Autonomic Nervous System Sympathetic (Adrenergic) Parasympathetic (Cholinergic) Have a balancing effect

Neurotransmitters Acetycholine (ACH) Norepinephrine (NE) Epinephrine Dopamine

Receptors Alpha 1 & 2 Beta 1 & 2 Muscarinic Nicotinie

Sympathetic Response Increase HR Increase RR Increase metabolic rate Increase fat & glycogen breakdown Pupillary dilation Smooth muscle vasoconstriction Skeletal & cardiac muscle vasodilation Decrease GI activity Bronchial relaxation

Parasympathetic Response Decrease HR Decrease RR Increase digestion & elimination Increase GI tone Bronchial constriction Pupillary constriction

Cholinergic Agonist (Direct Acting) Stimulates cholinergic receptors bethanechol chloride (Duvoid, Urecholine) * decreases urinary retention *antidote is atropine pilocarpine (Pilocar) * increases outflow aqueous humor (open angle glaucoma) * pupillary constriction (miosis) & decrease visual acuity *headache

Nicotine Stimulates nicotine receptors Used for cessation of tobacco smoking Cannot smoke when using patch

Antichoinesterase (Indirect-acting Cholinergic Agonists Inhibits enzyme acetlycholinesterase Results in decrease destruction of ACH Which results in increase cholinergic action Neostigmine (prostigmin)

Cholinergic Blockers (anticholergic) Interrupts parasympathetic nerve impulses Relaxes GI & urinary tract muscles & decrease GI secretions Counteracts bronchospasm & decrease respiratory secretions Decrease salivation Blocks cardiac vagal inhibitions

Atropine (cholinergic antagonist) Blocks actions of ACH at muscarinic receptors blocks vagal effects of SA node (tx bradycardia) preoperative - decrease salivation & respiratory tract secretions bronchodilator watch for tachycardia, urinary retention, constipation, dry mouth

Scopolamine Produces CNS depression with sedative & tranquilizing effects Used to tx motion sickness

Anticholinergic Overdose “mad as a hatter (CNS psychotic effect), dry as a bone (salivary), red as a bat (peripheral vasodilation), & blind as a bat (mydriasis)

Adrenergic Receptors Alpha-1 & alpha-2 are differentiated by location on nerve, alpha -1 causes vasoconstriction Beta - 1 primarily located in heart, causes cardiac stimulation Beta - 2 located in smooth muscle of bronchioles, arterioles and visceral organs, relaxation of bronchial & GI Side effects - alpha & beta may have headache, insomnia, restlessness, tachycardia, hypertension, N&V

Summary with receptors Alpha - 1 = vasoconstriction beta - 1 = cardiac stimulation beta - 2 = bronchiole dilation

Alpha-1 Adrenergic Agonist Phenylephrine: most common use is as decongestant, treat nasal congestion Side effects: sleep disturbances, headache

Epinephrine (nonselective) (Adrenergic Agonist) Increases heart rate & CO Increase in blood sugar Bronchiole dilation Indicated for anaphylaxis, cardiac arrest, asthma

Beta Adrenergic Agonist Isoproterenal (Isuprel) Increase contractility & heart rate Bronchodilator Indicated in asthma, bradycardia, cardiac arrest Dopamine (Intropin) Dobutamine (Dobutrex) Proventil & Brethine, respiratory, bronchodilators

Alpha Adrenergic Antagonist Disrupts sympathetic response Relaxation of vascular smooth muscle, peripheral vasodilation & decrease BP prazosin (Minipress) Used for hypertension, angina, peripheral vascular disorders Watch for orthostatic hypotension

Beta Adrenergic Blockers (antagonist) Prevents SNS stimulation decrease peripheral vascular resistance, decrease BP, decrease CO, decrease HR Used to tx hypertension, angina, arrhythmias

Beta Blockers Need to know whether cardioselective or nonselective Beta - 1 blockers will decrease myocardial contractility& HR, Lopressor (metoprolol) & Tenormin (atenolol) Nonselective - blocks beta - 1 and beta -2 which causes above & bronchiole constriction

Propranolol (Inderal) Nonselective Beta Blocker Important to ask if history of asthma, bronchitis, etc. Decrease HR so must check rate prior to giving client may experience decrease libido or impotence watch for orthostatic hypotension

Combined blocker Carvedilol (Coreg) Combined alpha and beta blocker Frequently administered with other antihypertensive agents. Watch for orthostatic hypotension & bradycardia