peripheral Nervous System
  • Somatic Nervous System (SNS)
  • Provides voluntary control over skeletal muscle
  • Autonomic Nervous System (ANS)
  • Provides involuntary control over smooth muscle,
    cardiac muscle, and glandular activity and
    secretions in response to the commands of the
    central nervous system

Autonomic Nervous System
  • Sympathetic nerves
  • Increase heart rate
  • Constrict blood vessels
  • Raise blood pressure
  • Fight-or-flight response
  • Parasympathetic nerves
  • Slow heart rate
  • Increase peristalsis of intestines
  • Increase glandular secretions
  • Relax sphincters

  • Substances that can produce a sympathomimetic
  • Endogenous
  • Dopamine (Dopaminergic) epinephrine
    norepinephrine (Adrenegeric)
  • 2. Synthetic
  • isoproterenol, dobutamine, phenylephrine

Fight or Flight Response
  • These catecholamine hormones facilitate immediate
    physical reactions These include the following
  • Acceleration of heart and lung action?Inhibition
    of stomach and intestinal action
  • Constriction of blood vessels in many parts of
    the body
  • Dilation of blood vessels for muscles
  • Inhibition of tear glands and salivation
  • Dilation of pupil
  • Relaxation of bladder
  • Inhibition of erection

Dopaminergic Receptors
  • An additional adrenergic receptor
  • Stimulated by dopamine
  • Causes dilation of the following blood vessels,
    resulting in INCREASED blood flow
  • Renal
  • Mesenteric
  • Coronary
  • Cerebral

Adrenergic Agents
  • Drugs that stimulate the sympathetic nervous
    system (SNS)
  • Also known as
  • adrenergic agonists or sympathomimetics
  • Mimic the effects of the SNS neurotransmitters
  • norepinephrine (NE) and epinephrine (EPI)

Adrenergic Receptors
  • Located throughout the body
  • Are receptors for the sympathetic
  • Alpha-adrenergic receptors respond to NE
  • Beta-adrenergic receptors respond to EPI

Types of ?-adrenergic receptor
  • ?-adrenergic receptors are adrenergic receptors
    that respond to norepinephrine and to such
    blocking agents as phenoxybenzamine.
  • They are subdivided into two types
  • ?1, found in smooth muscle, heart, and liver,
    with effects including vasoconstriction,
    intestinal relaxation, uterine contraction and
    pupillary dilation,
  • ?2, found in platelets, vascular smooth muscle,
    nerve termini, and pancreatic islets, with
    effects including platelet aggregation,
    vasoconstriction, and inhibition of
    norepinephrine release and of insulin secretion.

?-receptor types
  • ?-adrenergic receptors respond particularly to
    epinephrine and to such blocking agents as
  • There are three known types of beta receptor,
    designated ß1, ß2 and ß3.
  • ß1-Adrenergic receptors are located mainly in the
  • ß2-Adrenergic receptors are located mainly in the
    lungs, gastrointestinal tract, liver, uterus,
    vascular smooth muscle, and skeletal muscle.
  • ß3-receptors are located in fat cells.

What do the receptors do?Activation of ?
receptors leads to smooth muscle
contractionActivation of ?2 receptors leads to
smooth muscle relaxationActivation of ?1
receptors leads to smooth muscle contraction
(especially in heart)
Clinical Utility of drugs which affect the
adrenergic nervous system a. Agonists of the ?2
receptors are used in the treatment of asthma
(relaxation of the smooth muscles of the
bronchi) b. Antagonists of the ?1 receptors are
used in the treatment of hypertension and angina
(slow heart and reduce force of
contraction) c. Antagonists of the ?1 receptors
are known to cause lowering of the blood pressure
(relaxation of smooth muscle and dilation of the
blood vessels)
Drug Effects of Adrenergic Agents
  • Stimulation of alpha-adrenergic receptors on
    smooth muscles results in
  • Vasoconstriction of blood vessels
  • Relaxation of GI smooth muscles
  • Contraction of the uterus and bladder
  • Male ejaculation
  • Decreased insulin release
  • Contraction of the ciliary muscles of the eye
    (dilated pupils)

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Drug Effects of Adrenergic Agents
  • Stimulation of beta2-adrenergic receptors on the
    airways results in
  • Bronchodilation (relaxation of the bronchi)
  • Uterine relaxation
  • Glycogenolysis in the liver

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Drug Effects of Adrenergic Agents
  • Stimulation of beta1-adrenergic receptors on the
    myocardium, AV node, and SA node results in
  • Increased force of contraction (positive
    inotropic effect)
  • Increased heart rate (positive chronotropic
  • Increased conduction through the AV node
    (positive dromotropic effect) automaticity

Adrenergic Agents Therapeutic Uses
  • Anorexiants adjuncts to diet in the short-term
    management of obesity
  • Examples benzaphetamine phentermine dextroam
    phetamine Dexedrine
  • 2.Bronchodilators treatment of asthma and
  • Agents that stimulate beta2-adrenergic receptors
    of bronchial smooth muscles causing relaxation
  • Examples
  • albuterol ephedrine epinephrineisoetharine
    isoproterenol levalbuterolmetaproterenol salmete
    rol terbutaline

