1、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 Increase RR Increase metabolic
2、rate Increase fat & glycogen breakdown Pupillary dilation Smooth muscle vasoconstriction Skeletal & cardiac muscle vasodilation Decrease GI activity Bronchial relaxation,Parasympathetic Response,Decrease HR Decrease RR Increase digestion & elimination Increase GI tone Bronchial constriction Pupillar
3、y constriction,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
4、 visual acuity *headache,Nicotine,Stimulates nicotine receptors Used for cessation of tobacco smoking Cannot smoke when using patch,Antichoinesterase (Indirect-acting Cholinergic Agonists,Inhibits enzyme acetlycholinesterase Results in decrease destruction of ACH Which results in increase cholinergi
5、c action Neostigmine (prostigmin),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,Atropine (choli
6、nergic 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,Scopolamine,Produces CNS depression wit
7、h sedative & tranquilizing effects Used to tx motion sickness,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),Adrenergic Receptors,Alpha-1 & alpha-2 are differentiated by location on nerv
8、e, 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, hyper
9、tension, N&V,Summary with receptors,Alpha - 1 = vasoconstriction beta - 1 = cardiac stimulation beta - 2 = bronchiole dilation,Alpha-1 Adrenergic Agonist,Phenylephrine: most common use is as decongestant, treat nasal congestion Side effects: sleep disturbances, headache,Epinephrine (nonselective) (A
10、drenergic Agonist),Increases heart rate & CO Increase in blood sugar Bronchiole dilation Indicated for anaphylaxis, cardiac arrest, asthma,Beta Adrenergic Agonist,Isoproterenal (Isuprel) Increase contractility & heart rate Bronchodilator Indicated in asthma, bradycardia, cardiac arrest Dopamine (Int
11、ropin) Dobutamine (Dobutrex) Proventil & Brethine, respiratory, bronchodilators,Alpha Adrenergic Antagonist,Disrupts sympathetic response Relaxation of vascular smooth muscle, peripheral vasodilation & decrease BP prazosin (Minipress) Used for hypertension, angina, peripheral vascular disorders Watc
12、h for orthostatic hypotension,Beta Adrenergic Blockers (antagonist),Prevents SNS stimulation decrease peripheral vascular resistance, decrease BP, decrease CO, decrease HR Used to tx hypertension, angina, arrhythmias,Beta Blockers,Need to know whether cardioselective or nonselective Beta - 1 blocker
13、s will decrease myocardial contractility& HR, Lopressor (metoprolol) & Tenormin (atenolol) Nonselective - blocks beta - 1 and beta -2 which causes above & bronchiole constriction,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,Combined blocker,Carvedilol (Coreg) Combined alpha and beta blocker Frequently administered with other antihypertensive agents. Watch for orthostatic hypotension & bradycardia,
