The document discusses drugs that affect the autonomic nervous system, specifically the sympathetic nervous system. It describes how drugs can stimulate or block receptors in the sympathetic nervous system. Sympathomimetic drugs like epinephrine stimulate receptors to increase heart rate, blood pressure, and bronchodilation. Sympatholytic drugs like alpha-adrenergic blockers antagonize norepinephrine and epinephrine, resulting in vasodilation and lower blood pressure. The document provides examples of drugs that target different receptors and their clinical uses for conditions like hypertension and asthma.

1. AUTONOMIC NERVOUS
SYSTEM AGENTS
Nelia B. Perez RN, MSN
PCU – Mary Johnston College of Nursing

2. 1. Drugs that stimulate the sympathetic
nervous system are called
a. adrenergics
b. Cholinergics
c. Analeptics
d. benzodiazepines

3. 2. The sympathetic neurotransmitters are
norepinephrine and epinephrine.
a. true
b. false

4. 3. These receptors are found predominantly
in the smooth muscle membrane.
a. alpha adrenergic receptors
b. Alpha 2 adrenergic receptors
c. Beta adrenergic receptors
d. Beta2 adrenergic receptors

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. 5. A beta2 adrenergic drug which is
primarily used as a bronchodilator.
a. Epinephrine
b. Norepinephrine
c. albuterol
d. ephedrine

7. 6. When used as a Beta1 Adrenergic drug, it
causes over-stimulation of the heart.
a. Norepinephrine
b. Epinephrine
c. Ephedrine
d. isoetharine

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. 8. It antagonizes the effect of
Norepinephrine and epinephrine which
results in vasodilatation and thus decrease in
BP.
a. Alpha-adrenergic blocking drugs
b. Alpha2-adrenergic blocking drugs
c. Beta-adrenergic blocking drugs
d. Beta2-adrenergic blocking drugs

10. 9. It leads to a decrease in sympathetic
response resulting in decrease heart rate and
force of contraction.
a. Alpha-adrenergic blocking drugs
b. Alpha2-adrenergic blocking drugs
c. Beta-adrenergic blocking drugs
d. Beta2-adrenergic blocking drugs

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. Drugs Affecting the
Sympathetic Nervous
System

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. Drugs Affecting the Sympathetic Nervous
System
Adrenergic
Receptors
Alpha Beta
Receptors Receptors
Beta 1 Beta 2
Receptors Receptors

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. 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. 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. 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. Drugs Affecting the Sympathetic Nervous
System
Beta 1
Receptors
Found on smooth
muscle in the heart
Increase heart rate and
force of contraction.

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. Drugs Affecting the Sympathetic Nervous
System
Sympathetic
Drugs
Sympathomimetic Sympatholytic
Drugs Drugs

22. Drugs Affecting the Sympathetic Nervous
System
Sympathomimetic
Drugs
Alpha-adrenergic Beta- adrenergic
Selective Beta 1 Selective Beta 2
Adrenergic. Adrenergic.

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. 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. Drugs Affecting the Sympathetic Nervous
System
Alpha-adrenergic Drugs
Clinical Indications
• Hypotensive states
• Decongestion
• Pupillary dilation

26. Drugs Affecting the Sympathetic Nervous
System
Adverse Effects
• Hypertensive crisis
• Cerebral hemorrhage
• Cardiac arrhythmias
• Irritation of the nasal sinuses or eye.

27. Drugs Affecting the Sympathetic Nervous
System
Drug Main Use
Epinephrine To increase BP
Norepinephrine To increase BP
Pseudoephedrine Nasal decongestion
Tetrahydrozoline Ophthalmic decongestion

28. Drugs Affecting the Sympathetic Nervous
System
Beta-adrenergic Drugs
• Stimulation of the heart
• Bronchodilation
• Relaxes uterine smooth muscle

29. Drugs Affecting the Sympathetic Nervous
System
Drugs Classification Main Use
Epinephrine 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. 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. 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. 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. Drugs Affecting the Sympathetic Nervous
System
NE
NE
NE
MAO
Tyrosine DOPA Dopamine
NE
NE

34. Drugs Affecting the Sympathetic Nervous
System
DOPAMINE RECEPTORS EFFECTS
DOSE STIMULATED
Low 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. 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. 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. 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. Drugs Affecting the Sympathetic Nervous
System
Drugs Main Use
Doxazosin Treatment of Hypertension
Prazosin Treatment of Hypertension
Phentolamine Diagnosis of pheochromocytoma.
Treatment of vascular disease.

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. Drugs Affecting the Sympathetic Nervous
System
Beta-blocking
Drugs
Non-selective Selective Beta-1

41. Drugs Affecting the Sympathetic Nervous
System
Nonselective Blockers Main Use
Labetalol Hypertension
Nadolol Hypertension, Angina Pectoris
Pindolol Hypertension
Propanolol Hypertension, Angina Pectoris,
arrhythmhias, migraine
Timolol Hypertension, post myocardial
infarction.

42. Drugs Affecting the Sympathetic Nervous
System
Selective Blockers Main Use
Acebutolol Hypertension, ventricular
arrhythmias.
Atenolol Hypertension, Angina Pectoris
Bisoprolol Hypertension
Esmolol Supraventricular tachycardia
Metoprolol Hypertension, Angina Pectoris

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. 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. 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. 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. Drugs Affecting the Sympathetic Nervous
System
Reserpine
NE
NE
NE
MAO
Tyrosine DOPA Dopamine
NE
NE
Guanethidine
Alpha-methyl dopa

48. Drugs Affecting the Sympathetic Nervous
System
Drugs Mechanism of Action Main Use
Alpha-methyl dopa Blocks formation of Treatment of
Dopamine hypertension
Reserpine Depletes NE storage Treatment of
granule hypertension
Guanethidine Block release of NE Treatment of
and depletes NE hypertension
storage granule

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 carefully
Intravenous 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. 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. ANS - Adrenergic Drugs
Nursing Implications (cont’d)
 Salmeterol is indicated for prevention of
bronchospasms, not management of acute symptoms
 Overuse of nasal decongestants may cause rebound
nasal congestion or ulcerations
 Avoid OTC or other medications because of possible
interactions
Administering two adrenergic drugs together
may precipitate severe cardiovascular effects such
as tachycardia or hypertension

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. 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. Let’s take a break!