Adrenergic Agents Therapeutic Uses
  • 3. Reduction of intraocular pressure and
    mydriasis (pupil dilation) treatment of
    open-angle glaucoma
  • Examples epinephrine and dipivefrin
  • 4. Nasal decongestant
  • Intranasal (topical) application causes
    constriction of dilated arterioles and reduction
    of nasal blood flow, thus decreasing congestion.
  • Examplesepinephrine ephedrine naphazoline
    phenylephrine tetrahydrozoline

  • 5. Ophthalmic relieving conjunctival congestion.
  • Examples epinephrine naphazoline
    phenylephrine tetrahydrozoline
  • 6. Vasoactive sympathomimetics also called cardio
    selective sympathomimetics
  • Used to support the heart during cardiac failure
    or shock.
  • Examples
  • dobutamine dopamine ephedrine epinephrine fenoldo
    pam isoproterenol methoxamine norepinephrine pheny

Adrenergic Agents Side Effects
  • Alpha-Adrenergic Effects
  • CNS
  • headache, restlessness, excitement, insomnia,
  • Cardiovascular
  • palpitations (dysrhythmias), tachycardia,
    vasoconstriction, hypertension
  • Other
  • anorexia, dry mouth, nausea, vomiting, taste
    changes (rare)

Adrenergic Agents Side Effects
  • Beta-Adrenergic Effects
  • CNS
  • mild tremors, headache, nervousness, dizziness
  • Cardiovascular
  • increased heart rate, palpitations
    (dysrhythmias), fluctuations in BP
  • Other
  • sweating, nausea, vomiting, muscle cramps

Adrenergic Agents Nursing Implications
  • Assess for allergies and history of hypertension,
    cardiac dysrhythmias, or other cardiovascular
  • Assess renal, hepatic, and cardiac function
    before treatment.
  • Perform baseline assessment of vital signs,
    peripheral pulses, skin color, temperature, and
    capillary refill. Include postural blood pressure
    and pulse.
  • Follow administration guidelines carefully.

Adrenergic Agents Nursing Implications
  • With chronic lung disease
  • Instruct patients to avoid factors that
    exacerbate their condition.
  • Encourage fluid intake (up to 3000 mL per day)
    if permitted.
  • Educate about proper dosing and equipment care.

Adrenergic Agents Nursing Implications
  • Overuse of nasal decongestants may cause rebound
    nasal congestion or ulcerations.
  • Monitor for therapeutic effects (cardiovascular
  • Decreased edema
  • Increased urinary output
  • Return to normal vital signs
  • Improved skin color and temperature
  • Increased LOC

Adrenergic Agents Nursing Implications
  • Monitor for therapeutic effects (asthma)
  • Return to normal respiratory rate
  • Improved breath sounds, fewer rales
  • Increased air exchange
  • Decreased cough
  • Less dyspnea
  • Improved blood gases
  • Increased activity tolerance

Adrenergic-Blocking Agents
  • Bind to adrenergic receptors, but inhibit or
    block stimulation of the sympathetic nervous
    system (SNS)
  • Have the opposite effect of adrenergic agents
  • Also known as
  • adrenergic antagonists or sympatholytics

Adrenergic-Blocking Agents Drug Effects and
Therapeutic Uses
  • Alpha-Blockers
  • Cause both arterial and venous dilation, reducing
    peripheral vascular resistance and BP
  • Used to treat hypertension
  • Effect on receptors on prostate gland and bladder
    decreased resistance to urinary outflow, thus
    reducing urinary obstruction and relieving
    effects of BPH

Beta Blockers Mechanism of Action
  • Cardioselective (Beta1)
  • Decreases heart rate
  • Prolongs SA node recovery
  • Slows conduction rate through the AV node
  • Decreases myocardial contractility, thus
    decreasing myocardial oxygen demand

Beta Blockers Therapeutic Uses
  1. Anti-anginadecreases demand for myocardial
  2. Cardioprotectiveinhibits stimulation by
    circulating catecholamines
  3. Class II antidysrhythmic
  4. Antihypertensive
  5. Treatment of migraine headaches
  6. Glaucoma (topical use)

Adrenergic Blocking Agents Nursing Implications
  • Assess for allergies and history of COPD,
    hypotension, cardiac dysrhythmias, bradycardia,
    CHF, or other cardiovascular problems
  • Remember that alpha blockers may precipitate
  • Remember that beta blockers may precipitate
    bradycardia, hypotension, heart block, CHF, and

  • Encourage patients to take medications as
  • These medications should never be stopped
  • Report constipation or the development of any
    urinary or bladder distention.
  • Rebound hypertension or chest pain may occur if
    this medication is discontinued abruptly.
  • Patients should notify their physician if they
    become ill and unable to take medication.
  • Inform patients that they may notice a decrease
    in their tolerance for exercise dizziness and
    fainting may occur with increased activity.
    Notify the physician if these problems occur.

Beta Blocking Agents Nursing Implications
  • Patients should report the following to their
  • Weight gain of more than 2 pounds (1 kg) within
    a week
  • Edema of the feet or ankles
  • Shortness of breath
  • Excessive fatigue or weakness
  • Syncope or dizziness

Monitor for side effects, including
  1. Hypotension
  2. Fatigue
  3. Tachycardia (alpha blockers)
  4. Lethargy
  5. Bradycardia
  6. Depression
  7. Heart block
  8. Insomnia
  9. CHF
  10. nightmares
  11. Increased airway resistance

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