Autonomic Nervous System Drugs
Autonomic Nervous System Drugs
Autonomic Nervous System Drugs
DRUGS
Mimics the action of acetylcholine on the
neurons in certain target organs in the body.
They combine with receptors on the cell
CHOLINERGIC DRUGS membranes of target organs, then stimulate the
Promote the action of the neurotransmitter muscle and produce:
Salivation
Acetylcholine.
Bradycardia
Also called parasympathomimetic drugs
Vasodilatation
because they produce effects that imitate
Bronchoconstriction
parasympathetic nerve stimulation.
Increased activity of the GIT
Enhance the action of acetylcholine, stimulating Increased tone and contraction of the
the parasympathetic nervous system. muscles of the bladder
Two major classes: Pupillary constriction
Orally
Subcutaneous injection – more rapid than ANTICHOLINESTERASE DRUGS
oral and response is more effective
Block the action of the enzyme acetyl
cholinesterase, which breaks down
acetylcholine, at cholinergic receptor sites,
Metabolism and Excretion preventing the breakdown of acetylcholine.
Metabolized by cholinesterase: As Ach builds up, it continues to stimulate
At the muscarinic and nicotinic receptor the cholinergic receptors.
sites
In the plasma Two categories:
In the liver 1. Reversible
All drugs in this class are excreted by the 2. Irreversible
kidneys
1. Reversible Nursing Alert
have a short duration of action (minutes to
Symptoms of cholinergic crisis
hours) and include:
(cholinergic drug toxicity)
Ambenonium
include severe abdominal cramping,
Donepezil
diarrhea, excessive salivation, muscle
Edrophonium
weakness, rigidity and spasm, and
Neostigmine
clenching of the jaw.
Physostigmine salicylate
Pyridostigmine Treatment of over-dosage:
Tacrine
atropine (usual dosage of atropine is 0.4 to 0.6
Pharmacodynamics mg IV)
other treatment also may be prescribed.
Promote action of acetylcholine at receptor
sites. Possible Nursing Diagnoses
Depending on the site, drug’s dose, and
duration of action, they can produce a stimulant Disturbed Sensory Perception: Visual
or depressant effect on cholinergic receptors. related to adverse drug reactions or increased
pressure within the eye
Pharmacotherapeutics Risk for Injury related to muscular weakness,
rigidity, or spasms due to drug overdose
Reduce eye pressure in patients with glaucoma
Diarrhea related to adverse drug reaction.
and during eye surgery
Increase urinary bladder tone
Improve tone and peristalsis through GIT in
patients with paralytic ileus CHOLINERGIC BLOCKING DRUGS
(ANTICHOLINERGIC DRUGS)
Promote muscular contraction in patients with
myasthenia gravis Interrupt parasympathetic nerve impulses in
Diagnose myasthenia gravis (neostigmine and the CNS and ANS
edrophonium) Prevent Ach from stimulating cholinergic
Antidote to anticholinergic drugs, tricyclic receptors.
antidepressants, belladonna alkaloids, and Do not block all cholinergic receptors, just the
narcotics muscarinic receptor sites.
Treat mild to moderate Alzheimer’s dementia Muscarinic receptors are cholinergic receptors
(Donepezil) that are stimulated by the alkaloid muscarine
Adverse Reactions and blocked by atropine.
Major Cholinergic Blockers
Nausea and vomiting
Diarrhea 1. Belladonna Alkaloids:
Shortness of breath Atropine – the prototype
Wheezing or tightness in the chest Belladonna
Seizures Homatropine
Bradycardia Hyoscyamine sulfate
Hypotension Scopolamine hydrobromide
Respiratory depression
2. Synthetic Derivatives (Quarternary
Nursing Responsibilities: Ammonium drugs)
Always encourage to change position slowly Clidinium
to avoid dizziness Glycopyrrolate
Should be given as directed and the patient Propantheline
carefully monitored for toxicity.
