Drugs affecting the_sympathetic_nervous_system
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Transcript of Drugs affecting the_sympathetic_nervous_system
AUTONOMIC NERVOUS SYSTEM AGENTS
Nelia B. Perez RN, MSN
PCU – Mary Johnston College of Nursing
1. Drugs that stimulate the sympathetic nervous system are called
a. adrenergics
b. Cholinergics
c. Analeptics
d. benzodiazepines
2. The sympathetic neurotransmitters are norepinephrine and epinephrine.
a. true
b. false
3. These receptors are found predominantly in the smooth muscle membrane.
a. alpha adrenergic receptors
b. Alpha 2 adrenergic receptors
c. Beta adrenergic receptors
d. Beta2 adrenergic receptors
4. The most important clinical effect of this drug is contraction of smooth muscles.
a. beta adrenergic drugs
b. Anxiolitics
c. Alpha-adrenergic Drugs
b. Anticholinergics
• Most important clinical effect is contraction of smooth muscles.
5. A beta2 adrenergic drug which is primarily used as a bronchodilator.
a. Epinephrine
b. Norepinephrine
c. albuterol
d. ephedrine
6. When used as a Beta1 Adrenergic drug, it causes over-stimulation of the heart.
a. Norepinephrine
b. Epinephrine
c. Ephedrine
d. isoetharine
7. It is a Neurotransmitter in the brain and serves as a precursor in the synthesis of norepinephrine. a. Dopamineb. Dobutaminec. Epinephrined. Ephedrine
8. It antagonizes the effect of Norepinephrine and epinephrine which results in vasodilatation and thus decrease in BP.
a. Alpha-adrenergic blocking drugs
b. Alpha2-adrenergic blocking drugs
c. Beta-adrenergic blocking drugs
d. Beta2-adrenergic blocking drugs
9. It leads to a decrease in sympathetic response resulting in decrease heart rate and force of contraction.
a. Alpha-adrenergic blocking drugs
b. Alpha2-adrenergic blocking drugs
c. Beta-adrenergic blocking drugs
d. Beta2-adrenergic blocking drugs
10. Adrenergic neuronal blockers are those which
a. interfere with the formation and or storage of NE
b. Blocks the synthesis of epinephrine
c. Dilates blood vessels in hypertension
d. Serves as bronchodilators
Drugs Affecting the Sympathetic Nervous
System
Drugs Affecting the Sympathetic Nervous System
NE
NE
NE
NE
NE NE
Involuntary MuscleMembrane
Adrenergic nerve ending
Release
Metabolism Reuptake
MAO
Adrenergic Receptor
Drugs Affecting the Sympathetic Nervous System
AlphaReceptors
Beta 2 Receptors
Beta 1Receptors
Adrenergic Receptors
BetaReceptors
Drugs Affecting the Sympathetic Nervous System
Alpha-adrenergic Receptors
• Found predominantly on smooth muscle membrane.
• When stimulated by NE or EPI produce contraction.
• Produces vasoconstriction of most blood vessels.
Drugs Affecting the Sympathetic Nervous System
Beta-adrenergic Receptors
• Found on both cardiac and some smooth muscle membranes.
• In the heart, beta 1 receptors predominates.
• When stimulated by NE or EPI, they increase heart rate and force of contraction.
Drugs Affecting the Sympathetic Nervous System
Beta-adrenergic Receptors
• Found on smooth muscle in the bronchus and smooth muscles of blood vessels supplying muscle and the heart.
• Stimulated with EPI result in relaxation.
Drugs Affecting the Sympathetic Nervous System
Beta-adrenergic Receptors
• In smooth muscle, beta 2 receptors predominates.
• When stimulated by EPI, they produces muscle relaxation.
• Found in smooth muscles of blood vessels supplying skeletal muscle and the coronary arteries.
• Found on smooth muscle in the bronchial tree.
Drugs Affecting the Sympathetic Nervous System
Beta 1Receptors
Found on smooth muscle in the heart
Increase heart rate and force of contraction.
Drugs Affecting the Sympathetic Nervous System
Beta 2 Receptors
Found on smooth muscleof blood vessels supplyingskeletal muscle and the heart.
Found on smoothmuscle in the bronchial tree.
Vasodilatation. Bronchodilation.
