NS

CNS         PNS

  BRAIN   SPINE ANS               SNS

          SYMP.            PARASYMP

What does the PNS consist of?

Cranial and spinal nerves.

Autonomic and somatic nervous systems.

Branch of the PNS.

Voluntary system.

Autonomic NS

1. AKA

2. What it does.

3. Control by?

4. Pathway

1. Visceral NS.

2. Regulates organ function and maintains homeostasis (NOT voluntary).

3. CNS

4. Preganglion: CNS to a ganglion (thoracic and lumbar of spine)

    Postganglion: ganglion to effector organ.

Acetylcholine (ANS)

1. Receptors; divided into?

2. Synthesis

3. Released by?

1. cholinergic (parasym); muscarinic & nicotinic

2. choline

3. sweat glands & skeletal muscles

Norepinephrine (ANS)

1. Receptors

2. Synthesis

3. How is the action terminated?

1. Adrenergic (Sympathetic)

2. Tyrosine

3. Reuptake

Sympathetic Actions (Adrenergic)

1. Lion example

2. 5 actions

1. Running from Lion; fight or flight

2. Dilation: pupils, bronchi

3. Inhibition: saliva, peristalsis/secretion, bladder

4. Increased heart beat

5. create blood sugar

6. secretion: adrenaline/noradrenaline

Parasympathetic (Cholinergic) Actions

1. Lion example

2. 4 actions

1. Once you've gotten away from lion; rest

2. Stimulation: saliva, peristalsis/secretion, bile release

3. Bladder contraction

3. Constriction: Bronchi

4. Slow heart beat

PNS -> ANS -> Sympathetic (Adrenergic)

Alpha1, Alpha2, Beta1, Beta2, Dopamine

Alpha1

1. Receptor activated

2. Uses

3. Adverse

1. Blood, iris, and bladder

2. *Treat nasal decongestion

*Decrease intraocular pressure

Control topical superficial bleeding

Delay anesthetic absorption

3. *Hypertension

Necrosis with extravasation

Alpha2

1. Receptor activated

2. Uses

3. Adverse effects

1. Nerve membranes

2. Treat: glaucoma, HTN (dec. NE)

3. Burning sensation, Ptosis, redness & swelling of eyelid

Beta 1

1. Receptor activated

2. Uses

3. Adverse Effects

1. Heart

2. Stimulate HR/CO

Treat HF, cardiac arrest & shock.

3. Tachycardia (rapid pulse), angina, and arrhythmia (over stimulation).

Beta 2

1. receptor activated

2. uses

3. adverse effects

1. Lungs (blood vessels)

2. Bronchodilation & delay preterm labor

3. hyperglycemia & tremors

Dopamine

1. receptor activated

2. uses

3. adverse effects

1. kidneys & adrenal gland

2. Increase: renal flow, CO, & BP

3. Ectopy (unusual HB), NV, tachycardia and palpitations

Inclused rest and digest responses.

a. Direct: stimulate cholinergic receptor/ occupy ACh sit (postganglion)

b. Indirect: Stimulate receptor site; remove ACh enzyme (prevent ACh breakdown)

Allows sympathetic system to dominate.

Competes with ACh for muscarinic ACh receptor sites.

Comes from the Belladonna plant.

Alpha- & Beta- Adrenergic Agonists:

Drugs & function (6)

1. *Epinephrine (Adrenalin/Susphrine): Treat: shock & glaucoma; prolong anesthetics.

2. *Norepinephrine (Levophed): Treat: shock & cardiac arrest.

3. *******Dopamine (Intropin) & Isoproternol: Treat: shock; increase NE

4. Dobutamine (Dobutrex): CHF

5. Metaramino (Aramine): Shock & cardiac arrest

6. Ephedrine (Prez-D): Seasonal rhinitis & hypotensive episodes

Alpha- & Beta- Adrenergic Agonists:

Actions (6)

1. mediated by receptors in target organs.

2. HR increase

3. bronchodilation

4. vasoconstriction

5. intraocular pressure decreases

6. glycogenolysis

Alpha- & Beta- Adrenergic Agonists:

Indications (3)

1. Treat hypotensive shock

2. bronchospasm

3. some types of asthma

Alpha- & Beta- Adrenergic Agonists:

Adverse Rxns (5-4)

1. Arrhythmias

2. Hypertension

3. Palpitations

4. Angina

5. Dyspnea

6. Nausea

7. Vomiting

8. Headache

9. Sweating

Alpha- & Beta- Adrenergic Agonists:

Drug-to-drug Interactions (2)

1. Tricyclic antidepressants

2. MAOIs

Alpha-agonists:

Drugs (3)

