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DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM

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DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM * Winter 2013 * * Anticholinergic Crisis * * Winter 2013 Winter 2013 Winter 2013 * E = 10X NE * * * Winter 2013 ... – PowerPoint PPT presentation

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Title: DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM


1
DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM

1
2
Nicotinic - skeletal Muscarinic - organ
3
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4
Peripheral Nervous System
  • Somatic Voluntary
  • Innervates skeletal muscles
  • Controlled through conscious thought
  • Neurotransmitter
  • Acetylcholine

5
Autonomic Nervous System
  • Autonomic or visceral division not controlled
    by conscious
  • Controls
  • Blood pressure
  • Heart rate
  • Gastrointestinal activity
  • Glandular secretions

6
SUBDIVISIONS OF THE AUTONOMIC NERVOUS SYSTEM
  • Sympathetic nervous system
  • Fight or Flight
  • Useful in highly stressful or emergency
    situations
  • Parasympathetic nervous system
  • Maintains homeostasis
  • Works in opposition of the Sympathetic nervous
    system
  • Rest and Digest

7
VOCABULARYSYNONYMOUS TERMS
  • SYMPATHETIC
  • AKA ADRENERGIC
  • SYMPATHOMEMETIC
  • MIMICS THE SYMPATHETIC SYSTEM
  • PARASYMPATHETIC
  • AKA CHOLINERGIC
  • PARASYMPATHOMEMETIC
  • MIMICS THE PARASYMPATHETIC NERVOUS SYSTEM

8
Adrenergic/SympatheticNEUROTRANSMITTERS
(neurohormones)
  • CATECHOLAMINES
  • Epinephrine (prototype) secreted by Adrenal
    gland, direct response at nerve ending
  • Norepinephrine secreted by Adrenal gland.
    Stored in the axon, direct response at the nerve
    ending
  • RECEPTORS / RECEPTOR SITES
  • ALPHA 1
  • ALPHA 2
  • BETA 1
  • BETA 2

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RECEPTOR Responses to Stimulation
  • ALPHA I (located on the target cells)
  • Blood vessels Constriction
  • Pupils Dilation
  • Penis Ejaculation
  • Uterus Contraction
  • Sphincters Constriction

11
Alpha-1 Adrenergic drugs
  • Isuprel (isoproterenol)
  • Used for shock
  • Adrenalin (epinephrine)
  • Cardiac arrest
  • Anaphylactic shock
  • Nasal decongestants (phenylephrine
    Neo-Synephrine)
  • Pseudoephedrine (Sudafed)

12
RECEPTOR Responses to Stimulation
  • ALPHA 2 (located on presynaptic terminal)
  • Control the release of norepinephrine

13
ALPHA 2 Adrenergic Drugs
  • CLONIDINE (Catepres)
  • Decrease blood pressure
  • Management of Opioid withdrawal
  • METHYLDOPA
  • Decrease blood pressure

14
RECEPTOR Responses to Stimulation
  • DOPAMINE RECEPTORS
  • Located in various tissues and organs
  • Cause dilation of renal, mesenteric, coronary and
    cerebral arteries

15
Adrenergic drugs (Alpha 1)
  • ADVERSE EFFECTS V. THERAPEUTIC EFFECTS
  • Increased HR (tachycardia)
  • Increased Blood pressure
  • Decreased Gastric motility
  • Restlessness, irritability, anxiety, pallor
  • Increased Alertness

16
Adrenergic blocking drugs
  • Alpha and BETA blocking drugs
  • Uses (Beta1 receptors are located primarily on
    cardiac tissues - cardioselective)
  • Cardiac dysrhythmias
  • Angina
  • Hypertension
  • Congestive heart failure
  • Prostate hypertrophy (alpha blocker)

17
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Adrenergic (beta-1) blocking drugs
  • Beta-adrenergic blocking drugs
  • Propranolol (Inderal)
  • Nadolol (Corgard)
  • Atenolol (Tenormin)
  • Timolol (Timoptic)

