Bachelor of Science in Nursing 2YA

NCMA216: AUTONOMIC NERVOUS SYSTEM Discussed by Prof. Carmen Pacis

AUTONOMIC NERVOUS SYSTEM - Finofocus nya ung delivery ng blood will be

Review of Anatomy and Physiology (Nervous System) going towards to heart and lungs.
Central Nervous System b) Parasympathetic (energy conservation)
1) Brain – information will be delivered - Main organs: GI, Exocrine glands
2) Spinal Cord – nagkokonek sa peripheral - Pag yung parasympathetic nag stimulate, ito ung
Peripheral Nervous system stage na rest and digest. Papakalmahin yung
1) Somatic nervous system katawan nyo kasi kailangan mo magpahinga.
- Voluntary (like u need to have stimulus for you to be able - (Sympathetic – bumibilis ung heartbeat mo;
to respond) Parasympathetic – nagrerelax naman ang puso)
- Skeletal muscles and sensory information
- Carry messages form the outer areas of the body
a) Afferent
- Sensory neurons
- we need to detect using our senses first before
we could be able to process our information.
- This information that we detected from the
outside will be brought to the middle of the body,
which is the brain, wherein the brain will process
the information.
- Then the brain will process and after processing,
the brain will bring back the information via
afferent neuron, may dala dala na syang action.
- May command/ instruction na ipapagawa si
afferent neuron sa efferent/ motor neurons.
- Sample nahawakan mo ung mainit na bagay, at
inalis mo agad ung kamay mo (ganon kabilis
yung afferent and efferent response)
b) Efferent – motor neurons

Parasympathetic Sympathetic nerves

nerves
Constrict pupils – less
light will enter.
Dilate pupils – when your eyes are more
Sample, before you
dilated, it could help you see better. Ung
go to sleep, u will
surroundings mo mas makikita mo ng mas
turn off the light para
malawak. Parang bintana.
magkaroon ka ng
relaxation.
Stimulate saliva – nag Inhibit salivation – hindi ka gaano
increase yung laway. naglalaway
2) Autonomic nervous system (Automatic)
- Under peripheral Slow heartbeat Increase heartbeat
- Involuntary physiologic processes. Example: heartbeat,
digestion, release ng mga hormones yan ang mga Constrict airways –
involuntary. Relax airways – dahil nagkakaroon ka ng
kaya may snore pag
- Cardiac and smooth muscles broncho dilation.
natutulog ka. Kasi
- Glandular secretions Vasodilation- lumuluwag mga blood
yung hangin natin
a) Sympathetic (Fight or Flight system) vessels, pero pagdating sa lungs nag da-
dumadaan sa mas
- Nagbibigay ng energy. dilate – broncho dilation.
makitid na tunnel.
- Ito ung nagkokonek sa mga internal organs to the
brain by the spinal nerves. Stimulate activity of
- When this sympathetic is stimulated, it will stomach – tinutunaw
prepare upper body for stress. When sympathetic nya ung laman ng Inhibit activity of stomach – hindi ka
stimulated, will increase our heart rate, blood stomach, gaano nakakaramdam ng gutom
pressure, blood flow to the muscle and decrease nagpoproduce ka ng
flow to the skin. gastric acid.

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Stimulate release of glucose inhibit Effects of activation – Alpha

