1. Drugs for Autonomic Nervous System
J. Arzaga, MSN, RN

2. Two Major Divisions of the Nervous System
Central Nervous System (CNS)
Brain and spinal cord
Peripheral Nervous System
All nervous tissue outside the CNS, including sensory and motor neurons
J. Arzaga, MSN, RN

3. Basic Functions of the Nervous System
Recognizing change
Processing and integrating environmental change
Reacting to environmental change
J. Arzaga, MSN, RN

4. J. Arzaga, MSN, RN

5. J. Arzaga, MSN, RN

6. Autonomic Drugs Autonomic Nervous System –little disease
Used to stimulate or inhibit target organs such as heart and lungs
J. Arzaga, MSN, RN

7. Classification and Naming of Autonomic Drugs
Adrenergic agents or sympathomimetics
Stimulate sympathetic nervous system
Adrenergic-blocking agents, adrenergic antagonists
Inhibit sympathetic nervous system
J. Arzaga, MSN, RN

8. Classification and Naming of Autonomic Drugs (cont'd)
Cholinergic agents or parasympathomimetics
Stimulate parasympathetic nervous system
Cholinergic-blocking agents, anticholinergics
Inhibit parasympathetic nervous system
J. Arzaga, MSN, RN

9. Figure 13.3 Basic structure of the autonomic pathway

10. J. Arzaga, MSN, RN

11. J. Arzaga, MSN, RN

12. Prototype Drugs Phenylephrine (Neo-Synephrine)
Adrenergic Agents (Sympathomimetics)
Mechanism of action: to stimulate the sympathetic nervous system
Primary use:
Nasal congestion (intranasal)
Opthalmic (topical)
Acute Hypotension (IV)*
Adverse effects:
Increased BP
J. Arzaga, MSN, RN

13. Prototype Drugs Atropine (Atro-pen, Atropair, Atropisol)
Cholinergic-Blocking Agents
Mechanism of action: to inhibit the parasympathetic nervous system, induce fight-or flight response
Primary use:
Dilate pupils
Suppress secretions
Bradycardia
Adverse effects: increased HR,urinary retention, dry mouth, dry eyes, decreased sweating
J. Arzaga, MSN, RN

14. Role of Nurse Monitor vital signs Monitor breathing patterns
Monitor patient for abdominal distension, and auscultate for bowel sounds
Monitor intake and output
Provide comfort measures for dry mouth
END.
J. Arzaga, MSN, RN

15. Two Types of Adrenergic Receptors
Alpha-receptors and Beta-receptors
Hugely important to pharmacology
Drugs are selective and activate only one type of adrenergic receptor, whereas others affect all receptor subtypes
J. Arzaga, MSN, RN

16. Adrenergic Receptors In all sympathetic target organs except heart
Alpha1-adrenergic Receptors
Alpha2-adrenergic Receptors
In all sympathetic target organs except heart
Response
Constriction of blood vessels
Dilation of pupils
At presynaptic adrenergic neuron terminals
Activation inhibits release of norepinephrine
J. Arzaga, MSN, RN

17. Adrenergic Receptors In heart and kidneys Response
Beta1-adrenergic Receptors
Beta2-adrenergic Receptors
In heart and kidneys
Response
Activation increases heart rate and force of contraction of heart.
Increases release of renin
In all sympathetic target organs except the heart
Inhibit smooth muscle
J. Arzaga, MSN, RN

18. Role of Nurse Monitor patient’s condition
Provide education on drug therapy
Note adverse effects of drug therapy
Identify possible interactions
Identify contraindications of drug therapy
Look at Nursing Process Focus pg. 134
J. Arzaga, MSN, RN

19. Role of Nurse Monitor for adverse effects Monitor liver enzymes
Adrenergic Blocker
Parasympathomimetics
Monitor urinary hesitancy, incomplete bladder emptying, interrupted urinary stream
Monitor vital signs, level of consciousness, and mood
Monitor for dizziness, drowsiness, or light- headedness
Observe for side effects
Monitor cardiac output
Monitor for adverse effects
Monitor liver enzymes
Calculate and monitor doses
Assess and monitor for appropriate self-care administration
J. Arzaga, MSN, RN

20. Role of Nurse Monitor intake and output ratio
Direct Acting
Cholinesterase Inhibitors
Monitor intake and output ratio
Monitor for blurred vision
Monitor for orthostatic hypotension
Monitor muscle strength and neuromuscular status
Monitor ptosis, diplopia, and chewing
Schedule medication around mealtimes
Schedule activities to avoid fatigue
Monitor for muscle weakness
J. Arzaga, MSN, RN

21. Prototype Drugs Prazosin (Minipress)
Adrenergic-Blocking Agents
Mechanism of action: to inhibit the sympathetic nervous system
Primary use: hypertension, dysrhythmias, angina, heart failure, benign prostatic hypertrophy, narrow-angle glaucoma
Adverse effects: dizziness, drowsiness, headache, loss of energy and strength, palpitations, dry mouth
J. Arzaga, MSN, RN

22. Prototype Drugs Bethanechol (Duvoid, Urecholine)
Cholinergic Agents (Parasympathomimetic)
Mechanism of action: to activate the parasympathetic nervous system directly/indirectly, induce rest/digest response
Uses: glaucoma, urinary retention, myasthenia gravis, Alzheimer’s disease
Adverse effects: profuse salivation, sweating increased muscle tone, urinary frequency, bradycardia
J. Arzaga, MSN, RN