19
ADRENERGIC BLOCKING DRUGS
  • Adverse reactions
  • Drowsiness, fatigue
  • Bradycardia
  • Hypotension
  • Orthostatic hypotension
  • Diarrhea

20
Adrenergic blocking drugs
  • Nursing considerations
  • Patient teaching
  • Postural hypotension
  • Signs and symptoms of Heart Failure
  • Monitor blood pressure
  • Taking their own pulse

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22
Parasympathetic (Cholinergic)Nervous System
  • NEUROTRANSMITTER (neurohormone)
  • Acetylcholine Produced and stored in nerve
    endings
  • Acetylcholine (ACh) binds to Cholinergic receptor
    sites and causes a response
  • Stimulation results in rest and digest

23
Acetylcholinesterase(akacholinesterase)
  • Breaks down Acetylcholine or limits response
  • Maintains the balance between acetylcholine and
    dopamine

24
Uses only four for cholinergic drugsDrugs
that increase Acetylcholine in the Synapse
  • Glaucoma Reduce intraocular pressure
  • Myasthenia gravis Disease caused by the lack of
    ACh at the synapse
  • Relief of urinary retention
  • Increase GI motility

25
Indirect acting Cholinergic drugs
  • Neostigmine (Prostigmine) (anticholinesterase)
    prototype
  • Primarily used to treat Myasthenia Gravis
  • Pyridostimine (Mestinon)
  • Myasthenia Gravis
  • Donepezil (Aricept)
  • Works in the CNS to inhibit synthesis of
    Acetylcholinesterase
  • Used to treat Alzheimers disease

26
Cholinergic drugs
  • Direct acting Cholinergic drugs
  • Directly stimulates the nerve ending to secrete
    acetylcholine
  • Bethanechol (Urecholine)
  • Used to treat urinary retention

27
ADVERSE REACTIONS CHOLINERGIC DRUGS
  • Bradycardia
  • Hypotension
  • Headache, dizziness
  • Increased secretions
  • Abdominal cramping
  • Increased respiratory secretions and possibly
    bronchospasms

28
Anticholinergic Medication
  • Competitive antagonists
  • Compete with ACh
  • Inhibit nerve transmission
  • Sites of action
  • All systems except musculo-skeletal

29
Anticholinergic Medication
  • EXAMPLES
  • Bentyl (dicyclomine HCL)
  • Antispasmotic used to decrease intestinal
    cramping in IBS
  • Atropine (Prototype)
  • Acetylcholine antagonist
  • Antidysrhythmic
  • Antispasmotic
  • Antisecretory

30
Anticholinergic Medication
  • USES
  • Dry oral secretions
  • Increase heart rate
  • Treat ureteral colic
  • Decrease GI motility
  • Parkinsons disease
  • Decrease upper respiratory secretions

31
Urinary antispasmodics AKA anticholinergics
  • OXYBUTYNIN (DITROPAN)
  • Synthetic antimuscarinic
  • INCREASES BLADDER CAPACITY
  • DECREASES FREQUENCY OF VOIDING
  • TOLTERODINE (DETROL, DETROL LA)
  • Synthetic antimuscarinic
  • DELAYS THE URGE TO VOID
  • INHIBITS BLADDER CONTRACTIONS

32
Anticholinergic Medication
  • Adverse reactions / Side effects
  • Dry mouth
  • Blurred vision
  • Photophobia
  • Urinary retention
  • Constipation
  • Tachycardia
  • Drowsiness

33
Nursing Interventions
  • Monitor for signs of anticholinergic crisis
  • Report changes in heart rate, blood pressure, or
    development of dysrhythmias
  • Provide comfort measures for dryness of mucous
    membranes
  • Minimize exposure to heat or cold or strenuous
    exercise
  • Monitor IO
  • Monitor patient for abdominal distension, and
    auscultate for bowel sounds

34
Anticholinergic Crisis
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