gallbladder – there will be sudden energy.
Sample nasunog kapit bahay mo, tas
binuhat mo ung ref, kapag gantong
Inhibit release of
biglang tumaas adrenalin mo, kapag
glucose; stimulate
nastimulate si sympathetic because of
gallbladder –
certain emergency situation, si liver
kailangan magtunaw
nagrerelease ng stored glucose. And this
(acid)
glucose will give ourselves energy. Kaya
nagagawa or nabubuhat natin ung isang
activity na hindi naman natin gnagawa sa
normal situation.
Secrete epinephrine and norepinephrine –
main neurotransmitters in our sympathetic
nerves – main chemical substance na - If the epinephrine or norepinephrine will bind with alpha
narerelease kapag naactivate, itong system receptors. If this chemical messenger will bind with alpha
na to. receptors.
- Alpha1 will bind with the chemical messenger, the alpha1 will
Contract bladder – Relax bladder – nagkakaroon ng mas bring epinephrine or norepinephrine or dopamine to the blood
nacocontract yung maraming capacity for the urine to remain vessels, eye, bladder, prostate.
bladder kaya in the bladder. Yung bladder neck naka o Blood vessels – it will cause vasoconstriction. Kapag
lumalabas yung ihi. constrict kaya hindi lumalabas yung ihi. nagconstrict yung blood vessels, nag increased yung
blood pressure and also it will increase the contractibility
Promote erections of Promote ejaculation and vaginal of the heart. Mas nagiging malalim ung tibok ng puso.
genitals. contraction o Eyes – if alpha1 will bring the neurotransmitters to eyes,
the effect will pupil dilation (mydriasis) (constriction –
Sympathetic nervous system miosis) the eyes can accommodate more light.
- Adrenergic system neurotransmitters – norepinephrine, o Bladder – it will cause relaxation. Kaya mas maraming
epinephrine, dopamine urine ma-accommodate. Pero sa bladder neck nya is
o Alpha1 constricted kaya hindi ka naiihi.
o Alpha2 o Prostate – it will contraction, nagkakaroon ng mataas na
o Beta1 ejaculation. Kapag nagcontract ang muscle, may iniipit
o Beta2 sya, may pinepress kaya may lalabas.
- Main neurotransmitter – Ito ung nag rerelease ng chemical - Alpha2 considered inhibitory ; alpha1 considered stimulate.
messenger kapag activated sa sympathetic. Kaya kapag si alpha1 ang binind ng mga ating chemical
- Epinephrine and adrenaline is the same messengers, iistimulate nya, pinapataas nya yung effect ng
- Nor – target nila ay blood vessels; Epi – cardiac muscles. chemical messengers. Alpha2, nag modulate at nagcocontroll,
- This chemical messenger cannot reach the target organs, they kapag sobrang dami na ung epinephrine/ norepinephrine in
need to have receptors. (pharmacodynamics) before a your system, Alpha2 will bind with them, para iprevent naman
chemical messenger could be able to give or bring the message nya. Inhibitory effect
to the target organ, they need to have receptor, kailangan ng - If Alpha2 will bind with neurotransmitters, instead bringing
sasakyan. them to the target organ, ang nangyayari dito ay pineprevent
- Allows the body to function under stress. nya na magkaroon ng effect yung ating mga neurotransmitters
- Fight or flight system on the specific organs.
o Blood vessels – if this will not receive the epinephrine,
instead of vasoconstriction that has epinephrine,
nagkakaroon tayo ng vasodilation. Vasodilation will cause
the blood pressure will go down (nor is for blood vessels,
epi for cardiac muscle) pinigil or pinababa ni alpha2
receptor ung dami na nagcicirculate ng mga chemical
messengers.
o Smooth muscle – it will cause decreased gastrointestinal
tone and motility. Parasympathetic – naka focus kay GI,
alpha receptor is included in the sympathetic, kaya
kabaliktaran yan. Si GI function natin, kapag alpha2
receptor ang nagbind dito at napunta kay GI, pinapababa
nya ung motility. The patient will have constipation, or ito
naman ung ibibigay natin kapag ung patient natin ay super
active ang kanyang GI, nag da-diarrhea, kaya ibibigyan
sya ng alpha2 receptor, mababawasan ung times na mag
dudumi sya.

