NERVOUS SYSTEM PDF - General Biology

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/ /  / / 8D catechie go Autonomic Nervous eptinefhi.tn NE Nov Adrener pevogtf.sk Cholinergic recepta Retrotransmid cat and EEE Adrenergic fight and The functional unit gs sFageeEransmEight of nervous system is neuron has different types acc to functions and branches messengers hrough impulses 2 which move from fsite of_stimulation brain and spinal cord signally interpretted Figure 04-03: Cells of the nervous system. i ni ito.ca f ea3os stime a rest  Tante / / doing activati open kt out 3 Nat in difference in contraction Potential t 5 ws In 1 charge skeletal or smooth muscle Define pharmacology Key terms. Outline the underlying structures and functions of Autonomic nervous system (ANS). Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug–drug interactions associated with drugs acting on ANS. Compare and contrast the prototype drugs with other agents in their class and with other classes of drugs that act on ANS. Outline the nursing considerations, including important teaching points, for patients receiving drugs acting on ANS. A  / / Acetylcholinesterase Muscarinic Receptors Adrenergic receptors Nicotinic Receptors Alpha-receptors Parasympathomimetic Belladonna Parasympathetic Nervous System (PNS) Beta-receptors Parasympathomimetic Cholinergic receptors Pheochromocytoma Glycogenolysis Sympathomimetic Drug Mydriasis Sympathetic Nervous System Monoamine Oxidase (MAO) (SNS) Miosis Sympatholytic Sol I stion's s activity – Involuntary or visceral nervous mainly – Hypothalamus system – Medulla – Spinal Cord No – Mostly with little conscious Or awareness of its activity – Regulate and integrate the – Blood Pressure f body’s internal functions In – Heart Rate 5– Integrate parts of the CNS and – – Respiration Body Temperature PNS to react to changes in the – Water Balance perifer internal and external – Urinary Excretion environment – Digestive Functions  / / sffl.int Preganghstimkt – The ANS is divided into two branches: Sympathetic Parasympathetic opposite function Eige– These branches differ in three basic ways: gangli (1) The location of the originating cells in the CNS s (2) The location of the nerve ganglia (3) The preganglionic and postganglionic neurons HR post – P Blood pressure and heart rate increase gang – Respiratory efficiency also increases we need more oxygen – as and respiratory rate increases Bronchi are dilated – – E Pupils dilate Piloerection Fuses Cadriasis t – Blood to be diverted from GI tract – Blood also diverted away from internal organs 7 Egg jT O EE or sroidnormone oPÑ sympathetic figfugged release mg Energy so B I 2 I o pives 15 g 2 1T apes BENE Rt  / / α activation X1 v c Ñ Aa BP constrictionit poof – Epinephrine and – Blood Vessels wall 1st may Norepinephrine synthesis and Cause vasoconstriction and increase peripheral Iiiiii storage resistance, raising blood pressure – Epinephrine and – Iris pupil muscle Cause pupil dilation Eyoria Norepinephrine release – Adrenergic receptors gp– Urinary Bladder wall s Cause the increased closure of the internal Alpha1 α sphincter Kiwi Alpha2 2 É Beta1 B woid's – Nerve Membranes Act as modulators of norepinephrine release Beta2 Be – Beta Cells in the Pancreas Beta3 Help to moderate the insulin release stimulated – Termination of response Eacy by SNS activation 5 – Periphery stimulation Increased muscle and liver – Cardiac Tissue breakdown of glycogen and HR increased release of glucagon I Can stimulate increased myocardial activity and increased – Uterine Muscle glucose 6 1 Results in relaxed uterine smooth iT 0 heart rate Responsible for increased 1 muscle TJ lipolysis or breakdown of fat for gP8 energy in peripheral tissues – Their role in gallbladder physiology is Funknown, but they are thought to play a role in lipolysis and thermogenesis in – Smooth Muscle in Blood Vessels 43 brown fat. Stimulation leads to – In the urinary bladder it is thought to vasodilatation – Bronchi mm I cause relaxation of the bladder and prevention of urination. Can cause dilation Periferal resistance B payat Bharat BP  / / – Increased motility list in the GI tract S1 and secretions – t.tw Decreased heart rate and contractility to– – Constriction of the bronchi with increased secretion content Relaxation of the GI and wisesphincters s urinary bladder g content – Pupillary constriction Relaxant of sphincter cholin 8 rotransmitter urinate new p patgle chained chainers Ys – Cholinergic nerves: All preganglionic nerves in the ANS, both sympathetic and parasympathetic Related 6 Postganglionic nerves of PSNS and a few SNS nerves 3.5 a muscles Motor nerves on skeletal Cholinergic