autonomic nervous system - los angeles county,...
TRANSCRIPT
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Drugs affecting the autonomic nervous system
N231
Nursing Pharmacology
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Objectives
Analyze the implementation of the nursing process in the promotion and maintenance of system stability for individuals receiving autonomic nervous system drugs
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Required Reading
• Kee (Chapter 18) pp. 252-267
• Kee (Chapter 19) pp. 269-283
• Lecture Notes
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Autonomic Nervous System (ANS)
• Is an involuntary nervous system over which a person has little or no control
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Two main subdivisions
• Sympathetic
(fight or flight)
Neurotransmitters
Epinephrine
Norepinephrine
Dopamine
• Parasympathetic
(rest and digest)
Primary neurotransmitter
Acetylcholine
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Two subdivisions
• Sympathetic
Four main adrenergic receptors:
A1, A2, B1, B2
• Parasympathetic
Receptors: Muscarinic and Nicotinic
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Classifications
Sympathetic Nervous System (SNS)
• Adrenergic
• Adrenergic blocker
Parasympathetic Nervous System (PNS)
• Cholinergic
• Anticholinergics
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Alpha Adrenergic Receptors
• Located in the vascular tissues (vessels) of muscles. When the alpha 1 receptor is stimulated the arterioles and venules constrict increasing peripheral resistance and blood return to the heart improving circulation and increasing blood pressure
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Alpha2 Receptor
• Located in the postganglionic sympathetic nerve endings. When stimulated it inhibits the release of norepinephrine leading to a decrease in vasoconstriction. This results in vasodilation and a decrease in BP.
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Adrenergic Drugs therapeutic use
• Allergic reactions
• Heart Failure
• Shock
• Asthma
• Nasal congestion
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Adrenergic Agonists
• Norepinephrine (Levophed)
• Epinephrine (Adrenalin Chloride)
• Dopamine HCL (Intropin)
• Albuterol (Proventil)
• Phenylephrine (Neo-Synephrine)
• Dobutamine HCL (Dobutrex)
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Norepinephrine “Levophed”
• Used in the treatment of shock states when drugs such as Dopamine and Dobutamine have failed to produce adequate BP
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Side-effects of Norepinephrine “Levophed”
• Angina
• Tachycardia
• Hypertension
• Dysrhythmias
• Extravasation
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Epinephrine’s therapeutic use
• Drug of choice for anaphylactic shock
• Drug of choice for treatment of acute bronchospasm
• Cardiac arrest
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Epinephrine Contraindications
• Severe organic cardiac disease
• Diabetes
• During labor
• General anesthesia
• Hypertension
• Cerebrovascular disease
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Epinephrine Side-effects
• Cardiac arrhythmias
• Angina pectoris
• Subarachnoid hemorrhage
• Nervousness
• Disorientation
• Pulmonary edema
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Alpha Adrenergic Agonists
• Clonidine (Catapres)
• Methyldopa (Aldomet)
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Safe Nursing Practices with Adrenergic Drugs
Pre-administration
• Assessment
• Why are they being used?