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Effects of Activation – Beta

- Beta1 receptor – heart and kidney (activate/ stimulate)

o Heart – once the epinephrine/ adrenaline will bind with
the beta1 receptor, the heart will increase heart
contraction and increased heart rate. Kung problema ng • Sympatholytic (adrenergic blockers) = sympathetic
pasyente natin ay mabagal na heartbeat, we need depressant
medication na nakakapagkataas ng heartrate. So dapat sa - Antagonist – nagbabawas naman sila
classification ng gamot mo, may positive chronotropic - Alpha receptor or beta receptor depende yan sa target
effect. organ mo.
o Kidney – it will increase renin secretion, then the renin - Alpha receptor
secretion will increase angiotensin. (Angiotensin – • Nonselective – itatarget nya pareho 1 and 2
nagpapataas ng calcium release) kaya kapag tumaas ung • Selective – 𝑎𝑎1 , 𝑎𝑎2 selective – yung aatagonize ng
calcium release, tataas ang blood pressure kasi yung gamot natin ung specific number ng alpha receptor na
calcium pagpumasok sa loob ng cells natin, nagpapataas nakalagay sa mechanism of action nya.
yan ng pressure, nag ca-cause sya ng vasoconstriction. - Beta receptor
This will increase the blood pressure. • Nonselective – 𝑏𝑏1 and 𝑏𝑏2
- Beta2 receptor – regulation, inhibitory, modulate the amount
of this neurotransmitter to reach the specific target organs.
o Smooth muscles – decreased G tone and motility. (kapag
sympathetic bumababa ang GI function natin) if the
patient has diarrhea, magbibigay tayo beta2 receptor para
pabagalin ang kanyang peristalsis.
o Lungs – its will cause bronchodilation. (beta2 agonist – u
are stimulating more beta receptor, kaya mas maraming
beta receptor mas broncho dilated, mas nakakahinga ng
maluwag ang pasyente)
o Uterus – causing relaxation of uterine smooth muscle,
kapag nagbigay ng beta2 receptor, napeprevent or
namiminimize yung abnormal labor.
o Liver – it will cause activation of glycogenolysis, - ito ung
breakdown ng glycogen to glucose, masdadami ang
glucose. Then it will increase blood sugar. Pero kapag
laging mataas beta2 receptor mo, pwede mag lead sa
diabetes.
o Ang beta2 receptor ay para lng sa emergency, to give you
extra energy.
Sympathomimetics – imimimic
Sympathetic 1) Direct acting sympathomimetics
• Sympathomimetic (adrenergic) = sympathetic stimulants - Directed on the specific receptors, alpha or beta
- Mimic – gagayahin nya yung mga chemical messenger. - Directly will bind with receptors
- Kulang ang katawan mo sa dopamine/ epinephrin/ 2) Indirect acting
norepinephrine kaya imimimic sya. - it will stimulate the specific secretory cells that are
- Classification: releasing neurotransmitters.
a) Direct – alpha agonist and beta agonist - Reuptake – pineprevent nila mametabolize yung mga
b) Indirect – they will not act directly in producing more existing natin na, norepinephrine or adrelanine so they
alpha and beta receptor, they will focus on the would stay longer na active sa katawan. Hindi sila nag
secretory cells that are producing the epinephrine/ action sa receptor, but they act directly on the secretory
norepinephrine/ dopamine. (produce more on the cells, that are producing the neurotransmitters in
specific secretory cells) releasers sila. or reuptake sympathetic nervous system.
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3) Dual acting it will instruct the smooth muscle to relax. And this will cause
- They could act both. bronchodilation.
- for immediate release, instantly mafifeel mo na lumuluwag
ung daanan ng hangin mo.
- This is direct acting because this drug act directly with the beta
2 receptor.
- So, if you will be giving salbutamol, the effect will be
therapeutic or primary/ secondary effect.
- Nagkakaroon ng adverse effect kasi nasa sympathetic tayo, at
ito ay nagpapaincrease.

• Direct – will bind directly to the receptor

• Indirect – ung drug nag uup sila directly on secretory cells to
produce more neurotransmitter, kaya kapag mas maraming
neurotransmitter. Kaya kapag maraming neurotransmitter, they
could bind with receptor na.
• Mixed acting – pwede sila magbind directly or go to the
secretory cells, so the secretory cell will produce more
neurotransmitter and this neurotransmitter will bind with
receptor