nerves within the CNS g f Ostia SNS pens pyp.ly – ACh synthesis, release and storage constrict miosis chdi K I – Muscarinic Receptors 1 11 Receptors that are stimulated by muscarine (plant alkaloid from mushrooms) Found in visceral effector organs, sweat glands, some vascular smooth muscle miosis – Stimulation causes pupil constriction, increased GI motility, increase salivation, agile o bladder constriction, decreased heart rate increased urinary – Nicotinic Receptors w̅ Located in the CNS, adrenal medulla, the autonomic ganglia, and the neuromuscular junction We w̅ Stimulation causes muscle contraction, autonomic response, release of norepinephrine and epinephrine from the adrenal medulla stirred activatia of SNS integrated 05 859M  / / post 8 receptor SS't α 2k E chip 1 sympatheli 9 I v For stood so – Called sympathomimetic drugs because they mimic the effects of surgery the sympathetic nervous system (SNS) Eemma an.PE – Related to their stimulation of mÉ adrenergic receptor sites 1132508 I α I β – Varies from ophthalmic preparations for dilating pupils to i B.EE gers systemic preparations for shock S I 5 selective death  / / imaging I a PEE p of acates α s 1 1 overooslagonistm.ae exposeta C x B Congestive heart failure selective Non Shock adecoffjt.se Seasonal rhinitis; hypotensive episodes combinati Shock; 6W Lidocaine glaucoma; prolongs effects of regional anesthetic bronchial asthma THIS Treat shock or during cardiac bleeding arrest to get sympathetic activity Inotropic effect contraction heart of muscle  / / goser Bleeding α β – Increased effects of tricyclic agonist antidepressants Is 91 (TCAs) and monoamine oxidase inhibitors (MAOIs) can occur because of the increased norepinephrine levels or increased receptor Ione 9 EFF stimulation that occurs with both drugs. 1 – There is an increased risk of hypertension if alpha and beta-adrenergic agonists are given with any other drugs that cause hypertension, including herbal therapies and OTC preparations. – Any adrenergic agonist will lose effectiveness short config if combined with any adrenergic antagonist. – Monitor the patient’s drug regimen for Cns appropriate use of the drugs. I Yapital Dose sensitive drug effect II Dose is action  / / 20m90 – Patients being treated with any adrenergic agonists who are also taking ma huang,x x guarana, or o caffeine are at increased risk for overstimulation, including m increased blood pressure, stroke, Herbes and death. antain – Counsel patients to avoid these combinations. 9128 8 action differ Dose strength differ 15 C Arenal bloodfi a Ex Has got 5.8 5 Piggi Large dose in 1T I gone t gases agg x x x XXX x  / / jestanteffefiont co specific.iq 7 a – Drugs that bind primarily to I alpha-receptors rather than to beta-receptors c Is – Phenylephrine (Neo- Synephrine, and others) – Midodrine (generic) – Clonidine (Catapres) 70ᵗʰ I Don't ord b I b – Effect is related to its stimulation of the beta-adrenergic receptors – Increase heart AH.R snotrieff eÉsi oh rate, conductivity, and contractility, bronchodilation, increase blood flow to skeletal muscles and splanchnic bed, and relaxation of uterus i 88 – Rapidly distributed after injectionae i – Metabolized in the liver and excreted in the urine – T ½ less than 1 hour 5g i B 52 Eai s – Known allergy 9590 g – Pulmonary hypertension B.PK És – Eclampsia, uterine hemorrhage, and intrauterine death – Pregnancy and lactation glucose Category D aBlood – Diabetes, thyroid disease – Vasomotor problems – Heart disease and stroke gg s ending Shave 3 / / antagonist 4 antagonist BP we we – Called sympatholytic drugs because they lyse, or block, the effects of the SNS B2 ant – Related to their ability to react with specific bronchospasm adrenergic receptor sites without activating them x es – Prevent norepinephrine from activating the receptor Neurotransmitter II – Amiodarone (Cordarone): Serious emergencies and only used as an antiarrhythmic – Carvedilol (Coreg): Hypertension, congestive heart failure (adult) – Labetalol (Trandate): Hypertension, pheochromocytoma, clonidine withdrawal L 18 Apr viii wife c category sgsju.s D.TT ING I g go.E.EE  / / Bron a It c LOL family T block the effects of – Competitively 4 norepinephrine at the alpha and beta receptors throughout the SNS – Prevents the signs and symptoms associated with sympathetic stress reaction _Edge and results in lower blood pressure, slower pulse, and increased renal perfusion with Fd decreased renin levels s inf G a c – Essential hypertension T9 flow 61st affect use 3 hypot – Enflurane, halothane or isoflurane anesthetics S s – Diabetic agents E easiest – Calcium channel blockers I arsager acts 18 ye.p.ms Another blocker 