Drugs affecting the_sympathetic_nervous_system

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Drugs affecting the_sympathetic_nervous_system

  1. 1. AUTONOMIC NERVOUS SYSTEM AGENTS Nelia B. Perez RN, MSNPCU – Mary Johnston College of Nursing
  2. 2. 1. Drugs that stimulate the sympathetic nervous system are called a. adrenergics b. Cholinergics c. Analeptics d. benzodiazepines
  3. 3. 2. The sympathetic neurotransmitters are norepinephrine and epinephrine. a. true b. false
  4. 4. 3. These receptors are found predominantlyin the smooth muscle membrane. a. alpha adrenergic receptors b. Alpha 2 adrenergic receptors c. Beta adrenergic receptors d. Beta2 adrenergic receptors
  5. 5. 4. The most important clinical effect of this drug is contraction of smooth muscles. a. beta adrenergic drugs b. Anxiolitics c. Alpha-adrenergic Drugs b. Anticholinergics
  6. 6. 5. A beta2 adrenergic drug which isprimarily used as a bronchodilator. a. Epinephrine b. Norepinephrine c. albuterol d. ephedrine
  7. 7. 6. When used as a Beta1 Adrenergic drug, itcauses over-stimulation of the heart. a. Norepinephrine b. Epinephrine c. Ephedrine d. isoetharine
  8. 8. 7. It is a Neurotransmitter in the brain and serves as a precursor in the synthesis of norepinephrine. a. Dopamine b. Dobutamine c. Epinephrine d. Ephedrine
  9. 9. 8. It antagonizes the effect ofNorepinephrine and epinephrine whichresults in vasodilatation and thus decrease inBP. a. Alpha-adrenergic blocking drugs b. Alpha2-adrenergic blocking drugs c. Beta-adrenergic blocking drugs d. Beta2-adrenergic blocking drugs
  10. 10. 9. It leads to a decrease in sympatheticresponse resulting in decrease heart rate andforce of contraction. a. Alpha-adrenergic blocking drugs b. Alpha2-adrenergic blocking drugs c. Beta-adrenergic blocking drugs d. Beta2-adrenergic blocking drugs
  11. 11. 10. Adrenergic neuronal blockers are those which a. interfere with the formation and or storage of NE b. Blocks the synthesis of epinephrine c. Dilates blood vessels in hypertension d. Serves as bronchodilators
  12. 12. Drugs Affecting theSympathetic Nervous System
  13. 13. Drugs Affecting the Sympathetic Nervous System Release Adrenergic Receptor NE NE NE MAO NE NE Involuntary Muscle Membrane Metabolism Reuptake NE Adrenergic nerve ending
  14. 14. Drugs Affecting the Sympathetic Nervous System Adrenergic Receptors Alpha Beta Receptors Receptors Beta 1 Beta 2 Receptors Receptors
  15. 15. Drugs Affecting the Sympathetic Nervous System Alpha-adrenergic Receptors • Found predominantly on smooth muscle membrane. • When stimulated by NE or EPI produce contraction. • Produces vasoconstriction of most blood vessels.
  16. 16. Drugs Affecting the Sympathetic Nervous System Beta-adrenergic Receptors • Found on both cardiac and some smooth muscle membranes. • In the heart, beta 1 receptors predominates. • When stimulated by NE or EPI, they increase heart rate and force of contraction.
  17. 17. Drugs Affecting the Sympathetic Nervous System Beta-adrenergic Receptors • Found on smooth muscle in the bronchus and smooth muscles of blood vessels supplying muscle and the heart. • Stimulated with EPI result in relaxation.
  18. 18. Drugs Affecting the Sympathetic Nervous System Beta-adrenergic Receptors • In smooth muscle, beta 2 receptors predominates. • When stimulated by EPI, they produces muscle relaxation. • Found in smooth muscles of blood vessels supplying skeletal muscle and the coronary arteries. • Found on smooth muscle in the bronchial tree.
  19. 19. Drugs Affecting the Sympathetic Nervous System Beta 1 Receptors Found on smooth muscle in the heart Increase heart rate and force of contraction.
  20. 20. Drugs Affecting the Sympathetic Nervous System Beta 2 Receptors Found on smooth Found on smooth muscle muscle in the of blood vessels supplying bronchial tree. skeletal muscle and the heart. Vasodilatation. Bronchodilation.
