CNS

PNS

Brain Spinal cord

ANS SNS

AFFERENT

EFFERENT

Send impulses

Receive impulses

SNS Other term Neurotransmitter Receptors Adrenergic system Norepinephrine (NE) Alpha 1 Alpha 2 Beta 1 Beta 2

PSNS Cholinergic system Acetylcholine (ACh) Nicotinic Muscarinic

BODY TISSUE/ORGAN Eye Lungs Heart Blood vessels GIT Bladder Uterus Salivary gland

SNS RESPONSE Pupil dilation (mydriasis) Bronchodilation Increased HR Vasoconstriction GI smooth muscle relaxation Relaxation Uterine muscle relaxation

PSNS RESPONSE Pupil constriction (mioisis) Bronchoconstriction ; increase secretions Decreased HR Vasodilation Increase peristalsis Constriction

Increased salivation

Sympathetic Stimulants Other terms: Sympathomimetics, adrenergics, adrenomimetics, adrenergic agonists

Parasympathetic Stimulants

Direct-acting Parasympathomimetics, cholinergics, cholinergic agonists

Indirect-acting Cholinesterase inhibitors (anticholinesterase)

Actions: BP PR Bronchial relaxation Pupil dilation Uterine muscle relaxation blood sugar

Actions: (Direct-Acting) BP PR Bronchoconstriction Pupil constriction Bladder contraction peristalsis (Indirect-Acting) muscle tone

Sympathetic Depressants Other terms: Sympathloytics, adrenergic blockers, adrenolytics, adrenergic antagonists

Parasympathetic Depressants Other terms: Parasympatholytics, anticholinergics, cholinergic, antagonists, antispasmodics

Actions: BP PR Bronchoconstriction

Actions: PR mucous secretions GI motility urinary retention Pupil dilation

Dopaminergic
Location: Renal Mesenteric Coronary Cerebral arteries
Actions: Vasodilation

1. 2. 3.

Reuptake of the neurotransmitter back into the nerve cell terminal Enzymatic transformation or degradation Diffusion away from the receptor

Two enzymes that inactivate metabolism of NE:

Monoamine oxidase (MAO) inside the neuron Catechol-O-methyltransferase (COMT) outside

the neuron

1.

2.

Inhibits NE reuptake Inhibits degradation of NE

Catecholamines
Endogenous (epinephrine, NE, dopamine)
Synthetic (isoproterenol, dobutamine)

Noncatecholamines
Phenylephrine
Metaproterenol Albuterol

Epinephrine (Adrenalin)
Sites of action: A1 = BP B1 = HR B2 = Bronchodilation
Indications: Shock (cardiogenic, anaphylactic)

Albuterol (Ventolin)
Site of action B2
Indication: Asthma

Isoproterenol Hydrochloride (Isuprel)

Sites of action B1 B2

Clonidine (Catapres) Methyldopa (Aldomet)

Site of action A2

Indication Hypertension

Ephedrine
Site of action A1 B1 B2
Indication Orthostatic hypotension Hypotension rel. to spinal anesthesia Bronchial asthma

Monitor VS Obtain drug and medical history

Risk for Impaired Tissue Integrity Deceased Cardiac Output

VS within normal range

Record VS Report side effects Check UO For cardiac resuscitation:

Epinephrine 1:1000 IV (1mg/mL) diluted in 10 mL

of NSS

Dilute drug, assess IV site frequently

Client Teaching
Do not take drugs for cold symptoms
Do not breastfeed while taking adrenergics Do not continuously use nasal spray or drops that

contain adrenergics Administer nasal spray with the head in an upright position Encourage client to report side effects

Continue monitoring VS

Alpha-Adrenergic Blockers
Categories: Selective Non-selective Indication: BPH , peripheral vascular disease
Mechanism of action: Vasodilation Side effect: Dizziness , tachycardia

Beta-adrenergic Blockers Olol

Types: Selective (metoprolol) Non-selective (propanolol) Sites of action B1 B2
Contraindication Asthma

Bethanecol (Urecholine)
Site of action Muscarinic (GI and GUT)

Metoclopramide HCl (Reglan)

Site of action Muscarinic (GIT) Indication GERD

Pilocarpine
Indication Glaucoma

Acetylcholinesterase (AChE) Inhibitors Indication:

Myasthenia gravis

Monitor VS Assess UO (should be > 600mL/day) Medical history: PUD, urinary obstruction; asthma

Urinary retention Anxiety

Increased bladder and GI tone Increased neuromuscular strength

Direct acting
Monitor VS (especially BP and PR)
Monitor UO Give 1 hour before 0r 2 hours after meals

Observe for side effects: orthostatic hypotension,

gastric upset, increase salivation Auscultate bowel sounds Auscultate breath sounds Administer atropine sulfate as an antidote

Indirect-acting
Beware of possibility of cholinergic crisis

(overdose)

Client teaching
Direct-acting Take as prescribed Teach to arise from a lying position slowly Encourage effective oral hygiene Advise to report DOB
Indirect-acting Instruct to report changes in muscle strength

Atropine sulfate
Site of action Muscarinic
Indication Pre-op medication PUD Bradycardia

Obtain VS Assess UO Medical history

Narrow-angle glaucoma

Obstructive GI d/o
Paralytic ileus BOH

Myasthenia gravis

Urinary retention Impaired oral mucous membrane Constipation

No evidence of side effects

Monitor VS, report if tachycardia occurs Determine I&O Record bowel sounds Encourage to eat foods high in fiber Raise side rails Provide mouth care Maybe administer diluted / undiluted

Client Teaching
Avoid hot environments
Avoid atropine-like drugs Instruct not to drive

Advise to report side effects

Advise to use hard candy, ice chips

Re-assess for side effects

Trihexyphenidyl (Artane) Benztropine (Cogentin) Action

Decrease salivation and drooling

Decrease tremors and rigidity

Scopolamine
Indication Motion sickness