Dr ugs Acting on the Autonom ic Ner vous System :
Review:
- Parasympathetic (rest and digest): increase gastric motility, increase gastric secretions,
decrease HR and BP, constrict pupils, relax sphincters
- Two important response: muscarinic and Nicotinic (skeletal muscle contraction)
- Activator: Acetylcholine
Categor y: Cholin er gic dr ugs
Class: Dir ect acting Choliner gic agents:
Indication: urinary retention, induce pupil constriction, increase oral secretions, glaucoma
Drug: Bethanechol (duvoid)
Mechanism: act as cholinergic agonists at cholinergic receptors to mimic effects of acetylcholine
and parasympathetic stimulation. They increase the availability of acetylcholine at the
muscarinic receptor sites. (DIRECTLY AT RECEPTOR SITES)
Side effects: last longer in the body
- P: increased salivation, diarrhea and fecal incontinence, increased sweating, bradycardia,
hypotension, urinary frequency, blurred vision
- L: heart block, cardiac arrest, aspiration
Patient: maintain hydration, slow transfers from sitting to standing, advised to be taken on an
empty stomach, make sure bathroom facilities are available
Nurse: monitor vitals, assess bowel and bladder function, monitor urinary output, antidote
(atropine)
Class: Indir ect Acting Choliner gic agon ists
Indication: myasthenia gravis (nerve and muscle impaired communication), alzheimer’s disease
Drug: Donepezil (aricept), Pyridostigmine (Mestinon)
Mechanism: prevents acetylcholine from breaking down in the synaptic cleft by preventing the
enzyme acetylcholinesterase.
Side effects:
- P: increased salivation, diarrhea and fecal incontinence, increased sweating, bradycardia,
hypotension, urinary frequency, blurred vision
- L: heart block, cardiac arrest, aspiration
Patient: maintain hydration, slow transfers from sitting to standing, advised to be taken on an
empty stomach, make sure bathroom facilities are available
Nurse:monitor vitals, assess bowel and bladder function, monitor urinary output, antidote
(atropine)
CHOLINERGIC CRISIS: Atr opine an tidote
Salivation
Lacr im ation
Ur ination
Defecation
, Gastr ic upset
em esis
Review : Sy m path etic (fi gh t or fl igh t): in crease B P and HR, in crease respiration s,
bron ch odilation (airw ay is open ), sw eatin g, pu pil dilation , con strict, decrease
gastric activity an d secretion s
Adr ener gic dr ugs: stimulate the sympathetic nervous system ("fight or flight") by activating
adrenergic (alpha & beta) receptors. They are used to increase blood pressure, heart rate, or
open airways.
- Alpha-1 ( α1) → Vasoconstr iction (increases blood pressure), pupil dilation, tightens
bladder sphincter
- Alpha-2 ( α2) → Inhibits nor epin ephr in e r elease (decreases sympathetic activity,
lowers BP slightly)
● B eta-1 ( β1) → Incr eases heart r ate an d for ce of con traction (found mainly in the
heart)
● B eta-2 ( β2) → B r onchodilation (opens airways), relaxes smooth muscle (found in
lungs, uterus) better lungs!!
