Autonomic Nervous System_F07

8/12/2019 Autonomic Nervous System_F07

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Autonomic Nervous System

Chapter 16, 17, 18, 19, 20

Clinical Drug Therapy


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Nervous System

Two main divisions

Central Nervous System or CNS

Peripheral Nervous System or PNS


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Central Nervous System or CNS

Brain and spinal cord: receives and

processes incoming sensory information and

responds by sending out signals that initiate

or modify a process.


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Peripheral Nervous System or PNS

Includes all the neurons and ganglia found

outside the CNS

Afferent (sensory): modify motor output

Efferent:


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Afferent Neurons

Afferent neurons carry sensory input from the

periphery to the CNS and modify motor

output through the reflex arc.


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Efferent Neurons

Efferent neurons carry motor signals from the

CNS to the peripheral areas of the body.


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ANS / SNS

Autonomic nervous system controls

involuntary activities of smooth muscle,

secretory glands and the visceral organs of

the body such as the heart (involuntaryactivities of smooth muscle)

Somatic nervous system innervates the

skeletal muscles and controls voluntarymovement


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Autonomic Nervous System

Sympathetic Nervous System

Para sympathetic System

Enteric System


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The Race Horse and the Cow



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Sympathetic System

Fight or Flightstimulated by physical or

emotional stress (exercise or work), pain,

hemorrhage, intense emotions, temperature

extremes


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Protective mechanisms designed to help

person cope with the stress or get away from

it.


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Neurotransmitters

Neurotransmitters

Acetylcholine: skeletal muscle

Norepinepherine: stress response


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Norepinephrine and epinephrine

Both always present in the blood.

Norepinephrine varies according to the

amount of stress present and will cause

transient changes in heart rate and systemicarteries and veins.

Epinephrine is a constant in regulating heart

rate, vasoconstriction in systemic arteries andveins and vasodilation of muscles and liver.


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Dopamine

Adrenergic neurotransmitteressential for

normal brain function.

Studies focus on connection between dopamine

malfunction in schizophrenia and ParkinsonsDisease.

Role of dopamine in drug addition to drugs:

stimulants and depressants.


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Protective Mechanisms

Intensity of response depends on

Norepinephrine and epinephrine

Fight or flight


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Body Responses

Increase in blood pressure and cardiacoutput.

Increase blood flow to brain, heart and

skeletal muscles. Decrease blood flow to skin and organs not

needed for flight.

Increase in glycogen for energy, mentalactivity, muscle strength, blood coagulation,respiratory rate, pupil dilation to aid vision,and increase in sweating.


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Fight of Flight Response

Can be a problem if the body stay in the fight

or flight mode.

Type A personalities?

High stress environment?

Medications may be needed reduce the

physiologic body responses.


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Parasympathetic Nervous System

Rest and Digest

Save energy

Decreased heart rate


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Adrenergic Receptors

Norepinephrine and epinephrine interact with

two adrenergic receptors

Alpha and beta

Alpha 1 Alpha 2

Beta 1

Beta 2


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Alpha 1

Alpha 1 receptors allows calcium ions to

move into the cell and produce muscle

contraction.


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Alpha 1

Location

Blood vessels

Kidney

Intestinal smooth muscles

Genitourinary

Eyes = blinking

Pregnant uterus =

contractions

Male sexual organs =

sexual function

Effects of stimulation

Vasoconstriction

Release of renin (kidney)

Relaxation


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Alpha 2

Location

Nerve endings

Vascular smooth

muscles Pancreatic beta cells

Platelets


Inhibits release of

Norepinephrine

Vasoconstriction Inhibit insulin secretion

Aggregation or clotting


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Beta 1

Location

Heart

Kidneys


Increase heart rate,

force of contraction,

automaticity and rate ofatrial-ventricular

function

Increased renin release


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Beta 2

Location

Bronchioles

Blood vessels

Gastrointestinal tract Liver

Urinary bladder

Pregnant uterus


Vasodilation

Decreased motility and

tone Glycogenolysis

Relaxed detrusor

muscle (bladder

muscle)

Relaxation of uterus


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Parasympathetic Nervous System

Functions stimulated by PNS: Resting,

reparative, or vegetative function


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Body Responses

Dilation of blood vessels in skin

Decrease heart rate (bradycardia)

Increase secretion of digestive enzymes

Constriction of smooth muscle of bronchi Increase in sweat glands

Contraction of smooth muscles of urinary

bladder Contraction of smooth muscle of skeletal

system


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Autonomic Drugs

Drugs used due to their ability to stimulate or

block activity of the sympathetic or

parasympathetic nervous system.


