Autonomic Nervous System

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Autonomic Nervous System

• Sympathetic (Adrenergic)
• Parasympathetic (Cholinergic)
• Have a balancing effect

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Neurotransmitters

• Acetycholine (ACH)
• Norepinephrine (NE)
• Epinephrine
• Dopamine

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Receptors

• Alpha 1 2
• Beta 1 2
• Muscarinic
• Nicotinie

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Sympathetic Response

• Increase HR
• Increase RR
• Increase metabolic rate
• Increase fat glycogen breakdown
• Pupillary dilation
• Smooth muscle vasoconstriction
• Skeletal cardiac muscle vasodilation
• Decrease GI activity
• Bronchial relaxation

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Parasympathetic Response

• Decrease HR
• Decrease RR
• Increase digestion elimination
• Increase GI tone
• Bronchial constriction
• Pupillary constriction

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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 visual acuity
• headache
  

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Nicotine

• Stimulates nicotine receptors
• Used for cessation of tobacco smoking
• Cannot smoke when using patch

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Antichoinesterase (Indirect-acting Cholinergic
Agonists

• Inhibits enzyme acetlycholinesterase
• Results in decrease destruction of ACH
• Which results in increase cholinergic action
• Neostigmine (prostigmin)

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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

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Atropine(cholinergic 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

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Scopolamine

• Produces CNS depression with sedative
  tranquilizing effects
• Used to tx motion sickness

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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)

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Adrenergic Receptors

• Alpha-1 alpha-2 are differentiated by location
  on nerve, 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,
  hypertension, NV

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Summary with receptors

• Alpha - 1 vasoconstriction
• beta - 1 cardiac stimulation
• beta - 2 bronchiole dilation

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Alpha-1 Adrenergic Agonist

• Phenylephrine most common use is as
  decongestant, treat nasal congestion
• Side effects sleep disturbances, headache

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Epinephrine (nonselective) (Adrenergic Agonist)

• Increases heart rate CO
• Increase in blood sugar
• Bronchiole dilation
• Indicated for anaphylaxis, cardiac arrest, asthma

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Beta Adrenergic Agonist

• Isoproterenal (Isuprel)
• Increase contractility heart rate
• Bronchodilator
• Indicated in asthma, bradycardia, cardiac arrest
• Dopamine (Intropin)
• Dobutamine (Dobutrex)
• Proventil Brethine, respiratory, bronchodilators

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Alpha Adrenergic Antagonist

• Disrupts sympathetic response
• Relaxation of vascular smooth muscle, peripheral
  vasodilation decrease BP
• prazosin (Minipress)
• Used for hypertension, angina, peripheral
  vascular disorders
• Watch for orthostatic hypotension

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Beta Adrenergic Blockers (antagonist)

• Prevents SNS stimulation
• decrease peripheral vascular resistance, decrease
  BP, decrease CO, decrease HR
• Used to tx hypertension, angina, arrhythmias

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Beta Blockers

• Need to know whether cardioselective or
  nonselective
• Beta - 1 blockers will decrease myocardial
  contractility HR, Lopressor (metoprolol)
  Tenormin (atenolol)
• Nonselective - blocks beta - 1 and beta -2 which
  causes above bronchiole constriction

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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

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Combined blocker

• Carvedilol (Coreg)
• Combined alpha and beta blocker
• Frequently administered with other
  antihypertensive agents.
• Watch for orthostatic hypotension bradycardia

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