Direct Acting

- Sympathomimetic – Agonist
- Mechanism of action – what specific receptor will the drug Clonidine – sympathomimetic drug (alpha agonist)
bind to.
- It will stimulate the 𝑎𝑎2 adreno receptors.
- Mode of action – ito ung magiging effect kapag binigay natin
- 𝑎𝑎2 ang naactivate, ang effect nya ay mag modulate or to
ung albuterol.
decrease the amount of the circulating epinephrine/
- Pag binigyan ng salbutamol – it will activate b2 receptors in
norepinephrine/ dopamine in the system.
bronchial smooth muscle and it will activate the adenylyl
- Ang effect ni clonidine pagbaba ng pressure.
cyclase activity. (cAMP – Cyclic adenosine monophosphate
which is the second messenger) once na nactivate ung cAMP,
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Indirect acting Adrenergic Agents: Side Effects

Alpha adrenergic effects:
• CNS – headache, restlessness, excitement, insomniam
euphoria (kasi pinataas nya yung mood)
• Cardiovascular – palpitations (dysrhythmias), tachycardia,
vasoconstriction, hypertension.
• Others: anorexia, dry mouth, nausea, vomiting, taste
changes (rare)
Beta-adrenergic effects:
• CNS: mild tremors, headache, nervousness dizziness.
• Cardiovascular: increased heart ratem palpitations
(dysrhythmias), fluctuations in BP.
• Other: sweating, nausea, vomiting, muscle cramps
Sympatholytic Agents (Adrenergic Blockers)
- Drugs that block the effect of the sympathetic NS
- Lytic – pineprevent or binoblock nila
- They will act on the synapse.
- Catecholamines – neurotransmitter.
- Once we take this medication, it will stimulate the synapse to
produce or release more of neurotransmitter.
- Inhibit MAO – Monoamine oxidase – enzyme responsible in
removing yung mga norepinephrine, serotonin, and dopamine
sa system natin. If MAO is increased, wala tayong
catecholamines.
- If u will taking amphetamine, will remove MAO, kaya kapag
walang MAO, mataas ang norepinephrine serotonin and
dopamine). Classification – α- Adrenoceptor Antagonist
- More epinephrine circulating on the body, mataas ang action Non-selective block α1 & α2 (iboblock nya pareho)
ang nervous system. • Reversible
- CNS stimulant, increase alertness, reduce, fatigue, depress - Phentolamine
appetite – kasi yung sympathetic, walang GI. Kaya kapag - Tolazoline (Priscoline)
mataas yung sympathetic, hindi ka nakakaramdam ng gutom • Irreversible
pero sa parasympathetic baliktad naman. - Phenoxyben – zamine
- But this can cause dependence (limit their use) – hahanapin na Selective
ng system mo yan. ang ganda ng pakiramdam mo, d ka o α1 – blovkers
inaantok, d ka nagugutom, d ka napapagod, kaya hahanapin ng - prazosin
katawan mo. (Kailangan ko ata to para matapos lahat ng - terazosin
tasks… HAHAHAHA JOKE hehe) - doxazosin
Mixed Action - alfuzosin and Bunazosin
Ephedrine - Tamsulosin and Silodosin
- Mechanism of action: stimulates both o α2
alpha-and beta receptors, causing - yohimbine
increased heart rate, enhanced, - Idazoxan
cardiac output and, increased BP. - Miscellaneous
- Ergot alkaloids
• Raises systolic and diastolic BP
by vasoconstriction and cardiac
stimulation.
• Also causes bronchodilation but
is less effective than epinephrine.
- They could act directly on secretory
cell. Or they will act directly on
receptor.
- Kapag na-activate si alpha, more of
vasoconstriction pero pag naactivate
din si beta, magka- bronchodilation
ka naman.
- Ang problema dito, kapag may asthmatic at hypertensive ka, Phentolamine (nonselective)
hindi ka pwedeng bigyan ng ephedrine, kasi may - Non specific short acting reversible alpha antagonist
vasoconstriction, lalo tataas BP mo. - Patent competitive antagonist at both 1 and 2 ereceptors
- Quick acting