1122 DIE wait T my skin H.R B P 00 s.w www  / / Benign BPH HTN, BPH hyper Benign prostatic HTN, alone WB P or in combination with other drugs HR HTN, BPH HDL BPH – Vasodilators or antihypertensive drugs 2 1 1 x is.net we i Open angle glaucoma c Open angle glaucoma fig Hypertension, Easement angina Hypertension Hypertension, kidneyBi B2 angina, migraines Ventricular arrythimias Hypertension – Clonidine – NSAIDs – Insulin or anti-diabetic medications  / / d Bi 0 – Do not usually block beta2-receptor sites, including the sympathetic bronchodilation me Preferred for patients who smoke or have 5.1 asthma, obstructive pulmonary disease, or seasonal or allergic rhinitis ant – Hypertension, angina, some cardiac Ñ arrhythmias – Allergy, sinus bradycardia, heart block, cardiogenic shock, CHF, and hypotension COPD, diabetes, thyroid disease A M Drug no (ACh) q – Chemicals that act at the same site as the neurotransmitter acetylcholine – Often called parasympathomimetic __ drugs because their action mimics the action e of the parasympathetic nervous system – Not limited to a specific site; therefore associated with many undesirable systemic effects G g – Direct-Acting Cholinergic Agonists Occupy receptor sites for ACh on the membranes of the effector cells of the postganglionic cholinergic nerves Cause increased stimulation of the cholinergic receptor IT – Indirect-Acting Cholinergic Agonists React with the enzyme acetylcholinesterase and prevent it from breaking down the ACh that was released from the nerve I_ Cause increased stimulation of the ACh receptor sites Prganglionic neurons 9 a neuron agent Ach Mt eins pas 50519 fro and y  / / sietiques skeleta Categor C I am urinate pregando lung L I  / / T.at EJw – Any condition that would be exacerbated by parasympathetic effects—bradycardia, hypotension – Known allergy, peptic ulcer disease – Intestinal obstruction or recent GI surgery – Asthma – Bladder obstruction – Epilepsy and parkinsonism – Pregnancy and lactation I – Acetylcholinesterase iWiohsbs'em ehwiy 1 Antibodies C.AC h IW Lwo AchwiF 5kHibsidiopjathyy.M in neuromuscular transmission c – Autoimmune disease; patients make antibodies to ACh receptors, causing I – Chronic muscular disease caused by a defect a l gradual destruction of them r la – Progressive weakness and lack of muscle control with periodic acute episodes I – Neostigmine (Bioxiverz): Has a strong influence at the neuromuscular junction – Pyridostigmine (Mestinon): Has a longer duration of action than neostigmine Ly – Edrophonium (Enlon): Diagnostic agent for myasthenia gravis É Acht  / / block – Used to block the effects of acetylcholine – Lyse, or block effects of the PNS; also called parasympatholytic agents – Decrease GI activity and secretions (treat ulcers) – Decrease parasympathetic activities to allow the sympathetic system to become more dominant III – – Derived from the plant Belladonna Block only the muscarinic effectors in the PNS and cholinergic receptors in the SNS Ach – Act by competing with acetylcholine for the muscarinic acetylcholine receptor sites – Do not block the nicotinic receptors Have little or no effect at the neuromuscular junction – – Increase in heart rate Decrease in GI activity vasovagal attack bradycardia – – Decrease in urinary bladder tone and function Pupil dilation peptic sintinence – Cycloplegia (It is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation.) Topical stag Etona 10 Let Eso D Etsagore  / / – Aclidinium (Tudorza, Pressair) – Atropine (generic) – Darifenacin (Enablex) – Dicyclomine (generic) – Fesoterodine (Toviaz) – Flavoxate (generic) – Glycopyrrolate (Robinul) – Hycosamine (Symax, et al.) – Meclizine (Bonine) – Methscopolamine (Pamine) – Oxybutynin chloride (Ditropan XL, Gelnique, Oxytrol) – Popantheline (generic) – Scopolamine (Transderm Scop) – Solifenacin (VESIcare) – Tiotropium (Spiriva) – Tolterodine (Detrol) – Trospium (Sanctura) – Umeclidinium (Incruse Ellipta) or EEE.EC mmQ E eE – History and Physical Exam s – Known allergy, glaucoma; stenosing peptic WIFE ulcer, intestinal atony, paralytic ileus, GI obstruction, severe ulcerative colitis, and toxic megacolon; – Prostatic hypertrophy and bladder obstruction; Ias cardiac arrhythmias, tachycardia, and myocardial ischemia – Myasthenia gravis, pregnancy, impaired renal and hepatic function – Neurological status, including level of orientation, affect, reflexes, and papillary response – VS, CV status, ECG as appropriate – Bowel and bladder patterns – Renal function labs as appropriate g  / /  Karch, A., M., (2020): Focus on nursing pharmacology, 8th Edition, Lippincott Williams & Wilkins, ISBN: 978-1-9751-0096-4, Chapter 29- 33: 1542- 1748.