1. Slide 1 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 13 Drugs Affecting the Autonomic Nervous System

2. Slide 2 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 13 Lesson 13.1

3. Slide 3 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives Differentiate between afferent and efferent nerve conduction within the central nervous system Explain the role of neurotransmitters at synaptic junctions Name the most common neurotransmitters known to affect central nervous system function

4. Slide 4 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives (cont’d) Identify the two major neurotransmitters of the autonomic nervous system Cite the names of nerve endings that liberate acetylcholine and those that liberate norepinephrine Explain the action of drugs that inhibit the actions of the cholinergic and adrenergic fibers

5. Slide 5 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives (cont’d) List the neurotransmitters responsible for cholinergic activity Identify two broad classes of drugs used to stimulate the adrenergic nervous system Name the neurotransmitters that are called catecholamines Review the actions of adrenergic agents to identify conditions that would be affected favorably and unfavorably by these medications

6. Slide 6 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Central and Autonomic Nervous Systems Central nervous system (CNS)  Made up of brain and spinal cord  Receives signals from sensory receptors (vision, pressure, pain, cold, warmth, touch, smell)

7. Slide 7 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Central and Autonomic Nervous Systems (cont’d) Peripheral nervous system  Afferent nerves—transmit signals to the spinal cord and brain  Efferent nerves—carry impulses from CNS to other parts of body. Divided into two parts: Motor nervous system—controls skeletal muscle contractions Autonomic nervous system—regulates certain body functions

8. Slide 8 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Central and Autonomic Nervous Systems (cont’d) Neurons—segments that make up each nerve of the central and peripheral nervous systems Synapse—junction between one neuron and the next Neurotransmitters—chemical substances that cause transmission of nerve signals or impulses

9. Slide 9 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Central and Autonomic Nervous Systems (cont’d) Common neurotransmitters affecting CNS  Acetylcholine  Norepinephrine  Epinephrine  Dopamine  Glycine  Gamma-aminobutyric acid (GABA)  Glutamic acid

10. Slide 10 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Autonomic Nervous System Controls most tissue function Maintains a constant internal environment (homeostasis) and responds to emergency situations Made up of two major neurotransmitters  Norepinephrine—liberated by adrenergic fibers  Acetylcholine—liberated by cholinergic fibers

11. Slide 11 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Autonomic Nervous System (cont’d) Cholinergic drugs cause effects in the body similar to those produced by acetylcholine Adrenergic drugs cause effects similar to those produced by the adrenergic neurotransmitter Anticholinergic agents block or inhibit cholinergic activity Adrenergic blocking agents inhibit the adrenergic system

12. Slide 12 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Adrenergic Agents Two broad classes of drugs  Catecholamines—three occur naturally in the body and can be synthetically manufactured Norepinephrine Epinephrine Dopamine  Noncatecholamines—act in a similar way but more selective for certain types of receptors

13. Slide 13 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Adrenergic Agents (cont’d) Side effects usually dose related and resolved when reduced or discontinued  Side effects to expect—palpitations, tachycardia, skin flushing, dizziness, tremors, orthostatic hypotension  Side effects to report—dysrhythmias, chest pain, severe hypotension, hypertension, anginal pain, nausea, vomiting

14. Slide 14 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic Agents

15. Slide 15 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 13 Lesson 13.2

16. Slide 16 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives Explain the rationale for use of adrenergic blocking agents for conditions that have vasoconstriction as part of the disease pathophysiology Describe the benefits of using beta- adrenergic–blocking agents for hypertension, angina pectoris, cardiac dysrhythmias, and hyperthyroidism

17. Slide 17 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives (cont’d) Identify disease conditions that preclude the use of beta-adrenergic–blocking agents List the predictable side effects of cholinergic agents Describe the clinical uses of anticholinergic agents List the predictable side effects of anticholinergic agents

18. Slide 18 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Alpha- and Beta- Adrenergic–Blocking Agents Actions—prevent other agents, usually naturally occurring catecholamines, from stimulating the specific receptors by blocking alpha or beta receptors Uses  Alpha blockers used with diseases associated with vasoconstriction  Beta blockers used extensively to treat hypertension Used with caution in patients with diabetes or susceptible to hypoglycemia

19. Slide 19 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Beta-Adrenergic–Blocking Agents

20. Slide 20 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Cholinergic Agents Known as parasympathomimetic agents— produce effects similar to those of acetylcholine Act directly by stimulating the parasympathetic nervous system or indirectly by inhibiting the enzyme that metabolizes acetylcholine (acetylcholinesterase) once it is released by the nerve ending

21. Slide 21 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Cholinergic Agents (cont’d) Side effects to expect  Nausea, vomiting, diarrhea, abdominal cramping, dizziness, hypotension Side effects to report  Bronchospasm, wheezing, bradycardia

22. Slide 22 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cholinergic Agents

23. Slide 23 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Anticholinergic Agents Known as cholinergic blocking agents or parasympatholytic agents Actions  Block action of acetylcholine in the parasympathetic nervous system Uses  Effective in the treatment of Parkinson’s disease, GI and ophthalmic disorders, bradycardia, and genitourinary disorders

24. Slide 24 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Anticholinergic Agents (cont’d) Side effects to expect  Blurred vision, constipation, urinary retention, dryness of the mucosa of the mouth, nose, and throat Side effects to report  Confusion, depression, nightmares, hallucinations

25. Slide 25 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Anticholinergic Agents