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Understanding Autonomic Nervous System & Synaptic Transmission: Drugs, Schemes and Mind Maps of Nursing

An in-depth look into the autonomic nervous system (ANS), focusing on the adrenergic and cholinergic drugs. It covers the functions of the ANS, synaptic transmission, neurotransmitters, and the effects of adrenergic and cholinergic receptors. Students will gain a comprehensive understanding of the role of these drugs in the body.

What you will learn

  • What are the differences between cholinergic and anticholinergic drugs?
  • What are the main neurotransmitters in the autonomic nervous system?
  • What are the effects of stimulating alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors?
  • How does synaptic transmission occur?
  • What is the role of the autonomic nervous system in the body?

Typology: Schemes and Mind Maps

2021/2022

Uploaded on 09/12/2022

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Adrenergic and Cholinergic Drugs
Nervous System
Central nervous system
(brain and spinal cord) Peripheral nervous system
(neurons outside the brain
and spinal cord)
Efferent Afferent
Autonomic
nervous system Somatic
nervous system
Sympathetic
nervous system
(adrenergic)
Parasympathetic
nervous system
(cholinergic)
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Adrenergic and Cholinergic Drugs

Nervous System Central nervous system (brain and spinal cord) Peripheral nervous system (neurons outside the brain and spinal cord)

Efferent Afferent

nervous systemAutonomic nervous systemSomatic

nervous systemSympathetic (adrenergic)

Parasympatheticnervous system (cholinergic)

Functions of the ANS

  • Involuntary System
  • Responsible for:
    • Control of smooth muscle (e.g., bronchi, blood vessels, GI tract), , )
    • Cardiac muscle
    • Exocrine glands (e.g., gastric, sweat, salivary)
  • Monitored by both the sympathetic and parasympathetic nervous systems

Autonomic Nervous System

  • Balanced antagonism between the sympathetic and parasympathetic nervous systems.
  • A neurotransmitter needs to bind with an appropriate receptor site on the effector organ or tissue to produce effect
  • This is accomplished by synaptic transmission.

Synaptic Transmission

  • Synthesis of neurotransmitters in the

nerve terminal.

  • Neurotransmitter is stored awaiting

an action potentialan action potential.

  • Action potential causes release
  • Neurotransmitter diffuses across the

synaptic gap

NE

Receptor Names

  • Stimulated by Ach= Cholinergic
  • Stimulated by NE= Adrenergic

Sympathetic Nervous System

  • Mostly stimulated by NE
    • Direct
    • Indirect
  • Sympathomimetic
  • Catacholamines
  • Noncatecholamines
  • Adrenergic receptors

Adrenergic Receptors

  • Alpha-1, alpha-2, beta-1, and beta-2.
  • Drugs that stimulate the receptors are called agonists.
  • Drugs that block the receptors areD th t bl k th t called antagonists or blockers.
  • Most drugs stimulate or block more than one receptor at a time.
  • Some drugs are relatively selective in their stimulation or blockade.

Stimulation of Alpha-1 Receptors

  • Stimulation causes:
    • Vasoconstriction
    • Increased peripheral resistance
    • Increased blood pressure (BP)
    • Pupil dilation (mydriasis)
    • Closure of the internal sphincter of the bladder
  • Blocking causes the opposite effects.

Which of the adrenergic receptors shuts off NE when stimulated?

A. Alpha 1 B. Alpha 2 C. Beta 1 D. Beta 2

Which of the following is in the sympathetic nervous system? a. Norepinephrine (NE) b. Dopamine (DA) c. Beta 2 receptors d. All of the above

Parasympathetic Nervous System

(PSNS)

  • Acetylcholine is the neurotransmitter.
  • Direct
  • Indirect

Cholinergic Receptors

  • Muscarinic:
    • Concentrated in the heart, smooth muscle, and exocrine glands
  • Nicotinic
    • Found in the central nervous system (CNS), the neuromuscular junction, autonomic ganglia, and the adrenal medulla

