Chapters 15 and 16 Autonomic Nervous System

Classification and Action Drugs Therapeutic Uses Adverse Effects

Chapter 15 *Epinephrine 1. Anaphylactic Shock ↑ cardiac excitation:

Adrenergic Agonist  IV  Epi-pen for allergies Chest pain
 Activates the adrenergic receptors  SQ 2. Local Anesthesia Tachycardias
 Enhancing the actions of the SNS  Inhalation 3. Treat Heart Block Dysrhythmias
Mimics the sympathetic nervous system  Paired with Lidocaine  Not typically Hypertensive crisis
Sympathomimetic o Prolong effects 4. Restore cardiac function in arrest Tissue Necrosis due to
o Treat allergy if PT allergic  Get some electrical impulse extravasation
to Lidocaine back – out of asystole  Typically NOT placed in a
Alpha₁ & Alpha₂  V-fib peripheral vein
Beta₁ & Beta₂ 5. Bronchodilation (asthma) o Central line
 Not receptor site specific o Chest
 Watch IV sites – clear tape
o Swelling
o inflammation
o Redness
o Fever
Alpha₁ Norepinephrine 1. Hypotensive states Hypertension
Vasoconstriction  IV 2. Cardiac arrest Chest pain
 Blood vessels Alpha₁ & Alpha₂ Tachycardias
 Skin Beta₁ Dysrhythmias
 Mucous membranes ICU PT
Constricts:  Ventilator
 Arterioles  Very close observation
 Veins o Drug efficacy **ALL meds can be used to treat:
Constricts trigone & bladder sphincter o Side effects  Heart Failure
Contracts the radial muscle of iris  Hypotensive states
 Causes the pupil to dilate o ↓ BP
Contracts prostate capsule  Cardiac arrest
 Causes ejaculation  Cardiac electrical problems
Alpha₂ - not clinically significant o Heart block
Beta₁ Isoproterenol 1. Treat AV Heart Block Chest pain
Causes an ↑ in: Pure Beta stimulant 2. Improve outcomes in cardiac Tachycardias
 Heart rate  IV arrest Dysrhythmias
 Force of contraction  IM  PT not perfusing
o Pump Beta₁ & Beta₂ o Causes pain
 AV conduction  PT with no pulse
o Speed that electricity goes “electrical improvement” 3. ↑ cardiac output in states of shock
through AV node
Release of renin

Beta₂ Limitations: Strictly used for cardiac reasons

Dilation of:  Diabetics
 Arterioles  Asthmatics
 Bronchi
Relax the uterus
Glycogenolysis of liver
Contract skeletal muscle

Dopamine Dopamine 1. Shock Chest pain

Work on the dopaminergic receptors in the  IV 2. Heart Failure Tachycardias
kidney Alpha₁ Beta₁ Dysrhythmias
 Dilation of kidney vasculature Dopamine
Receptor specific at different doses
 Low
o Dopamine
 Medium
o Dopamine Making the heart work harder, PT more at risk for CV side effects
o Beta₁ stronger, more forceful along with having more cardiac
 High  Creating unstable situation effect
o Alpha₁  Making unstable situation  Non-selective at ↑ doses
o Beta₁ worse  Affects Alpha₁ & Beta₁
o Dopamine
Catecholamines Dobutamine 1. Heart Failure Tachycardia
 Short duration of action  IV  Failure to perfuse
 MUST be parenteral Beta₁ selective  Unable to meet perfusion Assess the PT
o Except Epinephrine inhalation demands of the body  How they’re tolerating it
 Cannot cross BBB  Not able to get enough blood  See drug efficacy
 ALL used for critical issues to the periphery to perfuse
o Brain
o Kidney
o Periphery

Does the PT respond neurologically

 Can they understand what’s
being said
 Can they squeeze my hand
What does the PT feel like
 Warm & dry
 Sweaty & clammy
Color
 Gray
 Cyanosis

Too much excitation & stimulation →

With ALL meds we must monitor:
 HR
 BP
 Chest pain
 Dysrhythmias
Chapter 15 Adrenergic Antagonists
o Cause direct blockade of the
adrenergic receptors
o Blocks the stimulation from the SNS
Classification and Action Drugs Therapeutic Uses Adverse Effects

Nonselective Alpha Blockers Phentolamine Pheochromocytoma Orthostatic Hypotension!!

 BLOCKS Alpha₁ & Alpha₂ receptors  Rare, potentially fatal tumor on the  Opening the vessels
o DILATES arterioles & veins adrenal medulla  BP is ↓
 Send out potent catecholamines  Take PT BP:
o Epinephrine o Supine
o Norepinephrine o Sitting
o Vasoconstrict o Standing
 ↑ BP  1st dose Hypotension
 Get BP stabilized o Administer at bedtime
o Surgery to remove the o Sleep through
tumor transition

Treatment of extravasation of Alpha Reflex Tachycardia

Agonists  Vasodilation ↓ BP
 Inject local area with medication  Baroreceptors sense ↓ BP &
try to restore back to normal ↑
Reverse effects of local anesthesia HR
with Epinephrine
Nasal congestion
Phenoxybenzamine Pheochromocytoma ONLY
Inhibition of ejaculation

Na⁺ retention
Alpha₁ Blockers Prazosin (Minipress) HTN & BPH Orthostatic Hypotension!!
 BLOCKS Alpha₁ receptors Doxazosin (Cardura)  Main reasons we use Alpha
o DILATES arterioles & veins blockers Reflex Tachycardia

