AUTONOMIC NERVOUS SYSTEM DRUGS

The

autonomic nervous system can be thought of as being automatic, self governing, or involuntary. That is to say, we have no control over the action of the autonomic nervous system. Chemical substances called neurotransmitter are released at the nerve endings to transmit the nerve impulses from nerve to nerve at the synapses or from nerve to muscle at the myoneural junction.

 The

autonomic nervous system is divided into the sympathetic and parasympathetic division. Drugs that affect the function of the autonomic nervous system are divided into four categories: Andrenergics (symphatomimetics) Andrenergic blockers (alpha and beta blockers) Cholinergics (parasymphatomimetics) Cholinergic blockers (anticholinergics)

SYMPATHETIC NERVOUS SYSTEM

The sympathetic nervous system activates what is often termed the fight or flight response. Like other parts of the nervous system, the sympathetic nervous system operates through a series of interconnected neurons. Sympathetic neurons of the spinal cord (which is part of the CNS) communicate with peripheral sympathetic neurons via a series of sympathetic ganglia.

SYMPATHETIC NERVOUS SYSTEM

The sympathetic nervous system is responsible for up- and down-regulating many homeostatic mechanisms in living organisms.

DRUGS ACTING ON THE SYMPATHETIC NERVOUS SYSTEM

Alpha1 receptor agonists (i.e. nasal decongestants) are most frequently used as vasoconstrictors. Adverse effects are related to excessive vasoconstriction and include increased blood pressure, abnormal heart rhythm, headaches, and strokes. (Overuse of topical decongestants can lead to local irritation and increased congestion.)

DRUGS ACTING ON THE SYMPATHETIC NERVOUS SYSTEM : Beta receptor agonists : bronchodilators such as ventolin are useful in the treatment of asthma and chronic obstructive pulmonary disease. Beta receptor agonists adverse effects are due to excessive sympathetic nervous system activity, heart rhythm abnormalities, palpitations, and subsequent exacerbation of angina.

DRUGS ACTING ON THE SYMPATHETIC NERVOUS SYSTEM Alpha2 receptor agonists (e.g. clonidine) produce their antihypertensive effects via an inhibition of sympathetic activity. The most common adverse effects associated with alpha2 agonists are sedation, confusion, sexual dysfunction, dry mouth, and bradycardia.

DRUGS ACTING ON THE SYMPATHETIC NERVOUS SYSTEM

Alpha receptor antagonists: e.g prazosin vasodilators used in the treatment of hypertension; also facilitate urine outflow and are used to treat benign prostatic hyperplasia. Adverse effects associated with alpha antagonists include hypotension (particularly postural/ orthostatic), reflex tachycardia, nasal congestion, and inhibition of ejaculation or ovulation.

DRUGS ACTING ON THE SYMPATHETIC NERVOUS SYSTEM

Beta receptor antagonists: e.g. Propranolol are used to treat a variety of conditions including hypertension, angina, myocardial infarction (heart attack), and abnormal heart rhythm (dysrhythmias). Agents such as timolol (Timoptic) and betaxolol (Betoptic) are commonly used topically for the treatment of glaucoma.

Adverse effects include bradycardia, bronchoconstriction (tightening of the airways), sedation, depression, and sexual dysfunction (impotence, decreased ejaculation or anovulation).

DRUGS ACTING ON THE SYMPATHETIC NERVOUS SYSTEM

The bronchoconstriction is of particular concern in asthmatic and chronic obstructive pulmonary disease patients. Beta-blockers adversely affect glucose homeostasis in diabetic patients, therefore, a risk: benefit analysis must be made prior to use of this type of therapy in diabetic patients. Abrupt discontinuation of beta-blocker therapy may lead to rebound or overshoot hypertension. (NOTE: AGONISTS effectively increase the neurotransmitter effect, ANTAGONISTS

ACTIONS OF ANDRENERGICS:
Cardiac

stimulation Increased blood flow to skeletal muscle Peripheral vasoconstriction Bronchodilation Dilation of pupils.

USES FOR THE ADRENERGIC:

Restoring

rhythm in cardiac arrest Elevating blood pressure in shock of all kinds Constricting capillaries Dilating bronchioles in acute asthmatic attacks, bronchospasm, or anaphylactic reaction. Ophthalmic procedure

SIDE EFFECTS:
Palpitations Nervousness or tremor Tachycardia Cardiac arrhythmia Anginal pain Hypertension Tissue necrosis Hyperglycemia Headache and insomnia

CONTRAINDICATION OR EXTREME CAUTION

Angina

Coronary

insufficiency Hypertension Cardiac arrhythmia Angle-closure glaucoma Organic brain damage Hyperthyroidism

CAUTION:
For

adrenergic also with administration; check dosage carefully (small amount only). Give subcutaneous, IM (deltoid) or IV.

INTERACTIONS:
CNS

drugs (e.g alcohol,monoamine oxidase inhibators and antidepressant.) Propranol (inderal) or other betaadrenergic blocker Terazosin (Hytrin) or other adrenergic blockers.