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Effect of Drugs

Drugs that act of ANS usually affect the entire

body.

Effects depend on whether you are trying to

stimulate or inhibit function.


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Receptor Activity

Drugs are developed to stimulate or inhibit

particular subtypes of receptors.

More selective on particular body tissues.

Decrease adverse effects on other body

tissuesside effects.


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Classifications: SNS

Sympathetic nervous system drug

classifications

Adrenergic - stimulating

Antiadrenergic - blocking


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Classifications: PNS

Parasympathetic

nervous system drugs

Cholinergic

Anticholinergic


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Adrenergic Drugs

Chapter 17


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Adrenergic Drugs

What do they do?

Stimulation of the sympathetic nervous

system.


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Mechanism of Action

Three mechanisms:

Directly with alpha 1 or beta-adrenergic receptors

on surface membrane.

Indirect effects of postsynaptic adrenergicreceptors.

Mixed actioncombination of action on direct and

indirect receptor.


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Heart

Direct stimulation of receptors

Alpha 1 - Vasoconstriction of blood vessels which

increases blood pressurepressor or

vasopressor effect. Beta 1 - increased force of myocardial contraction

- Increased speed of electrical conduction in the

heart.


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Lungs

Asthma and COPD (Chronic Obstructive

Pulmonary Disease): Beta 2 drugs or

bronchodilators are used to relieve broncho-

constriction and broncho-spasm.


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Pregnancy

Adrenergic drugs used to relax uterine

muscles in preterm labor.


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OTC Adrenergic Drugs

Common cold: anti-histamines

Allergy: nasal or oral to relieve nasal

congestion


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Adrenergic Drugs

Epinephrine

PseudoephedrineSudafed

Isoproterenol (Isuprel)

Phenylephrine (Neo-Synephrine)

Clonidine (antihypertensive)


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How does one choose a drug?

How emergent is the situation

PO or IM or IV


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Allergic Response

Runny nose, itchy eyes, cough

Asthma: Cough with bronchospasms,

difficulty breathing or SOB (shortness of

breath)

Anaphylactic shockedema of airway


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Pseudoephedrine

Therapeutic classification: allergy, cold, and coughremedies, nasal drying, and decongestants.

Indications: symptomatic management of nasal

congestion associated with acute viral upperrespiratory tract infection. Most often used incombination with other drugs.

Action: stimulates Alpha and beta-adrenergicreceptorsvasoconstriction in respiratory tract

mucosapossible bronchodilation Therapeutic effects: reduction of nasal congestion,

and swelling of nasal passages.


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Forms and Dosage

How supplied: tabs, chew tabs, extended

release tabs, liquid or drops

Dosing: 30 to 60 mg / dose q 6-8 hours PO

Maximum dose 240 mg/24 hours

Sustained release: 120 mg PO q 12 hours


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Contraindications

Severe Hypertension

Severe CAD / coronary artery disease

Use with caution in pregnancy, breast feeding

and renal failure


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Use with caution!

Mild or moderate hypertension,

hyperglycemia, hyperthyroidism, and cardiac

disease.


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Side Effects

Dizziness, nervousness, restlessness,

insomnia and arrhythmias

Seizures

Cardiovascular collapse


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Additional Information

OTC used in combination with anti-

histamines

Primarily excreted renallyadjust in patients

with renal impairment May cause false-positive for amphetamines

athletes

Currently need to ask pharmacist for SudafedOTC has been limited due to abuse


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Nursing Implications

Assess for congestion

Monitor pulse and blood pressure before

beginning therapy

Assess lung sound for signs of bronchialsecretions


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Severe Anaphylactic Shock

Usually involving the airways

Some thing as simple as food allergy can

trigger it

Peanuts, shell fish, legumes, bee sting,medications

Symptoms usually starts with numbness and

tingling of lips and leads to swelling of theglottis or epiglottisthis can result in closure

of the airway.


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How Do You Treat It?

Epinephrine would be the drug of choice

Classification: adrenergic

Action: affects both the beta (cardiac) and

beta (pulmonary) receptorsproduces

bronchodilationinhibits hypersensitivity

reaction of mast cells.


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Epinephrine

Therapeutic Effects:

Bronchodilation

Maintenance of heart rate and blood pressure

Adverse Side Effects:

Nervousness, restlessness, tremors, angina,

arrhythmias, hypertension, tachycardia


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How it is given?