 RELAXES smooth muscle in bladder neck & Pheochromocytoma Nasal congestion

prostate
o Relieves urinary symptoms Vasodilate PT with vascular disorder Inhibition of ejaculation
o Helps BPH PT with improved voiding  Raynaud’s Disease
o Vasospasm of vessels Na⁺ retention
 Taken at night  Inadequate
o 1st dose Hypotension perfusion ↑ fluid retention
 Avoid driving for 12 – 24  Causes severe pain  Edema
hours  Necrotic tissue  Diuretic to counteract
o PT sleeps through transition
o Initial dose should be ↓ Sexual Dysfunction
 ↑ as needed Terazosin (Hytrin) BPH – Benign Prostatic Hyperplasia
Tamsulosin (Flomax)  Overgrowth of prostate tissue that Report ADEs concerning to the PT
pushes on urinary system to cause:
o Urinary frequency
o Urinary hesitancy
o Urinary urgency
o Dribbling
o Incontinence
o UTIs
Beta₁ Blocking effects: ↓
 ↓ Heart rate ↓ peripheral vascular resistance in
o Negative chronotropic long term use
o Beating too fast  Antihypertensive effects
 ↓ Conduction through AV node
o Negative dromotropic
 ↓ Contractility
o Ionotropic
o Heart pumps less
 Renin release

Beta₂ Blocking effects:

 Arterial dilation (vasoconstriction)
 Bronchodilation (causes
bronchoconstriction)
Angina Bradycardia
1st Generation Propranolol (Inderal)  ↓ cardiac workload  PT feels sluggish
Blocks: Nadolol (Corgard)  No energy
 Beta₁ Pindolol (Visken) HTN
 Beta₂ Timolol (Bloccadren) AV block
 Non-selective Dysrhythmias  Affects conduction
 Treat acute dysrhythmias
 Prevent cardiac dysrhythmias Heart Failure
o Maintenance  PT has preexisting
 Atrial pulmonary issues i.e.
 SOME ventricular asthma

MI Rebound cardiac excitation

Migraine prophylaxis CNS effects

 Depression
Anxiety  Sleep disturbances
 Making a speech  Suicidal thoughts
 Stage fright Monitor VS
 Detrimental to diabetic PT:
 Blocking Beta₂ receptors in
muscle & liver
o Suppress
glycogenolysis
o Will NOT correct insulin
induced hypoglycemia
 Blocking Beta₁ receptors
o Suppress tachycardias
o Suppress perspiration
o Suppress tremors
o Warning signal that BP
or blood glucose level
is too ↓

2nd Generation Metoprolol (Lopressor) Angina SAME

 Cardioselective Atenolol (Tenormin) HTN
o Normal doses, selective Acebutolol (Sectral) MI
o ↑ dose, non-selective Heart Failure
 BLOCKS Beta₁
o Safe for asthmatic PT
o Will not effect lungs
3rd Generation Carvedilol (Coreg) HTN SAME
Blocks: Labetalol (Trandate, Normodyne) MI
 Beta₁  PT with hyperthyroid can look NONE of these 3 will be used for
 Beta₂ like they are having a MI BPH or BP
 Alpha₁ Angina  Too radical
o Has an additional vasodilation Heart Failure
effect

Beta Blockers Metoprolol (Lopressor) Heart Failure SAME

One of 3 medication used for Heart Failure Bisoprolol (Zebeta)  Improve outcomes in PT  Start at ↓ dosage
 ↓ hospitalizations  2nd generation Monitor for symptoms of ↑ HF
 ↓ progression of HF  Cardioselective 3 groups used to treat HF:
 ↑ LV ejection fraction Carvedilol (Coreg)  Diuretics
 ↑ exercise tolerance  3rd generation  ACE – Inhibitors
 Beta blockers
Classification and Action Prototype (Noted drugs) Therapeutic Uses Adverse Effects
Chapter 16 Muscarinic Agonists Bethanechol Relieve urinary retention Hypotension
 Activates muscarinic receptors also called (Urecholine)  Activates the muscarinic Bradycardia
Cholinergic receptors of urinary tract Alimentary System excessive effects
Heart
 Bradycardia Primary reason for using: Relaxes trigone and sphincter muscles Do NOT use in PT with urinary
Exocrine glands  “selective”  ↑ voiding pressure obstruction or bladder weakness
Increase reasons  Could rupture bladder
 Sweating
 Salivation Can exacerbate asthma
 Bronchial secretions
 Secretion of gastric acid Can cause cardiac dysrhythmias in
Smooth muscles: hyperthyroid PT
Contraction in lung
 Constriction Muscarinic Poisoning!!
GI tract  Over dosage of muscarinic
 Increased tone/motility agonist
Bladder
 Contraction of detrusor muscle
o Composes bladder wall
Vascular
 Relaxation
 Vasodilation
 Hypotension
Eye
 Pupillary constriction
 Ciliary contraction
Muscarinic Antagonist
 BLOCKS muscarinic receptors
Anticholinergic
 Against the above actions
Atropine Preoperative medication
 Protect heart from bradycardias
 ↓ respiratory secretions
o Mouth
o Lungs
 PT has to take deep breaths
o Cough
o Incentive spirometer
Dry mouth
Blurred vision photophobia
↑ intraocular pressure
 Avoid in glaucoma PT
Urinary retention

Treat symptomatic bradycardia Constipation

Paralyze the ciliary muscle & dilate the Blocks sweat glands
pupil for eye exams/surgery
Tachycardia
Treat hypertonicity/motility of GI tract
 Not the best choice Thickens & dries bronchial secretion
 Use in asthma may be
To reverse effects of Muscarinic harmful
poisoning