3. Tertiary Amines:
Benztropine
Dicyclomine Nursing Diagnoses
Ethopropazine
Disturbed Sensory Perception: Visual
Oxybutynin related to adverse drug reaction
Trihexyphenidyl Impaired Oral Mucous Membranes
Pharmacotherapeutics related to drug action on mucous
membranes
All cholinergic blockers are used to treat Risk for Injury related to effect of drug
spastic or hyperactive GI and urinary Constipation related to slowing of
tract conditions – relax muscles and peristalsis in the gastrointestinal tract
decrease GI secretions
Propantheline is the drug of choice Nursing Responsibilities:
Belladonna alkaloids are used with Apply pressure to inner canthus for a few
morphine to treat biliary colic due to gallstones. seconds after opthalmic use for mydriasis
Administered by IV injection to relax the GI The antidote is physostigmine salicylate
smooth muscle. Elderly patients to avoid exposure to high
Atropine is given before surgery to: temperature or strenuous exercise to prevent
Reduce oral and gastric secretions heat stroke. Encourage them to replace fluid
Reduce secretions in the respiratory system and sodium intake
Prevent a drop in heart rate caused by vagal Encourage wearing of dark glasses if
nerve stimulation during anesthesia experiencing sensitivity to light
Belladonna alkaloids can affect the brain
by:
1. Scopolamine ADRENERGIC DRUGS
when given with morphine or meperidine
causes drowsiness and amnesia in the Adrenergic drugs are also called
patient having surgery sympathomimetic drugs
used to treat motion sickness They produce effects similar to those produced
2. Cholinergic blockers by the sympathetic nervous system.
used to treat extrapyramidal (Parkinson-
like) symptoms caused by drugs and in
Classified into two groups:
treating Parkinson’s disease
Catecholamines
Noncatecholamines
Belladonna alkaloids have important
Divided according to how they act:
therapeutic effects on the heart by:
a. Direct-acting
1. Atropine is the drug of choice to treat:
Drug acts directly on the organ or tissue
a. Symptomatic Sinus Bradycardia
innervated by the SNS
b. Arrhythmias resulting from anesthetics
b. Indirect-acting
Cholinergic blockers are used as cycloplegics: Drug triggers the release of a
a. Paralyze the ciliary muscle of the eye neurotransmitter, usually
b. Alter the shape of the lens of the eye norepinephrine
Cholinergic blockers are used as mydriatics: c. Dual-acting
a. Dilate the pupils of the eye – easier to Can act both directly and indirectly
measure refractive errors during an eye Therapeutic use of adrenergic drugs depend on
exam or to perform eye surgery. which receptors they stimulate and to what
Adverse Reactions degree.
a. Can affect the ff. receptors:
Dry mouth Alpha-adrenergic receptors
Reduced bronchial secretions Beta-adrenergic receptors
Tachycardia Dopamine receptors
Decreased sweating
Blurred vision
Most adrenergic drugs produce their effects by Norepinephrine has nearly pure alpha
stimulating alpha and beta receptors – mimic activity
the action of epinephrine and norepinephrine. Dobutamine and isoproterenol have only
Dopaminergic drugs act primarily on receptors beta- related activity
in the SNS stimulated by dopamine. Epinephrine stimulates alpha receptors and
beta receptors
Catecholamines Dopamine primarily exhibits dopaminergic
activity.
Common properties:
Stimulate the nervous system Alpha adrenergic drugs:
Constrict peripheral blood vessels Treat hypotension caused by relaxation of
Increase heart rate the muscles of the blood vessels (loss of
Dilate the bronchi vasomotor tone) and blood loss due to
Common catecholamines: hemorrhage.
Dobutamine ( Dobutrex) Beta1 adrenergic drugs:
Dopamine ( Intropin) Treat bradycardia, heart block, paroxysmal
Epinephrine ( Adrenaline) atrial or nodal tachycardia, ventricular
Norepinephrine (Levarterenol, Levophed) febrillation, asystole, and cardiac arrest.
