Autonomic Nervous System Drugs PDF

Autonomic Nervous System Drugs Adrenergic Agonists and Antagonists Autonomic vs Somatic 1. What acts on smooth muscles and glands? 2. What controls and regulates the heart, respiratory system, gastrointestinal tract, bladder, eyes, and glands? 3. What is involuntary? 4. What acts on...

Autonomic Nervous System Drugs Adrenergic Agonists and Antagonists Autonomic vs Somatic 1. What acts on smooth muscles and glands? 2. What controls and regulates the heart, respiratory system, gastrointestinal tract, bladder, eyes, and glands? 3. What is involuntary? 4. What acts on skeletal muscles? Afferent vs Efferent 1. What is “sensory”? 2. What brings signals to the CNS? Sympathetic and Parasympathetic The 2 branches (SNS and PNS) act on the same organs with opposite responses. T or F 1. SNS or A a. Neurotransmitter: Norepinephrine b. Receptors: Alpha 1, Alpha 2, Beta 1, and Beta 2 c. Inactivation: Monoamine oxidase (MAO) and Catecholamine O-methyltransferase (COMT) 2. PNS or C a. Neurotransmitter: acetylcholine b. Receptors: Muscarinic and Nicotinic c. Inactivation: acetylcholinesterase Effects Body Tissue/ Organ Sympathetic Parasympathetic Pupils Bronchioles Heart Rate Blood Vessels Gastrointestinal Bladder Uterus Salivary Gland Classification of Medications and its Effects Sympathetic Parasympathetic Sympatholytic Parasympathomimetic Cholinergic Adrenergic Adrenergic Antagonist Cholinergic Agonist Adrenergic blockers Receptors Alpha 1 HBBEP Alpha 2 BS Beta 1 HK Beta 2 LLUnGS Dopamine B Adrenergic Agonists Medication Action Epinephrine Effect: Blood pressure A1, B1, B2 Pupil Heart rate Bronchioles Renal Tissue Perfusion (¯) Route: SQ/IM: 0.3 mg EpiPen auto-injector, may repeat in 5–20 min; max: 2 doses IV: Cardiac Arrest: 1 mg every 3 to 5 minutes, followed by flushing EpiPen: inject SQ, not ID, with pressure, hold the device for 5-10 seconds, outer thigh, massage for 10 seconds I: cardiac arrest, anaphylaxis SE: hypertension, tachycardia, palpitations, tremors, urinary retention Norepinephrine I: hypotension and shock A1, B1 Phenylephrine Nasal decongestant A1 Pseudoephedrine not a potent vasoconstrictor A1, A2, B1 I: nasal and sinus congestion without rebound congestion Albuterol Effect: Bronchioles B2l Onset of Action: 5 – 15 mins. SE: tremors, restlessness, and nervousness DDI: MAOI, Beta-blockers  Dobutamine Receptor B1 I: heart failure, cardiogenic shock Terbutaline I: asthma, COPD, tocolytic B2 CI: Glaucoma Antidote: phentolamine mesylate Centrally Acting Alpha Agonists Clonidine and Methyldopa MOA: decrease the release of NE A: vasodilation Adrenergic Antagonists (Adrenergic Blockers) Doxazosin, Prazosin A: Promote Vasodilation A: BP ( ) HR ( ) I: Raynaud’s disease Benign prostatic hyperplasia (BPH) Beta-adrenergic antagonists (Beta Blockers) BP ( ) HR ( ) Selective beta-blockers Non-selective beta-blockers COPD I: hypertension, angina, heart failure, myocardial infarction T: taper for 1-2 weeks SE: dysrhythmia, hypotension, weakness, erectile dysfunction, depression, and pulmonary edema B1 B2 ISA Propranolol x x Atenolol x Metoprolol x Carvedilol x x ✓ Acebutolol x ✓ Atenolol x Timolol x x Esmolol x Intrinsic sympathomimetic activity (ISA) - the ability of certain beta-blockers to bind with a beta-receptor to prevent strong agonists from binding to that receptor, producing complete activation I: for hypertension with bradycardia Cholinergic Agonists and Antagonists Cholinergic Agonists - mimic PNS Direct-acting - selective to muscarinic Indirect-acting - inhibit AChE Cholinergic Antagonist - inhibits Ach Cholinergic Agonists, Direct-Acting Bethanechol chloride I: Urinary retention SE: diarrhea, abdominal cramps, salivation, orthostatic hypotension, bradycardia Metoclopramide hydrochloride (HCl) IM/IV I: GERD, gastroparesis, and nausea/vomiting  Pilocarpine Route: Ophthalmic (topical) I: To reduce IOP, miosis Cholinergic Agonists, Indirect-acting Neostigmine and Pyridostigmine bromide Route: PO, IM/IV I: myasthenia gravis, postoperative urinary retention Edrophonium chloride Route: IM/IV I: diagnose myasthenia gravis The primary use of reversible cholinesterase inhibitors is to treat myasthenia gravis; another use is to treat Alzheimer disease. The primary clinical indication for irreversible cholinesterase inhibitors is glaucoma. Irreversible cholinesterase inhibitors are potent agents because of their long-lasting effect. These drugs are used to produce pupillary constriction. Cholinergic Agonists, Caution and Contraindications intestinal or urinary tract obstruction severe bradycardia active asthma Nursing Points Monitor UO (> 1500 mL/day) Give 1 hour ac or 2 hours pc Monitor cholinergic crisis: muscular weakness, increased salivation, nausea, cramps Antidote: Atropine (0.6 mg to 1.2 mg) Orthostatic hypotension precautions Oral hygiene Cholinergic Antagonists Atropine sulfate I: Preop Bradycardia Ocular Diagnostics Scopolamine - pre-anesthetic drugs, IBS, motion sickness, and delirium. Benztropine mesylate (Cogentin) - blocks dopamine reuptake, for parkinsons Anticholinergics affect the central nervous system (CNS) as well as the parasympathetic nervous system, suppressing the tremors and muscular rigidity of parkinsonism, but they have little effect on mobility and muscle weakness. Cholinergic Antagonists, Contraindications narrow-angle glaucoma obstructive GI disorders paralytic ileus ulcerative colitis benign prostatic hypertrophy myasthenia gravis