• Careful preparation
• Drug allergies
• Pulmonary status
• Medication reconciliation
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Safe Nursing Practices with Adrenergic Drugs
• Monitor BP and cardiac output
• Monitor ↑ or ↓ in peripheral resistance
• Monitor for ↓ in renal perfusion
• ECG and hemodynamic parameters
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Alpha Blockers Uses
• Are helpful in decreasing symptoms of BPH
• Can be used to treat peripheral vascular disease (Raynaud’s disease)
• Promote vasodilation causing decrease in BP
• Tic management
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Alpha 1 Adrenergic blocker
• Vasodilation of arteries and veins
• ↓ peripheral vascular resistance
• ↓ symptoms of urinary urgency, hesitancy and nocturia
• Relax muscles in the prostate and bladder neck
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Alpha adrenergic Blockers
• Terazosin (Hytrin)
• Flomax (Tamsulosin)
• Cardura(Doxazosin)
• Prazosin (Minipress)
Saw Palmetto- widely used to treat BPH
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Selective-Non Selective
• Alpha-blocking agents are divided into two groups
• Selective alpha blockers that block alpha1
• Non-selective alpha blockers that block alpha1 and alpha2
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General side effects of alpha blockers
• Orthostatic hypotension
• Tachycardia
• Vertigo
• Sexual dysfunction
• Nasal congestion
• Dry mouth
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Safe Nursing Practices
• Assess for hypotension
• Assess for syncope
• I & O
• Daily weights
• Monitor labs
• Provide resources
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Patient teaching
• Avoid driving
• Avoid hazardous activities
• Limit caffeine intake
• Limit clutter
• Use a night light
• Get out of bed slowly
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Beta Blocker Actions
• B1 Blockers affect the heart
• B2 Blockers affect the Lungs
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Selective vs. Non-Selective
Selective
• Affect the heart
Non-Selective
• Affect lungs, Liver, Glucose
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Beta Blockers Indications
• HTN
• Mitral Valve Prolapse
• CHF
• Asthma
• Glaucoma
• Migraine Prophylaxis
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Beta Blockers
• Block the actions of Epi and Norepi
• Slow down the nerve impulses that travel to the heart
• Selective
• Non-selective
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Examples of B-Blockers
• Atenolol (Tenormin)
• Metoprolol (Lopressor)
• Propranolol (Inderal)
• Carvedilol (Coreg)
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Beta Blockers Side Effects
• Bradycardia
• Erectile dysfunction
• Reduced exercise capacity
• Hypotension
• GI disturbance
• CHF
• Depression
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Cholinergic Agonists
• Drugs that stimulate the parasympathetic nervous system
• Cholinergic agonists or parasympathomimetics mimic the parasympathetic neurotransmitter acetylcholine
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Cholinergic Drugs Therapeutic use
• Myasthenia gravis
• Urinary Retention
• Glaucoma
• N/V
• Alzheimer’s
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Muscarinic and Nicotinic Receptors
• Two types of cholinergic receptors
• Muscarinic receptors stimulate smooth muscle and slow the heart rate
• Nicotinic receptors affect the skeletal muscles
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Cholinergic Agonists
The major responses of cholinergic agonists are to:
• stimulate bladder and gastrointestinal (GI) tone
• constrict the pupils
• increase neuromuscular transmission
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Cholinergic Agonists
Other effects of cholinergic agonists include:
• Decreased HR and BP
• Increase salivary, GI and bronchial glandular secretions
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Cholinergic Drugs
• Prostigmine (Neostigmine)
• Bethanechol (Urecholine
• Donepezil (Aricept)
• Endrophonium (Tensilon)
• Pyridostigmine (Mestinon)
• Reglan(Metoclopramide)
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Cholinergic Crisis
Salivation
Lacrimation
Urination
Defecation
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Anticholinergic Drugs
• Inhibit the action of acetylcholine by occupying acetylcholine receptors
• They have the opposite response of cholinergic drugs
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Therapeutic use of anticholinergics
• GI disorders
• GU disorders
• Parkinson’s disease
• Motion sickness
• Assist in preventing side effects of other drugs
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Anticholinergics
• Detrol (tolterodine)
• Atropine
• Oxybutynin (Ditropan)
• Scopolamine (Transderm-Scop)
• Trihexyphenidyl (Artane)
• Benztropine (Cogentin)
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Anticholinergic
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Safe Nursing Practices
• Monitor I&O
• Assess for constipation
• Assess for Bradycardia
• Assess for hypotension
• Assess for bronchospasms
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Nursing Diagnoses
• Ineffective airway clearance
• Risk for bleeding
• Risk for impaired skin integrity
• Risk for falls
• Sexual dysfunction
• Risk for disturbed personal identity
• Risk for situational low-self esteem
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Questions