Isoproterenol ( Isuprel) Beta2 adrenergic drugs:
treat acute and chronic bronchial asthma,
Pharmacokinetics emphysema, bronchitis, and acute
hypersensitivity reactions to drugs.
Cannot be taken orally because they are
Dopamine:
destroyed by digestive enzymes.
used in low doses to improve blood flow to
Rapidly absorbed through the mucous
the kidneys because it dilates the renal
membrane if given sublingually.
blood vessels.
Pharmacodynamics Manufactured catecholamines:
have a short duration of action, which can
Catecholamines are primarily direct-acting. limit their therapeutic usefulness.
Cause either excitatory or inhibitory effect:
Activation of alpha receptors generates an Adverse Reactions
excitatory response except for intestinal
Restlessness
relaxation.
Anxiety
Activation of beta receptors mostly
Dizziness
produces an inhibitory response except in
Headache
the cells in the heart, where norepinephrine
Palpitations
produces excitatory effects.
Arrhythmias
Clinical effects depend on the dosage and the Hypotension
route of administration. HPN and hypertensive crisis
Catecholamines are potent inotropes – makes Stroke
the heart contract more forcefully Angina
called: inotropic effect. Hyperglycemia
Also produce a positive chronotropic effect – Tissue necrosis at injection site (I.V. dose leaks
cause the heart to have regular rhythm and fast into the surrounding tissue)
rate.
As catecholamines cause vasoconstriction and Non-Catecholamines
rise of blood pressure, the heart rate can fall as Varied effects on the body:
the body tries to prevent excessive rise in blood
pressure. Local or systemic vasoconstriction:
Mephentermine
Pharmacotherapeutics
Metaraminol
Therapeutic use depends on the particular Methoxamine
receptor activity that is activated. Phenylephrine
Nasal and eye decongestion and bronchiolar Adverse Reactions
dilation:
Headache
Albuterol
Restlessness
Ephedrine
Anxiety or euphoria
Isoetharine
Irritability
Metaproterenol
Trembling
Terbutaline
Drowsiness and insomnia
Smooth muscle relaxation
Light-headedness
Ritodrine
Incoherence
Terbutaline
Seizures
Pharmacokinetics Hypertension
Hypotension
Absorption and Distribution Palpitations
Inhaled drugs (Albuterol) – gradually absorbed Bradycardia
from the bronchi of the lungs and result in Arrhythmias
lower drug levels in the body. Cardiac arrest
Oral drugs are absorbed well from the GIT. Irregular heart rate and blood pressure in
Ephedrine cross the BBB and can be found in pregnant woman and fetus
high concentrations in the brain and CSF. Coldness or tingling
Pallor or flushing
Metabolism Angina
Cerebral hemorrhage
Occur primarily in the liver but can also occur
in the lungs, GIT, and in other tissues. Nursing Diagnoses
Excretion Ineffective Tissue Perfusion related to
hypovolemia, blood loss, impaired
Drug and metabolites are excreted primarily in
distribution of fluid, impaired circulation,
the urine.
