Autonomic Nervous System Flashcards
Adrenergic
Refers to the SNS
Cholinergic
refers to the PSNS
Parasympathetic
-Components
Release Acetylcholine from both pre and post ganglionic sites
Sympathetic components
Release Acetylcholine from pre ganglion and
NorEpinepherine from post ganglionic site
Adrenergic Receptors
-Alpha 1 & 2
- Arteriole constriction
- Pupil dilation
- GI smooth muscle relaxation
Adrenergic Receptors
-Beta 1
- Increase heart Rate
- Increase contractility
- Increase automaticity & conduction
Adrenergic Receptors
-Beta 2
- Bronchodilation
- Arteriole constriction
- Glycogenolysis
Adrenergic’s
-Therapeutic Uses
- Hemodynamic compromise
- Shock, acute CHF, arrhythmias - Bronchospasms, asthma
- Nasal and sinus congestion
Specific Adrenergic drugs
- Epinephrine / norepinephrine
- Phenylphrine
- Dopamine
- Albuterol
- Pseudoephedrine (Sudafed)
Adrenergic
-contraindications / precautions
- Narrow-angle glaucoma
- pheochromocytoma
Use caution w/:
-Heart disease, CAD, arrhythmias, CHF, peripheral vascular disease
Adrenergic’s
-Drug interactions
Any Med that would stimulate the CNS
- MAOI’s
- Alcohol
- tricyclic antidepressants
- theophylline
- Atropine
- Antihistamines
- Any alpha or beta blockers
Adrenergic’s
-Adverse Reactions
- Nervousness/ tremor/anxiety
- Dysrhythmias
- Hypertension
- Cardiac ischemia
- Elevated glucose levels
- pupil dilation
- tissue necrosis
- Headache, insomnia / GI and bladder involvement
Adrenergic
-Implications
- Monitor BP, HR, anginal pain
2. Teach pt’s w/ CAD to watch OTC meds
Adrenergic Antagonists (Therapeutic Uses) -Hypertension
Alpha and beta 1, beta 2
Adrenergic Antagonists (Therapeutic Uses) -Tachycardias
beta 1
Adrenergic Antagonists (Therapeutic Uses) -Congestive heart disease
beta 1
Adrenergic Antagonists (Therapeutic Uses) -Angina
beta 1
Adrenergic Antagonists (Therapeutic Uses) -pupil constriction
Beta
Adrenergic Antagonists (Therapeutic Uses) -Increase peripheral blood flow
Alpha
Beta 2
Adrenergic Antagonists (Therapeutic Uses) -BPH
Alpha
Adrenergic Antagonists (Therapeutic Uses) -Migraine Headache
Alpha
Atenolol
- Adrenergic Antagonists treats:
- Hypertension, AMI, arrhythmia
Inderal
- Adrenergic antagonist that treats migraine’s
Adrenergic Antagonist’s
-Contraindications
- Ischemic Heart disease
- Hypotension
- Asthma (extreme caution)
- Diabetes (caution)
- Some dysrhythmias
Adrenergic Antagonist’s
-Adverse Reactions
- Hypotension (orthostatic)
- Bradycardia (tachycardia w/ alpha)
- Bronchoconstriction
- Hypoglycemia
- Fatigue/weakness
- GI upset (increased motility)
- Parasympathetic
Adrenergic Antagonist’s
-Implications/Teaching
- Do not discontinue abruptly
- Monitor for orthostatic hypotension, change position slowly
- Avoid alcohol, sedatives
- Watch BP, P, R
- Evenly dose around the clock
- Report GI or sexual adverse effects
Cholinergic Agents
-Receptor sites include..
- Muscarinic
- CNS, heart, smooth muscle of organs (GI), glands - Nicotinic
- Skeletal muscle, CNS
Cholinergic Agents
-Direct Action
Stimulates Muscarinic receptors sites (cholinergic Agonist)
Cholinergic
-Indirect Action
Prevents Ach degradation at synapses (cholinesterase inhibitor)
Cholinergic
-Therapeutic Uses (DIRECT ACTING)
- Urinary retention
2. GI tract Symptoms
Cholinergic (INDIRECT ACTING)
-Therapeutic Uses
- Restore skeletal muscle function
- Treatment & diagnosis of myasthenia gravis
- Differentiates bt myasthenia and Cholinergic crisis
- Slowing of Alzheimer’s disease
Cholinergic’s
-Specific Medications
- Bethanechol (urinary retention)
- Metoclopramide (Reglan) (GI motility)
- Edrophonium chloride (Tensilon)
- diagnosis of myasthenia gravis
Cholinergic’s
-Contraindications
- Bradycardia
- Hypotension
- Urinary tract or intestinal obstruction
- Asthma
Cholinergic
-ANTIDOTE TEST
- Atropine is the antidote for cholinergic overdose
2. Alcohol and CNS depressants enhance sedation
Cholinergic’s
-Adverse Effect
- Sedation and drowsiness
- Hypotension w/ tachycardia
- Excessive salivation
- GI symptoms, Diarrhea, cramping, abdominal pain
- Life threatening pulmonary effects
- Excessive secretions can cause drowning in fluid **
Cholinergic’s
-Implications and Teaching
- When treating GI symptoms, give 30 min before meal
- Watch cholinergic overdose
- Have ATROPINE at bedside when doing a TENSILON TEST
- Watch for respiratory complications
Anticholinergics
- Mimics sympathetic effects
2. Blocks Ach at muscarinic receptors
Anticholinergic’s
-Therapeutic Uses
- Dry up secretions - mostly pulmonary and salivary
- Decrease motility GI and GU
- Dilation of pupils
- Parkinson disease symptom Control
- Treat bronchospasm
- Treat CHOLINERGIC CRISIS
Anticholinergic’s
-Contraindications
- Narrow-Angle glaucoma
- Myasthenia gravis
- Coronary artery disease (caution)
Anticholinergic’s
-Drug Interactions
- Antihistamines
- Tricyclic antidepressants
- Antacids
Basic Nervous system Functions
- Balance
- Survival
- Control
- Pleasure and enjoyment
- Cognitive ability
Anticholinergic’s
-Adverse Effects
- Dryness (mouth, eyes)
- Decreases GI and GU motility
- Hypertension
- Drowsiness, nervousness
- Blurred vision
- Palpitations and confusion
ANS Summary
- A balance exists between the sympathetic and parasympathetic
- Med’s can cause an imbalance in this relationship as well as correct the balance
- The receptor site affected determines the outcome of the med seen clinically
Anticholinergic’s
-Implications/Teaching
- Give antacids one hour between anticholinergics
- Provide oral care
- Watch for sedative reaction w/ meds
- Watch for urinary retention & constipation
- KNOW HOW TO PROPERLY GIVE ATROPINE
ANS Divisions
Nervous System
CNS PNS
Somatic Autonomic
SNS PNS
Bethanechol
Cholinergic drug used for urinary retention
Metoclopramide (Reglan)
Cholinergic Drug used for GI motility
Edrophonium chloride (TENSILON)
Diagnosis of myasthenia gravis