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Drugs affecting the_parasympathetic_nervous_system

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  • 1. Drugs Affecting theParasympatheticNervous SystemNelia B. Perez RN, MSN
  • 2. 1. It is the main neurotransmitter in the PNS. a. MAO b. Ach c. ACTH d. ADH
  • 3. 2. This is the alkaloid substance found in tobacco. a. Caffeine b. Sugar c. Tar d. Nicotine
  • 4. 3. Found at the parasympathetic postganglionic nerve endings and acts like Ach. a. Nicotinic Receptors b. Ganglionic receptors c. Muscarinic receptors d. Sympathetic receptors
  • 5. 4. They produces ACH like effect and slowly inactivated by acetylcholinesterase. a. Direct Acting Cholinergic Drugs b. Muscarinic drugs c. Adrenergic drugs d. Indirect acting cholinergic drugs•.
  • 6. 5. It blocks cholinergic and nicotinic receptors.a.Reversible Inhibitorsb.Irreversible inhibitorsc.Cholinesterased.anticholinesterase
  • 7. 6. These are derivatives of organophosphate compounds which is widely used as insecticides, pesticides and chemical warfare agents. a. Cholinesterase b. Reversible Inhibitors c. Irreversible Inhibitors d. None of these
  • 8. 7. A situation where there is excessive drug dosage in patients with myasthenia gravis and a high concentration of ACH causes excessive stimulation of the muscarinic receptors. a. Cholinergic Crisis b. hypertensive crisis c. Stroke d. None of these
  • 9. 8. It binds to muscarinic receptors and act by competitive antagonism of ACH. a. Cholinergic drugs b. Cholinesterase c. anticholinesterase d. Anticholinergic Drugs
  • 10. 9. It is the opposing system of the SNS a. ANS b. PNS c. CNS d. CVS
  • 11. 10.Major effects of the Cholinergic drugs. a. STONES b. DUALS c. SLUDGE d. SMUDGE
  • 12. Drugs Affecting the Parasympathetic Nervous SystemParasympathetic Nervous System• Neurotransmitter is ACH• The receptors are called cholinergic receptors.• Drugs that bind to cholinergic receptors and produced effects similar to ACH are referred to as cholinergic drugs.
  • 13. Drugs Affecting the Parasympathetic Nervous System ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH Acetylcholinesterase
  • 14. Drugs Affecting the Parasympathetic Nervous System Receptors Muscarinic Receptors Nicotinic Receptors N-1 N-2
  • 15. Drugs Affecting the Parasympathetic Nervous System Nicotinic Receptors Nicotinic-I Receptors Nicotinic-II ReceptorsFound at ganglions of Found at Neuromuscular junction ofSympathetic and Parasympathetic Skeletal muscles.Post- ganglionic fibers
  • 16. Drugs Affecting the Parasympathetic Nervous System Ganglion, Nicotinic I receptor Sympathetic FibersPre-ganglionic Post-ganglionic FiberFiber Adrenergic Receptor Ganglion, Nicotinic I receptor Parasympathetic Fibers Pre-ganglionic Fiber Post-ganglionic Fiber Muscarinic Receptors Somatic Fibers Nicotinic II Receptors
  • 17. Drugs Affecting the Parasympathetic Nervous SystemNicotine• Alkaloid obtained from tobacco.• Stimulate the NI receptors at low doses.• Block the NII receptors at high doses.
  • 18. Drugs Affecting the Parasympathetic Nervous System Nicotinic I Drugs Ganglionic Ganglionic Stimulants Blockers
  • 19. Drugs Affecting the Parasympathetic Nervous SystemMuscarinic Receptors• Found at the parasympathetic postganglionic nerve endings• Drugs that act like ACH at these receptors are referred to as cholinergic or muscarinic drugs.• Drugs that block ACH at the muscarinic receptors are referred to as anticholinergic or antimuscarinic drugs.
