1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 13 Autonomic Nervous System Drugs

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Introduction Autonomic nervous system (ANS) –Governs involuntary actions –Sympathetic –Parasympathetic –Neurotransmitters

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Introduction Drugs that affect ANS –Adrenergics (sympathomimetics) –Adrenergic blockers (alpha and beta blockers) –Cholinergics (parasympathomimetics) –Cholinergic blockers (anticholinergics)

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Adrenergics Sympathetic nervous system (SNS) –Fright, fight, and flight –Neurotransmitters – catecholamines Epinephrine (adrenaline) Norepinephrine Dopamine

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Adrenergics Mimics actions of SNS –Cardiac stimulation –Increased blood flow to skeletal muscles –Peripheral vasoconstriction –Bronchodilation –Dilation of pupils Mydriatic actions

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Adrenergics Uses: –Restoring rhythm in cardiac arrest –Elevating blood pressure in shock –Constricting capillaries –Dilating bronchioles in acute asthmatic attacks, bronchospasm, or anaphylactic reaction –Performing ophthalmic procedures

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Adrenergics Side effects Contraindications or extreme caution Cautions Interactions

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Adrenergic Blockers Block action of SNS Alpha-adrenergic blockers Beta-blockers –Propranolol (Inderal)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Adrenergic Blockers Uses of beta-blockers: –Hypertension –Cardiac arrhythmias –Angina pectoris –Migraine headache

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Adrenergic Blockers Side effects Contraindications or extreme caution Interactions Patient education

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergics Parasympathetic nervous system Acetylcholine Mimic action of parasympathetic nervous system –Bethanechol –Neostigmine –Pilocarpine

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergics Actions: –Increased GI peristalsis –Increased contraction of urinary bladder –Increased secretions E.g., sweat, saliva, gastric juices –Increased skeletal muscle strength

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergics Actions: –Lowered intraocular pressure –Constriction of pupils –Slowing of heart

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergics Uses: –Non-obstructive urinary retention –Non-obstructive abdominal distention –Myasthenia gravis –Open-angle glaucoma

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergics Side effects Contraindications or extreme caution Interactions Patient education

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergic Blockers Anticholinergics Block action of parasympathetic nervous system –Atropine Also known as parasympatholytic

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergic Blockers Actions: –Drying All secretions decreased –Decreased GI and genitourinary (GU) motility –Dilation of pupils

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergic Blockers Uses: –Antispasmodic and antisecretory for GI or GU hypermotility –Preoperative and preanesthetic application –Neuromuscular block and other spastic disorders –Antidote for insecticide poisoning, cholinergic crisis, or mushroom poisoning

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergic Blockers Uses: –Emergency treatment of bradycardia and atrioventricular heart block with hypotension –Dilation of pupils Mydriatic –Prevention and treatment of bronchospasm

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cholinergic Blockers Side effects Contraindications or extreme caution Patient education