Drugs Affecting the Sympathetic Nervous System
SympatholyticDrugs
SympathomimeticDrugs
SympatheticDrugs
Drugs Affecting the Sympathetic Nervous System
SympathomimeticDrugs
Alpha-adrenergic Beta- adrenergic
Selective Beta 1Adrenergic.
Selective Beta 2Adrenergic.
Drugs Affecting the Sympathetic Nervous System
Alpha-adrenergic Drugs
• NE prototype
• Most important clinical effect is contraction of smooth muscles.
• Vasoconstriction of most blood vessels leading to increase in blood pressure.
• Contraction of sphincter muscles.
Drugs Affecting the Sympathetic Nervous System
Contraction of Sphincter Muscles
GI tract Urinary Tract Eyes
Inhibits movement ofintestinal contents
Restricts passage of urine.
Mydriasis
Drugs Affecting the Sympathetic Nervous System
Alpha-adrenergic Drugs
Clinical Indications
• Hypotensive states
• Decongestion
• Pupillary dilation
Drugs Affecting the Sympathetic Nervous System
Adverse Effects
• Hypertensive crisis
• Cerebral hemorrhage
• Cardiac arrhythmias
• Irritation of the nasal sinuses or eye.
Drugs Affecting the Sympathetic Nervous System
Drug Main Use
Epinephrine To increase BP
Norepinephrine To increase BP
Pseudoephedrine Nasal decongestion
Tetrahydrozoline Ophthalmic decongestion
Drugs Affecting the Sympathetic Nervous System
Beta-adrenergic Drugs
• Stimulation of the heart
• Bronchodilation
• Relaxes uterine smooth muscle
Drugs Affecting the Sympathetic Nervous System
Drugs Classification Main Use
Epinephrine Alpha, Beta-1 and Beta-2
Vasopressor, Cardiac stimulant, bronchodilator.
Isoproterenol Beta-1 and Beta-2
Cardiac stimulant, bronchodilator.
Albuterol Beta-2 Bronchodilator.
Ritodrine Beta-2 Arrest preterm labor.
Drugs Affecting the Sympathetic Nervous System
Epinephrine
• DOC for allergic reactions
• Use in combination with local anesthetics.
• Used as a cardiac stimulant in emergencies.
• Use in the treatment of asthma.
Drugs Affecting the Sympathetic Nervous System
Adverse Effects
• CNS stimulation – tremor, restlessness, anxiety (beta effect)
• Over-stimulation of the heart (beta 1 effect)
• Lower blood pressure (beta 2 effect)
Drugs Affecting the Sympathetic Nervous System
Dopamine
• Neurotransmitter in the brain.
• Precursor in the synthesis of NE
• Stimulates dopaminergic, beta-1 and alpha-receptors.
• Use as a drug.
• Dobutamine similar to dopamine but with more Beta-1 effect.
Drugs Affecting the Sympathetic Nervous System
NE
NE
NE
NE
Tyrosine
NE
DopamineDOPA
MAO
Drugs Affecting the Sympathetic Nervous System
DOPAMINE DOSE
RECEPTORS
STIMULATED
EFFECTS
Low dose Stimulate dopaminergic receptors in the renal and mesenteric blood vessels.
Increased renal blood flow and vasodilatation.
Moderate dose Stimulates beta-1 receptors in the heart.
Increase myocardial contractility.
Higher dose Stimulate alpha-receptors Produces vasoconstriction.
Drugs Affecting the Sympathetic Nervous System
Alpha-adrenergic blocking drugs
• Binds to Alpha receptors
• Antagonizes the effects of NE and EPI
• Leads to a decrease in sympathetic response
• Resulting in vasodilatation and thus decrease in BP.
Drugs Affecting the Sympathetic Nervous System
Alpha-adrenergic blocking drugs.
Clinical Indications
• Treatment of hypertension.
• Vasodilator in treatment of Raynaud’s disease.
• Diagnosis of Pheochromocytoma.
Drugs Affecting the Sympathetic Nervous System
Alpha-adrenergic blocking drugs.
Adverse Effects
• Constriction of pupils
• Increased GI activity
• Nasal congestion
• Reflex tachycardia ( if BP is lowered too much).
Drugs Affecting the Sympathetic Nervous System
Drugs Main Use
Doxazosin Treatment of Hypertension
Prazosin Treatment of Hypertension
Phentolamine Diagnosis of pheochromocytoma.
Treatment of vascular disease.
