Kellie A.

Pacanowski

Mr. Kendall

Pharmacology November 5th 2013

The Central and Peripheral Nervous System

In order to become a competent Respiratory Therapist and of course to pass our board exams we must understand how the drugs we use work on the body and why we would choose a certain drug over the other. Our central and peripheral nervous systems help to control our bodies. These systems can be manipulated by drugs which will either mimic or block the normal action of these two systems to produce the desired physiological effects. Desired effects will fall under the following terms: adrenergic, parasympatholytic, and sympathomimetic. In the following paragraphs the definitions and drugs under each previously listed classification will be discussed.

An adrenergic drug refers to a drug that stimulates a receptor for norepinephrine or epinephrine. The general indication for an adrenergic drug is to relax the airway smooth muscle when there is airflow obstruction associated with acute or chronic asthma, bronchitis, emphysema, bronchiectasis or other obstructive airway diseases. Current adrenergic bronchodilators are known as Levalbuterol, Salmeterol and Arformoterol. Levalbuterol or Xopenex is a short acting drug used to treat asthma and COPD by relaxing the smooth muscles of the airways from the trachea to the terminal bronchioles. Levalbuterol prevents or relieves

wheezing, shortness of breath, chest tightness and coughing. Some side effects of this drug are headaches, fever, or muscle pain. Salmeterol is used in combination with other drugs for the long term control of asthma, it may also be used to prevent breathing issues in those with nocturnal asthma or exercise related breathing problems. This drug works by widening the airways in the lungs allowing patients to breathe more easily. Salmeterol or Serevent Diskus currently only appears in the form of a DPI. Never prescribe salmeterol in large doses because of the risk of very serious heart problems such as irregular heartbeat, salmeterol may not be the best option for diabetics because it can negatively affect blood sugar. Arformoterol or Brovana is a long acting adrenergic bronchodilator used in the treatment of chronic bronchitis and emphysema. Brovana is administered by a SVN and should be given twice a day, 12 hours apart. Brovana cannot be used to treat sudden COPD attacks, but instead controls symptoms of COPD. Although your patient may try to convince you that the drug has cured their disease this is not the result. Brovana like the former drugs opens up the airways allowing easier breathing.

A sympathomimetic drug causes stimulation of the sympathetic nervous system by mimicking the actions of epinephrine which can cause tachycardia, elevated blood pressure, and smooth muscle relaxation of bronchioles. Examples of sympathomimetic drugs are Formoterol and Pirbuterol. Formoterol is a long acting drug used for the maintenance of bronchodilation, and control of bronchospasm. Formoterol is only prescribed if a patients asthma is so severe that two medications will be needed to control it. Formoterol helps to prevent an asthma or COPD attack but will not stop an attack that has already begun. Pirbuterol is used to treat wheezing and shortness of breath occurring with asthma and COPD. This drug comes in the form of an inhaler which allows the drug to reach far into the lungs for the most possible benefit. Pirbuterol will not

and should not be prescribed if the patient is using another short acting sympathomimetic bronchodilator such as Albuterol.

A parasympatholytic drug is a drug that blocks the parasympathetic nervous fibers. These drugs work to treat bradycardias, bradydysrhythmias and treat illnesses causing the bronchioles to constrict such as asthma. A drug falling under the parasympatholytic classification is Tiotropium bromide. Tiotropium bromide or Spiriva is a long acting 24 hour bronchodilator used to control the symptoms of COPD. Spiriva can reduce COPD flare-ups due to the improvement of lung function from opening the airways. Spiriva is not a rescue inhaler and should not be used as one; however patients who use Spiriva have been shown to use their rescue inhalers less often. Since Spiriva appears in a powder form, be sure to warn patients of the possible side effect of blurred vision or temporary blindness should the medication contaminate the eye.

It is important to know the understand why certain drugs should not be used in a patient, for example, a patient may be admitted who is suffering from an asthma attack and also has retained secretions, in a situation such as this a parasympatholytic drug should not be administered because parasympatholytic drugs have been found to dry secretions, even though they will offer bronchodilation. Be sure to check patient charts before blindly administering a drug, our job is to support the patient during their time of need, and to help them return to normal function, or at least their normal. Understanding the nervous system in correlation to respiratory care based on the control mechanisms and physiological effects will form the basis for knowledge of drug actions and drug effects of drugs that we one day will be asked to administer or recommend for a patient.