WORKSHEET AUTONOMIC NERVOUS SYSTEM

CLASSIFICATI ON AND DRUGS Epineprhine (Sympathomim etic,) PURPOSE SIDE EFFECTS epigastric pain; difficulty in micturition with urinary retention; dyspnea; hyperglycaemia ; sweating; hypersalivation; weakness, tremors; coldness of extremities; hypokalaemia. CONTRAINDIC PATIENT ATIONS OR EDUCATION CAUTIONS Preexisting hypertension; occlusive vascular disease; angleclosure glaucoma (eye drops); hypersensitivity ; cardiac arrhythmias or tachycardia. When used in addition to local anaesthetics. Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown solutions. Drug solutions should be clear and colorless (does not apply to suspension for injection)

For bronchospasm , ashtma, cardiac arrest, anaphylaxis

WORKSHEET AUTONOMIC NERVOUS SYSTEM

CLASSIFICATI ON AND DRUGS PURPOSE SIDE EFFECTS CONTRAINDIC PATIENT ATIONS OR EDUCATION CAUTIONS

Ephedrine Sulfate Injection, USP (sympathomimet ic)

indicated in the treatment of allergic disorders, such as bronchial asthma. The drug has long been used as a pressor agent, particularly during spinal anesthesia when hypotension frequently occurs.

Some patients have nausea, vomiting and anorexia. Vesical sphincter spasm may occur and result in difficult and painful urination. Urinary retention may develop in males with prostatism.

Allergic reactions to ephedrine sulfate are rare. The hypersensitivity , if known, is a specific contraindication . Patients hypersensitive to other sympathomime tic may also be hypersensitive to ephedrine sulfate.

Ephedrine sulfate is excreted in breast milk. Use by nursing mothers is not recommended because of the higher than usual risk for infants

WORKSHEET AUTONOMIC NERVOUS SYSTEM

CLASSIFICAT PURPOSE ION AND DRUGS
Dopamine To correct (Sympathomime hemodynamic tic,) imbalance in shock syndrome due to MI (cardiogenic shock), trauma, endotoxic septicemia (septic shock), open heart surgery, and CHF

SIDE EFFECTS

CONTRAINDIC PATIENT ATIONS OR EDUCATION CAUTIONS

Dopamine is contraindicated in patients with a tachyarrhythmi a, a rapid, abnormal heart rhythm. The administration of dopamine could raise the heart rate further, creating or worsening a life-threatening condition. Monitor for possible adversereactio n Assess for heartfailure: dsypnea,neck vain distention, Assess for oxygenation andperfusionde ficit.

nausea, vomiting, tachycardia, ectopic beats, palpitation, anginal pain, hypotension, vasoconstrictio n bradycardia, hypertension,dy spnoea, headache,

CLASSIFICAT ION AND DRUGS

PURPOSE

SIDE EFFECTS

CONTRAINDI CATIONS OR CAUTIONS Use of isoproterenol hydrochloride injection is contraindicated in patients with tachyarrhythmi as; tachycardia or heart block caused by digitalis intoxication; ventricular arrhythmias which require inotropic therapy; and angina pectoris.

PATIENT EDUCATION

Isoproterenol For use in (Sympathomim cardiac arrest etic,) until electric shock or pacemaker therapy, the treatments of choice, is available.

CNS: Nervousness, headache, dizziness, nausea, visual blurring Cardiovascular : Tachycardia, palpitations, angina, Adams-Stokes attacks, pulmonary edema, hypertension, hypotension,

Monitor for possible adversereactio n

Assess for tachyarrhytmia .

WORKSHEET AUTONOMIC NERVOUS SYSTEM

CLASSIFICAT ION AND DRUGS PURPOSE SIDE EFFECTS CONTRAINDI CATIONS OR CAUTIONS Concomitant use of cyclopropane or halothane anesthesia should be avoided. PATIENT EDUCATION

Metaraminol prescribed for (Sympathomim acute etic,) hypotensive state occurring with spinal anesthesia. It is also used as an adjuvant for the treatment of hypotension due to bleeding.

It may develop increased risk of liver damage, and abnormal heart rhythm, which may cause death in patients with Laennec's cirrhosis; consult with your healthcare provider about this before

Monitor central venous pressure and heart function regularly while taking this medication.

CLASSIFICATI PURPOSE ON AND DRUGS Norepinephrine Adjunctive (Sympathomim treatment in etic,) cardiac arrest and profound hypotension

SIDE EFFECTS

CONTRAINDIC ATIONS OR CAUTIONS Hypotension due to blood volume deficits except as an emergency measure. Mesenteric or peripheral vascular thrombosis. Profound hypoxia or hypercabia. Concomitant cyclopropane and halothane anesthesia.

PATIENT EDUCATION

ischemic injury, reflex bradycardia, arrhythmias, anxiety, transient headache, respiratory difficulties, extravasation necrosis, volume depletion (esp. long-term use).

Hypertension. Monitor BP every 2 minutes initially until desirable level is obtained, then every 5 minutes if administration is continued. Avoid extravasation. Asthma. Sulfite sensitivity. Elderly (avoid infusion into leg veins). Pregnancy (Cat. C). Nursing mothers.