1. ******Phenylephrine (Neo-Synphrine)

2. Midorine (ProAmantine)

3. Clonidine (Catapres) A2: Hypertension & decongestion

1. Hypertension

2. Constriction of topical vessels in nose

1. Well absorbed (peak lvls: 20-45 mins)

2. Widely distributed in body

3. metabolized in liver and excreted in urine

1. anxiety

2. restlessness

3. depression

4. fatigue

5. blurred vision

6. bad dreams

7. ECG changes

8. arrhythmias

9. bp changes

10. NV

11. Decreased urinary output

1. MAOIs

2. TCAs

3. digoxin

4. beta-blockers

1. **severe hypertension or tachycardia

2. allergy to drug

3. narrow angle glaucoma

4. pregnancy

1. CVD

2. vasomotor spasm

3. thyrotoxicosis

4. diabetes

Beta-Agonist:

Drugs (2)

1.****Isoproterenol (Isuprel): Treat: shock, cardiac standstill, heart block; Prevent: bronchospasm during anesthesia (inhaled)

2. Ritodrine (Yutopar): Manage preterm labor

1. Increase: HR, BP, conductivity, and contractility

5. Bronchodilation

6. increase blood flow to: skeletal muscles & spalnchnich bed

8. relax uterus

1. Increased with other sympathomimetic drugs

2. decreased with beta-adrenergic BLOCKERS

1. Diabete & thyroid disease => fast HR

3. Vasomotor problems

4. heart disease and stroke

Alpha- and Beta- Adrenergic Blockers:

Drugs (5)

1. ****Abetalol (Trandate)

2. ****Carvedilol (Coreg): hypertension and CHF (reverse damage of heart)

3. Guanadrel (Hylore)

4. Guanethidine (Ismelin)

5. Labetalol (Normadyne)

Alpha- and Beta- Adrenergic Blockers:

Actions (2)

1. Prevents NE from activating Alpha- & Beta- receptors

2. Hindes s/s associated w/ Sympathetic stress rxns

Alpha- and Beta- Adrenergic Blockers:

Indications (1)

Alpha- and Beta- Adrenergic Blockers:

Contraindications (2-2)

1. Bradycardia

2. heart block

3. shock

4. CHF

Alpha- and Beta- Adrenergic Blockers:

Caution(2)

1. ***Bronchospasm (difficulty breathing = asthma attack)

2. Hypoglycemia (Beta 1/2 Blockers)

Alpha- and Beta- Adrenergic Blockers:

Adverse Rxns (3-2-4-1)

1. Dizziness

2. insomnia

3. fatigue

4. nausea

5. vomiting

6. arrhythmias

7. hypotension

8. chf

9. pulmonary edems

10 bronchospasm

Alpha- and Beta- Adrenergic Blockers:

drug-to-drug interactions (3)

1. anesthetics

2. diabetic agents

3. calcium channgel blockers

Alpha- and Beta- Adrenergic Blockers:

Nursing teaching

1. Monitor HR

2. herbal inactions

1. Decrease sympathetic tone in vasculature

2. Cause vasodilation

3. diagnosis and management of severe hypertension during pheochromocytoma surgery

4. tumor in medulla adrenal gland

5. = release of catecholamines (NE, EPI; to inc. BP)

1. allergy

2. CAD

3. MI

1. Watch for Tachycardia

2. hypotension

3. orthostatic hypotension

4. angina

5. MI

6. CVA

7. arrhythmia

8. weakness

9. dizziness

1. Ephedrine

2. epinephrine

3. alcohol

A1- Blockers:

Drugs (4)

1.****Doxazosin (Cardura)

2. Tamsulosin (Flowmax): treat BPH

3. Prazosin (minipress): treat hypertension

4. Terazosin (Hytrin): treat hypertension and BP

1. Block postsynaptic a1-receptor site

2. decrease: vascular tone and vasodilation

1. BPH (trouble voiding)

2. Hypertension

1. dizziness

2. weakness

3. fatigue

4. nausea

5. vomiting

6. abdominal pain

7. diarrhea

8. arrhythmias

9 hypotension

10. edema

11. CHF

12. angina

Beta- Blockers:

Drugs (1)

Beta- Blockers:

Actions (1)

Beta- Blockers:

Indications (3-1-1)

1. Hypertension

2. angina

3. preventing reinfarction after MI

3. migraine

4. headaches

Beta- Blockers:

Cautions (1-1-1-1)

1. diabetes (hypoglycemia)

2. hepatic dysfunction

3. If stopped abruptly, you'll have hypersensitive effect; has to be gradual.

4.*** Never give if pulse is < 60.

