Autonomic nervous system Learning objectives Describe the four classifications of autonomic drugs For each drug class

in autonomic nervous system, explain: Mechanism of action Indications Side effects Describe the nursing process to care for patients using drugs affecting the autonomic nervous system Define medical terminology used in current lecture. Review Figure 13.4 and Table 13.1 Classification of autonomic drugs Sympathomimetics adrenergic agents Stimulates___ sympathetic nervous system Sympatholytics adrenergic antagonists Inhibit__ sympathetic nervous system Parasympathomimetics cholinergic agents stimulate parasympathetic nervous system Parasympatholytics _anticholinergic__; muscarinic blockers inhibit parasympathetic nervous system

Effects are similar between (draw lines) sympathomimetics sympatholytics parasympatholytics

parasympathomimetics

Sympathetic system Induce fight or flight responses Direct vs indirect receptor mechanisms Receptor types: or 1 - blood vessels 2 - inhibits release of Norepinephrine 1 - heart , kidneys beta one = one heart 2 - all organs except heart (__lungs___) beta two = two lungs selective vs nonselective Adrenergic agonists Table 13.2 Sympathomimetics Similar responses as anticholinergics Anti-SLUD: Salivation dry mouth Lacrimation dry eyes Urination decreased urine Defacation decreased defacation

Primary use of adrenergic agents Depends on receptors activated alpha1-receptors: blood vessels such as : nasal congestion, hypotension, __dilation of pupils_ for eye examination alpha2-receptors: hypertension____ beta1-receptors: cardiac arrest, heart failure__, shock beta2-receptors: __asthma____ and premature-labor contractions Monitoring of sympathomimetics Closely monitor IV insertion Monitor breathing patterns, shortness of breath, and/or audible wheezing Observe patients responsiveness to light Monitor for rhinorrhea and epistaxis

Prototype drug: phenylephrine (PE) Mechanism of action: selective stimulation of _a receptors (vasoconstriction)______ Uses: _nasal congestion_, ophthalmic exams, reverse acute hypotension Due to MethWatch, new use as oral decongestant what about bioavailability? Nursing implications with PE Administration alerts Extravasation (come out of area where it is supposed to be) with parenteral administration Ophthalmic drops Pregnancy Category C crosses placental barrier / in _breast milk____

Contrindicated with acute pancreatitis, heart disease, and hepatitis

SE of PE burning with topical administration

rebound congestion
tachycardia, hypertension ___ anxiety, _restlessness__, tremor _dry mouth_, N, V, anorexia Nursing process focus with sympathomimetic therapy Assessment Potential nursing dx Planning: Patient goals and outcomes Implementation: Intervention and rationales Patient education/discharge planning Evaluation of outcome criteria Sympatholytics Table 13.5 Adrenergic antagonists Directly block adrenergic receptors a___ receptors on vascular __smooth______________ muscle b____ receptors on __cardiac___ Uses: _hypertension_, glaucoma, HF, angina, dysrhythmias, benign prostatic hypertrophy___ Similar responses as cholinergic drugs

Prototype drug: prazosin (Minipress) Selective 1 blocker (_arterioles and veins__) MOA: rapid decrease in peripheral vascular resistance Short half-life taken three times daily (TID) Use: hypertension, BPH, Raynauds syndrome, narrow angle glaucoma SE: _orthostatic hypotension_ (first dose phenomenon), dizziness, drowsiness, HA, weakness Nursing process focus with adrenergic blockers Assessment Potential nursing dx Planning: Patient goals and outcomes Implementation: Intervention and rationales Patient education/discharge planning Evaluation of outcome criteria Parasympathomimetics Direct action muscarinic or nicotinic receptors Resistant to AchE _long acting_ Poorly absorbed, do not cross BBB Indirect action Inhibit destruction of AchE (acytlcholinesterase) cholinesterase inhibitors Nonselective bind at all Ach sites Prototype drug: bethanechol (Urecholine) Direct-acting MOA: stimulate smooth muscle contraction____ (bladder, GI tract) Use: nonobstructive _urinary retention___ myasthenia gravis, glaucoma Available PO (_take on empty stomach)

SE: (SLUD), D, N, V, urinary urgency, _hypotension_, HA, _abdominal cramping_, eructation (medical term for belching) Nursing process focus with cholinergic agonists Assessment Potential nursing dx Planning: Patient goals and outcomes Implementation: Intervention and rationales Patient education/discharge planning Evaluation of outcome criteria Anticholinergics Most action on muscarinic receptors _Competitive binding___ with Ach suppress Ach effects (similar effects as sympathomimetics) Uses: PUD, IBS, ophthalmic procedures, cardiac rhythm abnormalities, _COPD_, _motion sickness__, _preop medication___ Cholinergic crisis: hot as Hades, blind as a bat, dry as a bone, mad as a hatter Prototype drug: atropine MOA: blocks muscarinic receptor in _smooth muscle_, _secretory_, and CNS Available PO, IV, topical (ophthalmic ung(ointment), soln (solution) ) Uses: preop med_, _antidote_ (nerve agent toxicity/pesticide poisoning), ophthalmic procedures, symptomatic sinus bradycardia, asystole ( heart rate) SE: many and most dose-related, _anti slud__, arrhythmia, palpitation, tachycardia, ataxia, disorientation Nursing process focus with anticholinergic agonists Assessment Potential nursing dx Planning: Patient goals and outcomes Implementation: Intervention and rationales Patient education/discharge planning Evaluation of outcome criteria

Looks at the nervous system figure in book Stress response - sympathic Reflex actins - spine Intestinal motility - parasympathetic Feelings of joy and feer - brain Glandular secretions - autonomic Clenching fists somatic Drug class, moa, side effects, monitor parameters