  • 20. Drugs Affecting the Parasympathetic Nervous System Parasympathetic Drugs Cholinergic Anti-cholinergic Drugs Drugs
  • 21. Drugs Affecting the Parasympathetic Nervous System Cholinergic Drugs Direct Acting Indirect Acting Cholinergic Drugs Cholinergic Drugs
  • 22. Drugs Affecting the Parasympathetic Nervous System Direct Acting Cholinergic Drugs • Bind to muscarinic receptors. • Produces ACH like effect. • Slowly inactivated by acetylcholinesterase.
  • 23. Cholinergic Drugs Drugs that stimulate the parasympathetic nervous system (PSNS)  opposing system to the SNS  Known as: cholinergic agonists or parasympathomimetics  Mimic the effects of the PSNS neurotransmitter: acetylcholine (Ach)
  • 24. Cholinergic Drugs“rest and digest” system “SLUDGE”  Salivation  Lacrimation  Urinary incontinence  Diarrhea  Gastrointestinal cramps  Emesis
  • 25. Cholinergic Drugs Drug Effects Stimulate intestine and bladder  Increased gastric secretions  Increased gastrointestinal motility  Increased urinary frequency Stimulate pupils  Constriction (miosis)  Reduced intraocular pressure Increased salivation and sweating Cardiovascular effects  Decreased heart rate  Vasodilation Respiratory effects  Bronchial constriction, narrowed airways
  • 26. Drugs Affecting the Parasympathetic Nervous System Pharmocological Effects • Increase GI secretion and motility • Increase in genitourinary activity. • Bronchoconstriction
  • 27. Drugs Affecting the Parasympathetic Nervous System Pharmocological Effects • Miosis • Vasodilatation (lower BP) • Decrease heart rate.
  • 28. Drugs Affecting the Parasympathetic Nervous System Direct Acting Main UseAcetylcholine MioticBethanecol Nonobstructive urinary retentionCarbachol Treatment of glaucomaMethacholine MioticPilocarpine Treatment of glaucoma
  • 29. Drugs Affecting the Parasympathetic Nervous System Indirect Acting Cholinergic Drugs (Anticholinesterases) Reversible Irreversible Inhibitors Inhibitors
  • 30. Drugs Affecting the Parasympathetic Nervous System ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH ACH Acetylcholinesterase Anticholinesterases
  • 31. Drugs Affecting the Parasympathetic Nervous System Reversible Inhibitors • Blocks cholinergic and nicotinic receptors. • Use in the diagnosis and treatment of myasthenia gravis.
  • 32. Drugs Affecting the Parasympathetic Nervous System Irreversible Inhibitors • Derivatives of organophosphate compounds. • Widely used as insecticides, pesticides and chemical warfare agents. • Long duration of action
  • 33. Drugs Affecting the Parasympathetic Nervous SystemClinical Use• Topical use in glaucoma• Treatment of myasthenia gravis• Treatment of urinary retention and intestinal stasis
  • 34. Drugs Affecting the Parasympathetic Nervous SystemClinical Use• Treatment of Alzheimer’s disease.• Antidote to skeletal muscle blockers.• Antidotes to anticholinergic drug poisoning.
  • 35. Drugs Affecting the Parasympathetic Nervous System Indirect-Acting Cholinergic Drug Reversible Irreversible Ambenonium Isoflurophate Edrophonium Neostigmine Physostigmine Pyridostigmine
  • 36. Drugs Affecting the Parasympathetic Nervous SystemAdverse and Toxic Effect• Nausea• Vomiting• Diarrhea• Blurred vision
  • 37. Drugs Affecting the Parasympathetic Nervous SystemAdverse and Toxic Effect• Excessive sweating• Muscular tremors• Bronchoconstriction• Bradycardia
  • 38. Drugs Affecting the Parasympathetic Nervous SystemAdverse and Toxic Effect• Hypotension• Mucular paralysis• Respiratory arrest
  • 39. Drugs Affecting the Parasympathetic Nervous SystemCholinergic Crisis• Excessive drug dosage in patients with myasthenia gravis.• High concentration of ACH causes excessive stimulation of the muscarinic receptors.• High concentration of ACH causes blockade of nicotinic receptor.
