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

2. Neurotransmitters Acetycholine (ACH) Norepinephrine (NE) Epinephrine
Dopamine

3. Receptors
Alpha 1 & 2
Beta 1 & 2
Muscarinic
Nicotinie

4. 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

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

6. 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

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

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

9. 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

10. 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

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

12. 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)

13. 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

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

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

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

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

18. 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

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

20. 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

21. 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

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