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- Reduction in Peripheral Resistance – blocking both α1 & - Enter CNS - ↑ BP, HR, motor activity (kapag mataas si A2,
α2 receptors – causes noradreline release and venadilation
pineprevent nya ung sobrang taas ng epinephrin,
more than arteriolar. (si veins nag da-dilate more of the
norepinephrine sa mga target organ. Eh wala na tagacontrol
arteries, kapag mas nagdilate ung blood vessels going to
kasi binolock si a2, tataas ngayon ang concentration ng ating
the heart, mas maraming blood na inaaccomodate ng puso
mga epinephrine/ norepinephrine sa body. Kaya ang effect
natin, kaya ang effect nito will be more of increase
nya vasoconstriction, pagtaas ng BP)
heartrate.) (pero ung palabas sa puso ay hindi, kaya ang
- Actions appear opposite that of clonidine (clonidine –
magiging effect nito ang pressure papunta sa periphery ay
centrally acting, alpha2 agonist – pinapataas ni clonidine
hindi naman mataas kaya pinapaba nito ang blood
yung alpha 2)
pressure pero pinapataas ung heartrate.)
- Used (herbal treatment) for male sexual dysfunction (too
• Cardia stimulation much a2 will result to decrease contraction sa muscle)
- Enhanced NA release due to alpha-2 blockage (si
noradrelanine ang nagcacause ng vasoconstriction, kaya
kapag binolock mo si NA, wala kang vasoconstriction
pero may vasodilation ka bumababa ang BP mo)
- Inhibits serotonin release – muscarinic agonist (?)
• Uses: Pheochromocytoma (tumor sa adrelan gland, ito ung
magiging cause para mag produce mas maraming epinephrine/
norpinephrine), chloride withdrawal, cheese reaction and in
extravasations of NA and Adr injection.
• Dose: 5 mg IV injection and when needed
Selective – A1 – Adrenergic Blockers
Prazosin: Doxazosin, Terazosin
Mechanis of Action Nonselective a blocker – side effects
- Blocka α1 receptors in arterioles and venules thereby
produce vasodilation ↓ peripheral vascular resistance. (a1
cause vasoconstriction, kaya kapag binolock mo yung a1
receptors magkakaron ng vasodilation)
- Uses:
• Mild to moderate hypertension
• Benign prostate enlargement – ang effect ng a1 ay
constriction, kaya kapag nablock ung a1, nawawala ung
constriction at magrerelax sya.
• Raynaud’s phenomenon – ang blood vessels natin ay
mababa papunta sa mga dulo ng daliri. (kapag binolock
natin si a1, lumuluwag ang daanan ng blood natin
papunta sa distal extremities.) Classification of Beta blockers
• Pheochromocytoma (nonselective α blocker
phenoxybenzamine)
- Adv effects:
• Postural hypotension – 1st dose phenomenon (1st dose
should be small and should be administered at bed time)
dahil bumababa BP.
• Nasal stuffiness, dizziness, palpitation
- Blocks α1 AR on resistance vessels from binding NE
released from nerve terminals
- Decreases vascular tone (vasodilates)
- Thereby decrease PVR and BP
Non-Selective
Propranolol
- Class II
- Non-selective (iboblock nya pareho, b1 – pinapataas nya
ung heartrate; b2 – 2 lungs, kapagbinolock si b2,
magkaka- bronchoconstriction)
- D natin pwede ibigay to asthmatic patient kasi
magkakaroon sya ng bronchoconstriction, mahihirapan
Selective – A2 sya huminga dahil binolock din ung beta2 nya.
Yohimbine (Yocon) - Hindi porke highblood ka, magtetake ka na ng kahit
- Competitive antagonist, α2 selective anong klase ng anti-hypertensive medication, kung non
- Bark of Pausinystalia yohimbe selective yan at ikaw ay asthmatic, d mo pwede itake yan.
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- Mechanism: Beta a- adrenergic Antagonists (Beta A- Blockers) Side Effects

• Decrease SA node automaticity
• Decrease AV node conduction speed
• Decrease cardiac contractility
- Similar to calcium channel blockers in effect
- Use: ST, VT, AT
- PO – IV in emergency situation
- Adverse Effects:
• Hypotension
• Bronch ospasm
• Decreased cardiac contractility