  21. 21. Drugs Affecting the Sympathetic Nervous System Sympathetic Drugs Sympathomimetic Sympatholytic Drugs Drugs
  22. 22. Drugs Affecting the Sympathetic Nervous System Sympathomimetic Drugs Alpha-adrenergic Beta- adrenergic Selective Beta 1 Selective Beta 2 Adrenergic. Adrenergic.
  23. 23. Drugs Affecting the Sympathetic Nervous System Alpha-adrenergic Drugs • NE prototype • Most important clinical effect is contraction of smooth muscles. • Vasoconstriction of most blood vessels leading to increase in blood pressure. • Contraction of sphincter muscles.
  24. 24. Drugs Affecting the Sympathetic Nervous System Contraction of Sphincter Muscles GI tract Urinary Tract Eyes Inhibits movement of Restricts passage Mydriasis intestinal contents of urine.
  25. 25. Drugs Affecting the Sympathetic Nervous System Alpha-adrenergic Drugs Clinical Indications • Hypotensive states • Decongestion • Pupillary dilation
  26. 26. Drugs Affecting the Sympathetic Nervous System Adverse Effects • Hypertensive crisis • Cerebral hemorrhage • Cardiac arrhythmias • Irritation of the nasal sinuses or eye.
  27. 27. Drugs Affecting the Sympathetic Nervous System Drug Main UseEpinephrine To increase BPNorepinephrine To increase BPPseudoephedrine Nasal decongestionTetrahydrozoline Ophthalmic decongestion
  28. 28. Drugs Affecting the Sympathetic Nervous System Beta-adrenergic Drugs • Stimulation of the heart • Bronchodilation • Relaxes uterine smooth muscle
  29. 29. Drugs Affecting the Sympathetic Nervous System Drugs Classification Main UseEpinephrine Alpha, Beta-1 Vasopressor, Cardiac and Beta-2 stimulant, bronchodilator.Isoproterenol Beta-1 and Beta- Cardiac stimulant, 2 bronchodilator.Albuterol Beta-2 Bronchodilator.Ritodrine Beta-2 Arrest preterm labor.
  30. 30. Drugs Affecting the Sympathetic Nervous System Epinephrine • DOC for allergic reactions • Use in combination with local anesthetics. • Used as a cardiac stimulant in emergencies. • Use in the treatment of asthma.
  31. 31. Drugs Affecting the Sympathetic Nervous System Adverse Effects • CNS stimulation – tremor, restlessness, anxiety (beta effect) • Over-stimulation of the heart (beta 1 effect) • Lower blood pressure (beta 2 effect)
  32. 32. Drugs Affecting the Sympathetic Nervous System Dopamine • Neurotransmitter in the brain. • Precursor in the synthesis of NE • Stimulates dopaminergic, beta-1 and alpha- receptors. • Use as a drug. • Dobutamine similar to dopamine but with more Beta-1 effect.
  33. 33. Drugs Affecting the Sympathetic Nervous System NE NE NE MAO Tyrosine DOPA Dopamine NE NE
  34. 34. Drugs Affecting the Sympathetic Nervous System DOPAMINE RECEPTORS EFFECTS DOSE STIMULATEDLow dose Stimulate dopaminergic Increased renal blood flow receptors in the renal and and vasodilatation. mesenteric blood vessels.Moderate dose Stimulates beta-1 Increase myocardial receptors in the heart. contractility.Higher dose Stimulate alpha-receptors Produces vasoconstriction.
  35. 35. Drugs Affecting the Sympathetic Nervous System Alpha-adrenergic blocking drugs • Binds to Alpha receptors • Antagonizes the effects of NE and EPI • Leads to a decrease in sympathetic response • Resulting in vasodilatation and thus decrease in BP.
  36. 36. Drugs Affecting the Sympathetic Nervous System Alpha-adrenergic blocking drugs. Clinical Indications • Treatment of hypertension. • Vasodilator in treatment of Raynaud’s disease. • Diagnosis of Pheochromocytoma.
  37. 37. Drugs Affecting the Sympathetic Nervous System Alpha-adrenergic blocking drugs. Adverse Effects • Constriction of pupils • Increased GI activity • Nasal congestion • Reflex tachycardia ( if BP is lowered too much).
  38. 38. Drugs Affecting the Sympathetic Nervous System Drugs Main UseDoxazosin Treatment of HypertensionPrazosin Treatment of HypertensionPhentolamine Diagnosis of pheochromocytoma. Treatment of vascular disease.