impaired transport of oxygen across alveolar
Acidic urine increases excretion
and capillary bed, other (specify)
Alkaline urine slows excretion
Decreased Cardiac Output related to
Pharmacodynamics altered heart rate and/or rhythm
Imbalanced Nutrition: Less Than Body
Can be direct-acting, indirect-acting, or dual-
Requirements related to adverse reaction
acting
(anorexia) to the drug
Direct-acting that stimulates alpha activity:
Disturbed Sleep Pattern related to
Methoxamine and phenylephrine
adverse reactions (insomnia, nervousness)
Selective to Beta2 activity: to the drug
Albuterol, isoetharine, metaproterenol,
ritodrine, and terbutaline Nursing Responsibilities:
Indirect-acting:
Monitor v/s
Phenylpropanolamine
Monitor urinary output and assess bladder for
Dual-acting: distention
Ephedrine, mephentermine, metaraminol Report S/E
Pseudoepherine Offer foods to avoid nausea & vomiting
Pharmacotherapeutics With dopamine, check IV site frequently
because infiltration causes necrosis [antidote –
Metaraminol causes vasoconstriction – used to Regitine (Phentolamine Mesylate)]
treat hypotension in severe shock
Ritodrine is used to stop preterm labor
ADRENERGIC BLOCKING DRUGS Bradycardia or tachycardia
Edema
Also called sympatholytic drugs
Difficulty of breathing
Used to disrupt the SNS function
Light-headedness
Blocks impulse transmission at adrenergic
Flushing
neurons or adrenergic receptor sites by:
a. Interrupting the action of adrenergic drugs Arrhythmias
b. Reducing available norepinephrine Angina
c. Preventing the action of cholinergic drugs Heart attack
Classified according to their site of Vasospasms
action: Shock-like state
1. Alpha-adrenergic blockers
Nursing Responsibilities:
2. Beta-adrenergic blockers
Encourage to take as prescribed & not to
Alpha-Adrenergic Blockers
abruptly stop taking the medication
Interrupt the actions of epinephrine and Avoid over the counter medications
norepinephrine at alpha receptors. Avoid alcohol ingestion
Results in: Avoid hazardous activities until stable blood
Relaxation of the smooth muscle in the levels are achieved
blood vessels Report weight gain of more than 1 kg / week
Increase vasodilatation Beta-Adrenergic Blockers
Decrease blood pressure
Representative drugs: Most widely used adrenergic blockers
Ergoloid mesylates Prevent stimulation of the SNS by inhibiting the
Ergotamine action of catecholamines at beta- adrenergic
Phenoxybenzamine receptors
Phentolamine Commonly called Beta Blockers
Prazosin Can be selective or non-selective
Ergotamine is a mixed alpha agonist and Nonselective drugs affect:
antagonist and acts as an alpha blocker at high Beta1 receptor sites – located mainly in the
doses. heart
Beta2 receptor sites – located in the
Pharmacodynamics
bronchi, blood vessels, and uterus
Alpha blockers interfere with the synthesis, Include: Carvedilol, Labetalol, Levobunolol,
storage, release, and reuptake of Penbutolol, Pindolol, Sotalol, Nadolol,
norepinephrine by neurons. Propranolol, and Timolol.
They antagonize epinephrine, norepinephrine, Selective beta blockers primarily affect
or adrenergic drugs at alpha receptor sites. the Beta-1 sites only:
Acebutolol
Pharmacotherapeutics Atenolol
Alpha blockers cause smooth muscles to relax Betaxolol
and blood vessels to dilate, thus, increase local Bisoprolol
blood flow to the skin and other organs and Esmolol
reduce blood pressure. Metoprolol tartrate
Used to treat: Pharmacodynamics
1. Hypertension
2. Peripheral vascular disorders Beta blockers have widespread effects in the
3. Pheochromocytoma body
Produce blocking action not only at adrenergic
Adverse Reactions nerve endings but also in the adrenal medulla
Orthostatic hypotension Effects on the heart:
Severe hypertension Increased peripheral vascular resistance
Decreased blood pressure
Decreased force of cardiac contraction
Nursing Responsibilities:
Decreased oxygen consumption of the heart
Slowed conduction of impulses between Encourage to always take meds as prescribed,
atria and ventricles of the heart no more, no less
Decreased cardiac output Instruct to never abruptly stop the medication
Selective beta1 blockers are cardio-selective Change position slowly or avoid sudden change
beta blockers because they reduce stimulation of position
of the heart. Report constipation, urinary hesitancy or
Nonselective beta blockers not only reduce bladder distention
stimulation of the heart but also cause
bronchiolar constriction – leading to
bronchospasms, especially in patients with
COPD. –which is not seen with cardio-selective
beta blockers.
Pharmacotherapeutics
Adverse Reactions
Hypotension
Bradycardia
Heart failure
Peripheral vascular insufficiency
Bronchospasm
Diarrhea or constipation
Nausea and vomiting
Abdominal distention and flatulence
Anorexia
Skin rashes
Respiratory distress due to allergic reaction
Nursing Diagnoses