Nursing Implications
• Monitor vital signs for bradycardia and hypotension
• Monitor blood glucose for hypoglycemia (kapag binolock
natin ung receptor sa sympathetic, binoblock mo rin ung
pagproduce ng glucose)
• Advise the client about the possibility of impotence

Parasympathetic Nervous System

- Cholinergic system – acetylcholine – neurotransmitter that
innervates the muscles.
• Nicotinic
• Muscarinic
- Regulates vegetative functions
Selective – B1 - Rest and Digest
Metoprolol - These two systems work in constant opposition to control
- Mechanism of Action: Selectively blocks beta-1 receptors, organ response
slowing sinus heart rate, decreasing cardiac output, and
decreasing BP.
- Pwede ibigay to sa asthmatic patient.
- Target nya lang ay heart.

Beta 1 vs Beta 2 Selectivity

o Nicotinic – coordination, movement

o Muscarinic – pagrelease ng mga fluids sa body.

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Parasympathetic • Direct-acting cholinergic agonists

• Parasympathomimetic (cholinergic) = parasympathetic - Action: mimics acetylcholine to produce parasympathetic
stimulants (agonist) papadamihin si acetylcholine stimulation (binds directly with Ach receptors)
• Parasympatholytic (anticholinergics) = parasympathetic - Prototype drugs: bethanechol chloride → for bladder
depressants (antagonist) babawasan ang acetylcholine or atony. (bladder atony – u are not urinating)
icocontrol ang mga receptors na kumukuha kay - Pilocarpine HCI (Pilomann, Pilogel) → for glaucoma
acetylcholine. - Causes: salivation, urination, defecation, sweating,
Parasympathomimetic Agents (Cholonergic Agents) vomiting, and abdominal cramps.
- Drugs that cause the same effect as stimulation of - Side effects: hypotension, hypersalivation, hyperhidrosis,
parasympathetic NS nausea, vomiting, diarrhea.
- (Like putting your foot on the brake) gusto mo magpahinga. Indirect Acting
Physostigmine
- Actions: inhibitors of
cholinesterase; amplifier
of endogenously
released Ach.
(Cholinesterase – ito ung
mga enzyme that
catalyzes the hydrolysis
of acetylcholine. Kapag
maraming Acetylcholine,
o Direct acting – ang purpose ng gamot ay pwede magbind sa minemetabolize ni
receptor agad. They will bind directly with muscarinic or cholinesterase. Kapag nametabolize nya, nagiging
nicotinic. Examples: inactive si acetylcholine. Kaya kapag maraming
- Acetyl-choline cholinesterase, less ang acetylcholine) (acetylcholine –
- Methacholine main neurotransmitter in parasympathetic)
- Carbachol - Indicators
- Bethanechol • Reversal of severe atropine poisoning (IV)
- Pilocarpine • Occasionally used in acute glaucoma (topical)
o Indirect acting – ang purpose neto ay doon sa secretory cells (induced miosis and spasm of accommodation)
na nagpoproduce ng neurotransmitters na si acetylcholine. • Used in intestinal atony (increases their motility)
o - Pharmacokinetics:
Direct acting • Lipid soluble
• Can be used topically in the eye
• Duration: 2-4hours
- Adverse Effect: generalized cholinergic stimulation plus
CNS effects: seizures
- Adverse effects of reversible inhibtors of cholinesterase –
all of the side effects seen w/ direct
parasympathominmetics + caused by increased nicothine
component
- Possible side effects:
• Bradycardia and hypotension (we are on
parasympathetic, binabagal nya ung tibok ng puso)
• Bronchospasm/ respiratory insufficiency – apply
atropine that is parasympatholytic drug (conclusion,
coma)
Parasympatholytic Agents (Cholinergic Blockers)
- Drugs that block the action of parasympathetic NS
- (Like taking your foot off the brake)