Sub-Q or IV or inhaled

The subcutaneous or intramuscular

administration will help it to get into the blood

stream quickerepi-pen is given to clientswith severe allergy reactions

Not given by mouth because drug is

inactivated by gastric juices Can be inhaled in asthma attack


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P i i h


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Precautions with Use

Tachyarrhythmia's (fast irregular heart rate),

headache, nausea, and palpitations

Short acting so more definitive treatment

needs to be initiated Need cardio-respiratory monitoring

Pulse oximetry

Cardiac monitor

C di A


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Cardiac Arrest

Epinephrine is the best studied and most

widely administered adrenergic agonist used

for the treatment of cardiac arrest.

Used to jump start the heart.

V / I i D


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Vasopressor / Inotropic Drugs

Used extensively along with Dopamine to

maintain myocardial and cerebral perfusion

post cardiac arrest.

Administered in small, consistent amountsintravenous.


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Antiadrenergic Drugs

Chapter 18


A i d i D


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Antiadrenergic Drugs

Blocks the effects of the sympathetic nerve

stimulation, endogenous catecholamine and

adrenergic drugs.


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Wh U d?


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When Used?

To manage hypertension and a number of

cardiovascular disorders.


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Ch li i D


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Cholinergic Drugs

Cholinergic drugs stimulate the

parasympathetic nervous system.

M h i f A i


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Mechanism of Action

Direct acting cholinergic drugs are synthetic

derivative of choline.

Effects of drug

Decrease heart rate, vasodilation, and changes inBP

Increase tone and contractibility of smooth muscle

Increase tone and contractibility of bronchial

smooth muscles

Increased respiratory secretions


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N i A t i t ti


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Nursing Assessment: urine retention

Urinary retention

Bladder distention

Fluid intake

Time of last void

How do you know drug is working?

Fluid intake equal to urine output

Patient has voided within the last 8 hours

N i A t l ti il


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Nursing Assessment: paralytic ileus

Paralytic ileus

Hypo-peristalsis

Decreased bowel sounds

No gas or bowel movement

How do you know drug is working?

Bowel sounds heart in all four quadrants

Client states has passes gas Client states has had a bowel movement

Nursing Assessment: Myasthenia Gravis


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Nursing Assessment: Myasthenia Gravis

Signs and symptoms: muscle weakness,

ptosis (droopy eye lid), diplopia (double

vision), difficulty chewing and swallowing,

decreased activity intolerance. How do you know medication is working?

Increased muscle tone, no droopy eye lid or

double vision, increased activity tolerance.


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Use in Older Ad lts


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Use in Older Adults

May be used in myasthenia gravis orAlzheimers disease

Contraindications


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Contraindications

Renal obstruction

Liver disease


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Anticholinergic Drugs

Chapter 20




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Anticholinergics are a class of medicationsthat inhibit parasympathetic nerve impulses

by selectively blocking the binding of the

neurotransmitter acetylcholine to its receptorin nerve cells.

Mechanism of Action


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Mechanism of Action

Drugs act by occupying receptor sites ontarget organs innervated by parasympathetic

nervous system leaving fewer receptor sites

free to respond to acetylcholine. Parasympathetic response is absent or

decreased depending on number of receptors

blocked.

Effects of Anticholinergic Drugs


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Effects of Anticholinergic Drugs

CNS stimulation followed by depression Decreased cardiovascular response to

parasympathetic (vagal) stimulation that

slows heart rate Bronchodilation and decrease respiratory

secretions

Antispasmodic effects in GI system

Change in intra-ocular pressure in patientswith glaucoma

Uses


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Uses

GI disorderspeptic ulcer disease, gastritis,increased gastric acid secretionrelax gastricsmooth muscle (replaced by newer drugs)

Genitourinaryanti-spasmodicurgency

Excessive secretions Ophthalmologyrelax eye for exam

Respiratory disorderasthma or bronchitisinhaled form only

Cardiac disordersbradycardia or heart block

Parkinsons disease


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Atropine


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Atropine

Pharmacological classification:anticholinergic

Therapeutic classification: antiarrhythmic

Action: Inhibits the action of acetylcholine atpostganglionic sites located in the smooth

muscle, secretory glands, CNS. Low doses

decrease: sweating, salivation andrespiratory secretions.


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Atropine


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Atropine

Side effects: drowsiness, blurred vision,tachycardia, dry mouth, urinary hesitancy.

Atropine


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Atropine

Prototype of anticholineric drugsatropinesulfate

Therapeutic

Previously used in preoperative patients toreduce secretionsother newer drugs have

replaced

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Autonomic Nervous System_F07