  39. 39. Drugs Affecting the Sympathetic Nervous System Beta-adrenergic blocking drugs. • Binds to beta receptors • Antagonizes the effects of NE and EPI • Leads to a decrease in sympathetic response. • Resulting in decrease heart rate and force of contraction.
  40. 40. Drugs Affecting the Sympathetic Nervous System Beta-blocking Drugs Non-selective Selective Beta-1
  41. 41. Drugs Affecting the Sympathetic Nervous System Nonselective Blockers Main UseLabetalol HypertensionNadolol Hypertension, Angina PectorisPindolol HypertensionPropanolol Hypertension, Angina Pectoris, arrhythmhias, migraineTimolol Hypertension, post myocardial infarction.
  42. 42. Drugs Affecting the Sympathetic Nervous System Selective Blockers Main UseAcebutolol Hypertension, ventricular arrhythmias.Atenolol Hypertension, Angina PectorisBisoprolol HypertensionEsmolol Supraventricular tachycardiaMetoprolol Hypertension, Angina Pectoris
  43. 43. Drugs Affecting the Sympathetic Nervous System Propranolol • Decrease heart rate • Decrease force of contraction • Decrease rate of conduction • Resulting decrease in effort and work of the heart causes a decrease in oxygen consumption.
  44. 44. Drugs Affecting the Sympathetic Nervous System• Oral and iv preparation• Drug is carried directly to the liver by the portal system.• Significant first pass metabolism.• Lipid soluble and passes into the brain.• Causes CNS sedation, depression and decreased central sympathetic activity.
  45. 45. Drugs Affecting the Sympathetic Nervous System • Used in the treatment of angina, and various cardiac arrhythmia. • Adverse effects include nausea, vomiting and diarrhea, bradycardia with resulting reduced cardiac function, bronchoconstriction. • Most serious drug interactions involve therapy of beta blockers with other drugs that decrease cardiac function (cardiac glycosides, anti- arrhythmic drugs and calcium blockers).
  46. 46. Drugs Affecting the Sympathetic Nervous System Adrenergic neuronal blockers • Drugs that interfere with the formation and or storage of NE • Alpha-methyl dopa • Reserpine • Guanethidine
  47. 47. Drugs Affecting the Sympathetic Nervous System Reserpine NE NE NE MAO Tyrosine DOPA Dopamine NE NE Guanethidine Alpha-methyl dopa
  48. 48. Drugs Affecting the Sympathetic Nervous System Drugs Mechanism of Action Main UseAlpha-methyl dopa Blocks formation of Treatment of Dopamine hypertensionReserpine Depletes NE storage Treatment of granule hypertensionGuanethidine Block release of NE Treatment of and depletes NE hypertension storage granule
  49. 49. ANS - Adrenergic Drugs Nursing Implications Assess for allergies and history of hypertension, cardiac dysrhythmias, or other cardiovascular disease Assess renal, hepatic, and cardiac function before treatment Perform baseline assessment of vital signs, peripheral pulses, skin color, temperature; include postural blood pressure and pulse Follow administration guidelines carefullyIntravenous administration Check IV site often for infiltration Use clear IV solutions / Use an infusion pump Infuse drug slowly to avoid dangerous cardiovascular effects Monitor cardiac rhythm
  50. 50. ANS - Adrenergic Drugs Nursing Implications (cont’d)With chronic lung disease:Instruct patients to avoid factors that exacerbate their conditionEncourage fluid intake (up to 3000 mL per day) if permittedEducate about proper dosing, use of equipment (MDI, spacer, nebulizer), and equipment care
  51. 51. ANS - Adrenergic Drugs Nursing Implications (cont’d) Salmeterol is indicated for prevention ofbronchospasms, not management of acute symptoms Overuse of nasal decongestants may cause reboundnasal congestion or ulcerations Avoid OTC or other medications because of possible interactionsAdministering two adrenergic drugs togethermay precipitate severe cardiovascular effects suchas tachycardia or hypertension
  52. 52. ANS - Adrenergic Drugs Nursing Implications (cont’d)Monitor for therapeutic effects:(cardiovascular uses) Decreased edema Increased urinary output Return to normal vital signs Improved skin color and temperature Increased LOC
  53. 53. ANS - Adrenergic Drugs Nursing Implications (cont’d)Monitor for therapeutic effects(bronchospasm/asthma):• Return to normal respiratory rate• Improved breath sounds, fewer rales• Increased air exchange• Decreased cough• Less dyspnea• Improved blood gases• Increased activity tolerance
  54. 54. Let’s take a break!

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