Drugs Affecting the Sympathetic Nervous System
Beta-adrenergic blocking drugs.
• Binds to beta receptors
• Antagonizes the effects of NE and EPI
• Leads to a decrease in sympathetic response.
• Resulting in decrease heart rate and force of contraction.
Drugs Affecting the Sympathetic Nervous System
Selective Beta-1Non-selective
Beta-blockingDrugs
Drugs Affecting the Sympathetic Nervous System
Nonselective Blockers Main Use
Labetalol Hypertension
Nadolol Hypertension, Angina Pectoris
Pindolol Hypertension
Propanolol Hypertension, Angina Pectoris, arrhythmhias, migraine
Timolol Hypertension, post myocardial infarction.
Drugs Affecting the Sympathetic Nervous System
Selective Blockers Main Use
Acebutolol Hypertension, ventricular arrhythmias.
Atenolol Hypertension, Angina Pectoris
Bisoprolol Hypertension
Esmolol Supraventricular tachycardia
Metoprolol Hypertension, Angina Pectoris
Drugs Affecting the Sympathetic Nervous System
Propranolol
• Decrease heart rate
• Decrease force of contraction
• Decrease rate of conduction
• Resulting decrease in effort and work of the heart causes a decrease in oxygen consumption.
Drugs Affecting the Sympathetic Nervous System
• Oral and iv preparation
• Drug is carried directly to the liver by the portal system.
• Significant first pass metabolism.
• Lipid soluble and passes into the brain.
• Causes CNS sedation, depression and decreased central sympathetic activity.
Drugs Affecting the Sympathetic Nervous System
• Used in the treatment of angina, and various cardiac arrhythmia.
• Adverse effects include nausea, vomiting and diarrhea, bradycardia with resulting reduced cardiac function, bronchoconstriction.
• Most serious drug interactions involve therapy of beta blockers with other drugs that decrease cardiac function (cardiac glycosides, anti-arrhythmic drugs and calcium blockers).
Drugs Affecting the Sympathetic Nervous System
Adrenergic neuronal blockers
• Drugs that interfere with the formation and or storage of NE
• Alpha-methyl dopa
• Reserpine
• Guanethidine
Drugs Affecting the Sympathetic Nervous System
NE
NE
NE
NE
Tyrosine
NE
DopamineDOPA
Alpha-methyl dopa
MAO
Reserpine
Guanethidine
Drugs Affecting the Sympathetic Nervous System
Drugs Mechanism of Action Main Use
Alpha-methyl dopa Blocks formation of Dopamine
Treatment of hypertension
Reserpine Depletes NE storage granule
Treatment of hypertension
Guanethidine Block release of NE and depletes NE storage granule
Treatment of hypertension
ANS - Adrenergic Drugs Nursing Implications
Assess for allergies and history of hypertension, cardiac dysrhythmias, or other cardiovascular disease
Assess renal, hepatic, and cardiac function before treatment
Perform baseline assessment of vital signs, peripheral pulses, skin color, temperature; include postural blood pressure and pulse
Follow administration guidelines carefully
Intravenous administration Check IV site often for infiltration Use clear IV solutions / Use an infusion pump Infuse drug slowly to avoid dangerous cardiovascular effects Monitor cardiac rhythm
ANS - Adrenergic Drugs Nursing Implications (cont’d)
With chronic lung disease:
Instruct patients to avoid factors that exacerbate their condition
Encourage fluid intake (up to 3000 mL per day) if permitted
Educate about proper dosing, use of equipment (MDI, spacer, nebulizer), and equipment care
ANS - Adrenergic Drugs Nursing Implications (cont’d)
Salmeterol is indicated for prevention of bronchospasms, not management of acute symptoms Overuse of nasal decongestants may cause rebound nasal congestion or ulcerations
Avoid OTC or other medications because of possible interactions
Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as tachycardia or hypertension
ANS - Adrenergic Drugs Nursing Implications (cont’d)
Monitor for therapeutic effects: (cardiovascular uses)
Decreased edema Increased urinary output Return to normal vital signs Improved skin color and temperature Increased LOC
ANS - Adrenergic Drugs Nursing Implications (cont’d)
Monitor for therapeutic effects
(bronchospasm/asthma):
• Return to normal respiratory rate• Improved breath sounds, fewer rales • Increased air exchange• Decreased cough• Less dyspnea• Improved blood gases• Increased activity tolerance
Let’s take a break!