Beta- Blockers:

Adverse Rxns (4-3-1-3-1)

1. **** Fatigue

2. dizziness

3. depression

4. sleep disturbances

5. bradycardia

6. heart block

7. hypotension

8. bronchospasm

9. nausea

10. vomiting

11. diarrhea

12. ****decreased libido

Beta- Blockers:

drug-to-drug interactions (3)

1. Clonidine (antihypertensive)

2. NSAIDs

3. Insulin or antidiabetic medications

Beta 1- Blockers:

Drugs (1)

1. Doesn't effect B2 or bronchodilation

2. smokes

3. asthmatics

4. OPD

5. seasonal/allergic rhinitis

1. hypertension

2. angina

3. cardiac arrhythmias

1. allergy

2. sinus bradycardia

3. heart block

4. cardiogenic shock

5. CHF

6. hypotension

1. COPD

2. diabetes

3. thyroid disease

1. ***Fatigue

2. dizziness

3. sleep disturbances

4. bradycardia

5. heart block

6. hypotension

7. CHF

8. Bronchospasm

9. rhinitis

10. nausea

11. vomiting

12. diarrhea

13. decreased: libido & impotence

1. NSAIDs

2. IV lidocaine

Direct Cholinergic Agonist:

Drugs (2)

1.**** Bethanecho (Urecholine)

2. Carbachol (Miostat): **Pupil constriction; relieve intraocular pressure of glaucoma; surgical procedures; induce miosis

1. increase bladder muscle tone by relaxing bladder sphincter

2. improve bladder function

3. increase urination

1. Well absorbed & short half life

2. metabolism-excretion unknown

1. any condition exacerbated by parasympathetic effects: Bradycardia and hypotension

2. PUD

3. intestinal obstruction or GI surgery

4. asthma

5. bladder obstruction

6. epilepsy and parkinsonism

1. pregnancy and lactation

2. ***MAY LEAD TO LOSS OF BOWEL AND BLADDER CONTROL

1. NV, cramps, diarrhea, involuntary defacation

2. bradycardia, heart block and hypotension

3. ****URINARY URGENCY

4. flushing, increased sweating, and increased salivation

Indirect Cholinergic Agonist: Myasthenia Gravis

Definition

1. chronic muscular disease (defect in neuromuscular transmission)

2. autoimmune disease (antibodies to ACh receptors

1. progressive weakness

2. lack of muscle control w/ periodic acute episodes

1. Pyridostigmine (Mestinon): long duration; reverse nerve gas

2. Edrophonium (tensilon): diagnostic agent

1. Neurofibrilliary tangles w/ T protein

2. Neuritic plaques w/ B-amyloid protein (sticky buildup outside nerve cells).

1. memory failure

2. personality changes

3. difficult w/ ADLs

4. communication, metabolism, repair

- Acetylcholinesterase Inhibitors

1.****Donepezil (Aricept): once-a-day

2. Tacrine (Cognex): first to treat dementia

3. Galantamine (reminyl): stops progression of alzheimer's

4. Rivastigmine (exelon): solution for swallowing ease

1. allergy

2. Bradycardia

3. intestinal or urinary tract obstruction

4. lactation

Indirect Cholinergic Agonist: Myasthenia Grave & Alzheimer's Disease

1. any condition that could be exacerbated by cholinergic stimulation

2. asthma

3. coronary disease, arrhythmias, epilepsy, parkinsonism

4. peptic ulcer

Indirect Cholinergic Agonist: Myasthenia Grave & Alzheimer's Disease

1. bradycardia & hypotension

2. Increased: GI secretions/activity, bladder tone

3. relaxation of GI and genitourinary sphinters

4. bronchoconstriction

5. pupil constriction

Anticholinergics:

Drugs

1. ****Atropine

2. Dicyclomine (antispas): relax GI, IBS

3. Glycopyrrolate (robinul): ulcer treatment

4. Propantheline (pro-banthine): ulcer treatment

5. Scopolamine: motion sickness (q72 hours)

1. restore cardiac rate & BP

2. decrease preop. secretions

3. reduce pylorospasm & IBS

4. relax uterine hypertonicity

5. pupil dilation

6. cycloplegia

7. dilate bronchi

1. allergy

2. conditions exacerbated by blocking PNS: glaucoma, PUD, prostatic hypertrophy, bladder obstruction

1. phenothiazines

2. drugs w/ anticholinergic activity (antihistamines, antiparkinsons, etc)

1. blurred visions and photophobia

2. mydriasis

3. cycloplegia

4. palpitations and tachycardia

5. dry mouth and altered taste perception

6. urinary hesitancy and retention

7. decrease sweating and predisposition to heart prostration