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Spasmolytics
Dantrolene (anticholinergic) (DOPA decarboxylase) (dopamine as such cannot be
- Pineprevent nya si used since it does not enter the brain)
acetylcholine. • Levodopa itself is largely inert. Its effects in the brain
- Binabawasan nya yung and are mostly related to activation of D2 receptors.
receptor na kumukuha kay
acetylcholine.
- Naiinhibit nya yung
pagrelease ng calcium kasi binoblock nya si nyanodine
receptor that are receiving the calcium.
- Less calcium – muscle relaxation
- Nicotinic antagonist
Mechanism of action:
• Dantrolene reduces skeletal muscle strength by interfering
w/ excitation-contraction coupling in the muscle fibers Vasico Selective (Anti-muscarinic)
• Normal contraction involves release of calcium from its Oxybutynin
stores in the sarcoplasmic reticulum through a calcium Indications
channel • Neurogenic bladder (hindi mo kaya icontrol ung pagihi
• Dantrolene interferes w/ the release of calcium channel mo)
this sarcoplasmic reticulum calcium channel • Urgency
• Cardiac muscle and smooth muscle are depressed only • Frequency
slightly, perhaps bec. the release of calcium from their • Incontinence
sarcoplasmic reticulum involves a diff. process • Detrusor muscle hyperreflexia
Mydriatics Action:
Anticholinergic mydriatic • anti-muscular/anticholinergic (block muscarinic effects of
- Parasympathetic – constrict; mydriatic = dilate acetylcholine) receptors specific; antispasmodic (ang
- are predominantly acting anticholinergic mydriatic muscarinic receptor pinapataas nya yung urination dahil
substances. secretion sya, so kapag nablock si muscarinic,
- Purpose: Cycloplegic – pinapa- numb nila yung sensation nababawasan ung pagproduce mo ng urine.)
sa mata, Lalo na sa mga pasyenteng ooperahan. To numb Side Effects
and to dilate. • Dry skin
- Pharmacodynamics Action: Produces mydriasis and • Eyes and mucous
cyloplegic effect shorter than atropine membranes
- Therapeutic use: in ophthalmology for retinal examination • Constipation or diarrhea
and pre-operative for cataract • Nausea
- Homatropine, eye drops 1%: Mydriasis and cycloplegia • Tachycardia
are fast and duraza 1-3 days • Blurred vision
- Cyclopentolate, eye drops 1%: Mydriasis and cyclopegia • Somnolence
duraza 24hrs
Caution
• Narrow angle glaucoma

Anti-Parkinsonian
- Hindi mo kaya icontrol ung muscles mo.
- Parkinson disease – mababa ung level ng dopamine. 1) Muscarinic Antagonists
(Dopamine is messenger to the brain that will control the
movement and coordination) - Action: compete with acetylcholine at muscarinic
Levodopa receptors
- Nicotinic antagonist - Uses: preoperatively given to reduce salivation and gastric
- Inaallow nya yung mas maraming dopamine na secretions•
magproduce sa body.
- Chemistry: The amino acid levodopa is the biosynthetic
precursor of dopamine
- MOA:
• In the brain levodopa is taken up by dopaminergic
terminals in the striatum and is converted to
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Side Effects: • Tubocurarine

• Vecuronium
• Pancuronium
- Uses: facilitate endotracheal intubation decrease the
number of anesthetics to be used relaxed skeletal muscles
of intubated patients

Summary

Nursing implications:
- Provide comfort measures for sides
- Encourage fluids to decrease risk of constipation. (dahil
binagal mo ung muscarinic kaya babagal ang peristalsis.)
- Monitor vital signs

2) Nicotinic Antagonists

- Action: block ganglionic nicotinic receptors in both

sympathetic and Parasympathetic NS.
- Dapat balance silang dalawa.
- Kapag tumaas si sympathetic, pinapababa mo naman si
parasympathetic.
- Pero kapag mataas naman si parasympathetic, pinapababa mo
naman ang action ni sympathetic nervous system.

• Hexamethonium – nicotinic receptor antagonist

• Side effects: marked venous pooling-> postural hypotension

(kasi nag vavasodilate ka, kaya epekto sayo neto bababa ang
BP)

b) Neuromuscular blocking drugs (n1)

- Compete with Ach for the receptor sites on motor end

plates or by blocking depolarization

J.A.K.E 10 of 10