A. PSNS stimulant B. PSNS agonist

Which of the following describes a

drug that stimulates the

parasympathetic system?

g C. Cholinergic D. All of the above

Anticholinergic Effects

  • Increased intraocular pressure
  • Mydriasis (dilation of pupils)
  • Photophobiap
  • Decreased sweating
  • Dry mouth
  • Decreased bronchial secretions
  • Respiratory depression

Anticholinergic Effects (cont)

  • Decreased GI motility with possible constipation
  • Decreased BP followed by increased BP
  • Tachycardia and, possibly, palpitationsT h di d ibl l it ti
  • Urinary retention
  • Vasodilation
  • Drowsiness, confusion, and agitation

Excess Anticholinergic Mnemonics

  • Mad as a hatter
  • Blind as a bat
  • Red as a beet
  • Dry as a bone

Drug Actions

  • Attaches to the neurotransmitter receptor sites
  • Drug effect from stimulating/blocking receptor

ADRENERGIC Drugs Epinephrine

  • Nonselective adrenergic agonist:
    • Stimulates all alpha and beta receptors

Ask a nurse!

  • Why would you want to give a drug that stimulates all alpha and beta receptors?
  • What adverse effects would you expect to be common?

Put it together!

  • Why don’t we just turn off infusion andj elevate the hand after infiltration of phenylephrine?
  • Why is this different than if D5.45 NS infiltrates?

ADRENERGIC DRUGS

Phenylephrine

  • Alpha-1 stimulant
  • Potent vasoconstrictor
  • Avoid IV extravasation
  • Pharmacotherapeutics include:• Pharmacotherapeutics include:
    • Vascular failure
    • Hypotension
    • Shock states
  • Topical pharmacotherapeutics:
    • Nasal decongestant
    • Pupil dilation (mydriasis)

Prazosin Alpha-1 blocker

  • What effect does the drug have on blood vessels? On blood pressure?
  • What nursing actions are needed to minimize adverse effects?

ADRENERGIC DRUGS

Dopamine- Nonselective alpha 1 and

beta-1 stimulant

  • Also stimulates dopaminergic receptorsAl ti l t d i i t
  • Increases cardiac output
  • Low doses- don’t see alpha 1 effects, just dopaminergic
  • Higher doses see alpha 1 effects

Dopamine

  • This is a catecholamine.
  • How will you need to administer this drug?

ADRENERGIC DRUGS

Propranolol Nonspecific beta blocker Metoprolol- relatively selective for Beta 1

  • Which type of adverse effects might be common to both of these drugs?
  • Which adverse effects would be more likely to occur with propranolol?

CHOLINERGIC DRUGS

Neostigmine - Indirect-acting cholinergic

  • Acts by reversibly inhibiting postsynaptic cholinesterasepostsynaptic cholinesterase (acetylcholinesterase)
  • What serious adverse effects would be seen with an overdose?
  • What would be the antidote?

CHOLINERGIC DRUGS

Atropine - Anticholinergic

  • Anticholinergic effects
  • Antidote to cholinergic poisoning
  • Pharmacotherapeutics:
    • Preoperatively to dry secretions
    • Acute cardiac emergencies
    • Topically (homatropine) to treat ophthalmic disorders
    • Treatment of motion sickness and diarrhea

CHOLINERGIC DRUGS

Atropine - Anticholinergic

  • What is responsible for adverse effects from this drug?from this drug?
  • Which age group is most sensitive to anticholinergic adverse effects?
  • What can the nurse do to minimize adverse effects?

Atropine (cont)

  • Adverse effects related to loss of acetylcholine stimulation on receptors
  • Most serious adverse effect:• Most serious adverse effect: anticholinergic overdose (poisoning)

Put it together!

Why is atropine ( anticholinergic )

given pre-op?

A. To cleanse the GI tract BB. To prevent aspiration of oralTo prevent aspiration of oral secretions C. To induce miosis D. To prevent motion sickness