  • 40. Drugs Affecting the Parasympathetic Nervous SystemTreatment• Stop anticholinesterase drug administration.• Give atropine to block the effect of excess muscarinic stimulation
  • 41. Drugs Affecting the Parasympathetic Nervous SystemCholinergic Crisis• Excessive exposure to sprays containing derivatives of irreversible anticholinesterase.• High concentration of ACH causes excessive stimulation of the muscarinic receptors.• High concentration of ACH causes blockade of nicotinic receptor.
  • 42. Drugs Affecting the Parasympathetic Nervous SystemTreatment• Remove person from the exposure.• Give Pralidoxime to reactivate the anticholinesterase enzyme.• Give atropine to block the effect of excess muscarinic stimulation
  • 43. Drugs Affecting the Parasympathetic Nervous SystemAnticholinergic Drugs• Binds to muscarinic receptors.• Act by competitive antagonism of ACH.• Prototype drugs: Belladonna alkaloids, atropine and scopolamine
  • 44. Drugs Affecting the Parasympathetic Nervous SystemPharmacological Action• Increase heart rate.• Increase the secretions of the respiratory tract and may cause bronchoconstriction.• Reduce salivary and GI tract.• Inhibit urinary peristalsis and voiding of urine.
  • 45. Drugs Affecting the Parasympathetic Nervous SystemPharmacological Action• Depressant effects on the CNS causing drowsiness and sedation.• At high doses cause both stimulation and depression of the CNS• At toxic doses excitation, delirium, hallucination and profound CNS depression leading to respiratory arrest and death.
  • 46. Drugs Affecting the Parasympathetic Nervous System Ocular Effect • Mydriasis • Cycloplegia • Increases Intraocular pressure.
  • 47. Drugs Affecting the Parasympathetic Nervous SystemAdverse and Toxic Effect• Cause by excessive blockage of the Parasympathetic Nervous System.• Dry mouth.• Visual disturbances• Urinary retention• Constipation.
  • 48. Drugs Affecting the Parasympathetic Nervous SystemAdverse and Toxic Effect• Dryness of the skin• Flushing• Hyperpyrexia• CNS stimulation and depression
  • 49. Drugs Affecting the Parasympathetic Nervous System Anticholinergic DrugsBelladonna Alkaloids Synthetic Drugs Atropine Semisynthetic Drug Diclyclomine Scopolamine Isopropamide Hyoscyamine Homatropine Propantheline Methantheline
  • 50. Nursing Implications Assess for allergies, presence of GI or GU obstructions, asthma, peptic ulcer disease, or coronary artery disease Perform baseline assessment of vital signs and systems overview Medications should be taken as ordered and not abruptly stopped The doses should be spread evenly apart to optimize the effects of the medication Overdosing can cause life-threatening problems. Only physicians should adjust the dosages
  • 51. Nursing Implications• Encourage patients with myasthenia gravis to take medication 30 minutes before eating to help improve chewing and swallowing• When cholinergic drugs are prescribed for Alzheimer’s disease, be honest with caregivers and patients that the drugs are for management of symptoms, not a cure• Therapeutic effects of anti-Alzheimer’s drugs may not occur for up to 6 weeks
  • 52. Nursing ImplicationsMonitor for therapeutic effects Alleviated signs and symptoms of myasthenia gravis In postoperative patients with decreased GI peristalsis, look for:  Increased bowel sounds  Passage of flatus  Occurrence of bowel movements In patients with urinary retention/hypotonic bladder, urination should occur within 60 minutes of bethanechol administration• ALSO monitor for adverse effects
  • 53. Thank You andSee You nexT week!

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