● B eta-3 ( β3) → B r eaks dow n fat (lipolysis) , found in adipose tissue
Class: Catecholam ines: Alpha and B eta Adr en er gic agon ists
Drug: norepinephrine and epinephrine
Mechanism: directly acts on the alpha and beta receptor causing vasoconstriction,
bronchodilation, and increased HR
Indication: hypotension and shock (Alpha), bronchospasm or asthma (beta 2), bradycardia
(beta 1), anaphylaxis
Side effects:
- P: HTN, arrhythmias, palpitations, tachycardia, angina, anxiety
Patient: may experience jitteriness, if epipen does not improve symptoms in 5-15 minutes, go to
ED. avoid caffeine
Nurse: assess vitals, monitor urinary output, monitor for necrosis if given IV
Class: Noncatecholam ines: adr en er gic agon ists (lon ger actin g)
Drug: phenylephrine, ephedrine, albuterol
Mechanism: can directly or dually act on the alpha and beta receptors. Is longer acting and
causes vasoconstriction, bronchodilation and increased HR
Indication: cold, allergies, systemic constriction of blood vessels, rosacea, bronchospasm
Side effects:
Review:
- Parasympathetic (rest and digest): increase gastric motility, increase gastric secretions,
decrease HR and BP, constrict pupils, relax sphincters
- Two important response: muscarinic and Nicotinic (skeletal muscle contraction)
- Activator: Acetylcholine
Categor y: Cholin er gic dr ugs
Class: Dir ect acting Choliner gic agents:
Indication: urinary retention, induce pupil constriction, increase oral secretions, glaucoma
Drug: Bethanechol (duvoid)
Mechanism: act as cholinergic agonists at cholinergic receptors to mimic effects of acetylcholine
and parasympathetic stimulation. They increase the availability of acetylcholine at the
muscarinic receptor sites. (DIRECTLY AT RECEPTOR SITES)
Side effects: last longer in the body
- P: increased salivation, diarrhea and fecal incontinence, increased sweating, bradycardia,
hypotension, urinary frequency, blurred vision
- L: heart block, cardiac arrest, aspiration
Patient: maintain hydration, slow transfers from sitting to standing, advised to be taken on an
empty stomach, make sure bathroom facilities are available
Nurse: monitor vitals, assess bowel and bladder function, monitor urinary output, antidote
(atropine)
Class: Indir ect Acting Choliner gic agon ists
Indication: myasthenia gravis (nerve and muscle impaired communication), alzheimer’s disease
Drug: Donepezil (aricept), Pyridostigmine (Mestinon)
Mechanism: prevents acetylcholine from breaking down in the synaptic cleft by preventing the
enzyme acetylcholinesterase.
Side effects:
- P: increased salivation, diarrhea and fecal incontinence, increased sweating, bradycardia,
hypotension, urinary frequency, blurred vision
- L: heart block, cardiac arrest, aspiration
Patient: maintain hydration, slow transfers from sitting to standing, advised to be taken on an
empty stomach, make sure bathroom facilities are available
Nurse:monitor vitals, assess bowel and bladder function, monitor urinary output, antidote
(atropine)
CHOLINERGIC CRISIS: Atr opine an tidote
Salivation
Lacr im ation
Ur ination
Defecation
, Gastr ic upset
em esis
Review : Sy m path etic (fi gh t or fl igh t): in crease B P and HR, in crease respiration s,
bron ch odilation (airw ay is open ), sw eatin g, pu pil dilation , con strict, decrease
gastric activity an d secretion s
Adr ener gic dr ugs: stimulate the sympathetic nervous system ("fight or flight") by activating
adrenergic (alpha & beta) receptors. They are used to increase blood pressure, heart rate, or
open airways.
- Alpha-1 ( α1) → Vasoconstr iction (increases blood pressure), pupil dilation, tightens
bladder sphincter
- Alpha-2 ( α2) → Inhibits nor epin ephr in e r elease (decreases sympathetic activity,
lowers BP slightly)
● B eta-1 ( β1) → Incr eases heart r ate an d for ce of con traction (found mainly in the
heart)
● B eta-2 ( β2) → B r onchodilation (opens airways), relaxes smooth muscle (found in
lungs, uterus) better lungs!!
● B eta-3 ( β3) → B r eaks dow n fat (lipolysis) , found in adipose tissue
Class: Catecholam ines: Alpha and B eta Adr en er gic agon ists
Drug: norepinephrine and epinephrine
Mechanism: directly acts on the alpha and beta receptor causing vasoconstriction,
bronchodilation, and increased HR
Indication: hypotension and shock (Alpha), bronchospasm or asthma (beta 2), bradycardia
(beta 1), anaphylaxis
Side effects:
- P: HTN, arrhythmias, palpitations, tachycardia, angina, anxiety
Patient: may experience jitteriness, if epipen does not improve symptoms in 5-15 minutes, go to
ED. avoid caffeine
Nurse: assess vitals, monitor urinary output, monitor for necrosis if given IV
Class: Noncatecholam ines: adr en er gic agon ists (lon ger actin g)
Drug: phenylephrine, ephedrine, albuterol
Mechanism: can directly or dually act on the alpha and beta receptors. Is longer acting and
causes vasoconstriction, bronchodilation and increased HR
Indication: cold, allergies, systemic constriction of blood vessels, rosacea, bronchospasm
Side effects:
