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Autonomic Nervous System

Autonomic Nervous System. Sympathetic (Adrenergic) Parasympathetic (Cholinergic) Have a balancing effect. Neurotransmitters. Acetycholine (ACH) Norepinephrine (NE) Epinephrine Dopamine. Receptors. Alpha 1 & 2 Beta 1 & 2 Muscarinic Nicotinie. Sympathetic Response. Increase HR

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Autonomic Nervous System

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  1. Autonomic Nervous System • Sympathetic (Adrenergic) • Parasympathetic (Cholinergic) • Have a balancing effect

  2. Neurotransmitters • Acetycholine (ACH) • Norepinephrine (NE) • Epinephrine • Dopamine

  3. Receptors • Alpha 1 & 2 • Beta 1 & 2 • Muscarinic • Nicotinie

  4. Sympathetic Response • Increase HR • Increase RR • Increase metabolic rate • Increase fat & glycogen breakdown • Pupillary dilation • Smooth muscle vasoconstriction • Skeletal & cardiac muscle vasodilation • Decrease GI activity • Bronchial relaxation

  5. Parasympathetic Response • Decrease HR • Decrease RR • Increase digestion & elimination • Increase GI tone • Bronchial constriction • Pupillary constriction

  6. Cholinergic Agonist (Direct Acting) • Stimulates cholinergic receptors • bethanechol chloride (Duvoid, Urecholine) * decreases urinary retention *antidote is atropine • pilocarpine (Pilocar) * increases outflow aqueous humor (open angle glaucoma) * pupillary constriction (miosis) & decrease visual acuity *headache

  7. Nicotine • Stimulates nicotine receptors • Used for cessation of tobacco smoking • Cannot smoke when using patch

  8. Antichoinesterase (Indirect-acting Cholinergic Agonists • Inhibits enzyme acetlycholinesterase • Results in decrease destruction of ACH • Which results in increase cholinergic action • Neostigmine (prostigmin)

  9. Cholinergic Blockers (anticholergic) • Interrupts parasympathetic nerve impulses • Relaxes GI & urinary tract muscles & decrease GI secretions • Counteracts bronchospasm & decrease respiratory secretions • Decrease salivation • Blocks cardiac vagal inhibitions

  10. Atropine(cholinergic antagonist) • Blocks actions of ACH at muscarinic receptors • blocks vagal effects of SA node (tx bradycardia) • preoperative - decrease salivation & respiratory tract secretions • bronchodilator • watch for tachycardia, urinary retention, constipation, dry mouth

  11. Scopolamine • Produces CNS depression with sedative & tranquilizing effects • Used to tx motion sickness

  12. Anticholinergic Overdose • “mad as a hatter (CNS psychotic effect), dry as a bone (salivary), red as a bat (peripheral vasodilation), & blind as a bat (mydriasis)

  13. Adrenergic Receptors • Alpha-1 & alpha-2 are differentiated by location on nerve, alpha -1 causes vasoconstriction • Beta - 1 primarily located in heart, causes cardiac stimulation • Beta - 2 located in smooth muscle of bronchioles, arterioles and visceral organs, relaxation of bronchial & GI • Side effects - alpha & beta may have headache, insomnia, restlessness, tachycardia, hypertension, N&V

  14. Summary with receptors • Alpha - 1 = vasoconstriction • beta - 1 = cardiac stimulation • beta - 2 = bronchiole dilation

  15. Alpha-1 Adrenergic Agonist • Phenylephrine: most common use is as decongestant, treat nasal congestion • Side effects: sleep disturbances, headache

  16. Epinephrine (nonselective) (Adrenergic Agonist) • Increases heart rate & CO • Increase in blood sugar • Bronchiole dilation • Indicated for anaphylaxis, cardiac arrest, asthma

  17. Beta Adrenergic Agonist • Isoproterenal (Isuprel) • Increase contractility & heart rate • Bronchodilator • Indicated in asthma, bradycardia, cardiac arrest • Dopamine (Intropin) • Dobutamine (Dobutrex) • Proventil & Brethine, respiratory, bronchodilators

  18. Alpha Adrenergic Antagonist • Disrupts sympathetic response • Relaxation of vascular smooth muscle, peripheral vasodilation & decrease BP • prazosin (Minipress) • Used for hypertension, angina, peripheral vascular disorders • Watch for orthostatic hypotension

  19. Beta Adrenergic Blockers (antagonist) • Prevents SNS stimulation • decrease peripheral vascular resistance, decrease BP, decrease CO, decrease HR • Used to tx hypertension, angina, arrhythmias

  20. Beta Blockers • Need to know whether cardioselective or nonselective • Beta - 1 blockers will decrease myocardial contractility& HR, Lopressor (metoprolol) & Tenormin (atenolol) • Nonselective - blocks beta - 1 and beta -2 which causes above & bronchiole constriction

  21. Propranolol (Inderal)Nonselective Beta Blocker • Important to ask if history of asthma, bronchitis, etc. • Decrease HR so must check rate prior to giving • client may experience decrease libido or impotence • watch for orthostatic hypotension

  22. Combined blocker • Carvedilol (Coreg) • Combined alpha and beta blocker • Frequently administered with other antihypertensive agents. • Watch for orthostatic hypotension & bradycardia

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