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16254037.doc 4/6/2009 2
Autonomic Nervous System and Drugs
Chapter 16, Anatomy and Physiology
1. Design a tree showing the relationships of the nervous system; include the central with the brain and spinal cord, the
peripheral nervous system, with the somatic and autonomic nervous system, and the major branches of the autonomic
nervous system including the parasympathetic and sympathetic nervous systems.
See the diagram at the end of these LOs and Abrams, Page 266, “Divisions of the Human Nervous System”
2. On the Nervous System Transmitters diagram at the end of these LOs, see the long and short fibers, the synapses,
and the neurotransmitters for the sympathetic nerves, the parasympathetic nerves, and the somatic nerves. Also see
“Organization of the Autonomic and Somatic Nervous Systems in Abrams, page 267.
3. Identify the neurotransmitter sequence, the alpha 1 and 2 actions and drugs and the beta 1 and 2 actions and drugs.
See the table "Catecholamine (Monoamines), at the end of these LOs.
4. Make a synthesis card for each element of the Catecholamine Table. (You will need to know this information
throughout the course.)
Review “Synthesis Cards” under the burgundy "Course Guide" button.
Describe the actions, indications for use, and contraindications, for pseudoephedrine/Sudafed
Pseudoephedrine/Sudafed is an over-the-counter drug. It is an adrenergic vasoconstrictor. It is used to treat nasal
congestion; it is an alpha1 adrenergic agonist. It is a stimulant and can cause increased heart rate, increased blood
pressure, nervousness and sleeplessness, dry mouth, and urinary retention in men with enlarged prostates.
Describe the actions, indications for use, and contraindications, for oxymetazoline/Afrin
Oxymetazoline/Afrin is an over-the-counter drug. It is an adrenergic vasoconstrictor and is used to treat nasal
congestion. It comes as a spray. Because it is topical it does not cause the systemic stimulation of other adrenergic
drugs. If used over six doses it can cause rebound nasal congestion.
. Describe the actions, indications for use, and contraindications, for albuterol/Proventil.
Albuterol/Proventil is a Beta2 adrenergic bronchodilator. It is used to treat acute asthma. It causes little cardiac
stimulation because it is designed to affect primarily the lungs and to spare the heart.
Phenylpropanolamine, another adrenergic vasoconstrictor, has been off the market for a few years.
Phenylpropanolamine is similar to pseudoephedrine and was used as a nasal decongestant and as a weight loss pill. It
was taken off the market after several young women suffered strokes after using it for a few days as a diet drug.
Describe the actions, indications for use, and contraindications, for terazosin/Hytrin.
Terazosin/Hytrin is an alpha1 blocker that causes peripheral vasodilation. It is treatment for hypertension. It is given
once a day and is also a treatment for benign prostatic hypertrophy.
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Describe the actions, indications for use, and contraindications, for propranolol/Inderal.
Propranolol/Inderal is a nonselective beta blocker that blocks both alpha and beta receptors in both the heart and
lungs.
It is a treatment for hypertension. It slows the heart by decreasing sympathetic input and dilates blood vessels.
It decreases mortality after a heart attack (myocardial infarction-MI).
It is a treatment for angina because it slows the rate and decreases cardiac workload. It is a Hawaiian vacation for the
heart see illustration at the end of these LOs.
It treats arrhythmias by slowing the heart rate.
One dose before a performance reduces performance anxiety.
Thyrotoxicosis causes a very fast heart rate so propranolol/Inderal protects the heart by slowing the rate.
Propranolol/Inderal treats migraine headaches by unknown mechanisms.
Because it can have a deleterious effect on the lungs—it constricts bronchioles— it is contraindicated for people with
severe asthma.
It used to be contraindicated for people with congestive heart failure (CHF) because of its negative inotropic (strength)
and chronotropic (speed) effects but is now considered an appropriate treatment (except for severe [uncompensated]
CHF) because of its cardioprotective blockade of sympathetic stimulation.
Propranolol/Inderal should not be discontinued suddenly. The nurse should watch for a severely decreased blood
pressure, bradycardia, dyspnea, and severe fatigue or dizziness.
Propranolol/Inderal will be studied further in the Cardiovascular Unit
Describe the actions, indications for use, and contraindications, for atenolol/Tenormin.
Atenolol/Tenormin blocks only beta 1 receptors so is cardio specific. It is treatment for hypertension and angina. It
decreases mortality after MI. Because of its specificity for the heart, there is less chance of bronchospasm but it still
should be used cautiously for persons with even mild asthma.
Atenolol/Tenormin has the same precautions as propranolol/Inderal.
Atenolol/Tenormin will be studied further in the Cardiovascular Unit
Describe the actions, indications for use, and contraindications, for timolol/timoptic.
Timolol/Timoptic is a beta blocker. It is used to treat glaucoma and sometimes hypertension. It decreases aqueous
humor formation in the eye and is antiadrenergic. It will be covered in Eye and Skin Unit.
Describe the actions, indications for use, and contraindications for donepezil/Aricept.
Donepezil/Aricept is an autonomic-cholinergic drug. It is the treatment for Alzheimer’s dementia. It increases CNS
acetylcholine. It may cause nausea and vomiting, diarrhea and bradycardia. It should be used cautiously in patients
with cardiac disease, peptic ulcer disease, seizures, asthma, or obstructive pulmonary disease.
2. Describe the actions, indications for use, and contraindications for ipratropium/Atrovent.
Ipratropium/Atrovent is an autonomic drug, an anticholinergic bronchodilator. It is inhaled to treat acute asthma.
3. Describe the actions, indications for use, and contraindications for scopolamine/Transderm V.
Scopolamine/Transderm V is an autonomic drug, an anticholinergic antiemetic. It prevents motion sickness and treats
vertigo.
4. Describe the actions, indications for use, and contraindications for benztropine/Cogentin.
Benztropine/Cogentin is an autonomic anticholinergic. It is used to treat early Parkinson’s disease and
pseudoparkinsonism seen in the treatment of schizophrenia.
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5. Describe the actions, indications for use, and contraindications for oxybutynin/Ditropan.
Oxybutynin/Ditropan is an anticholinergic urinary tract antispasmodic treatment for overactive bladder. It inhibits the
action of acetylcholine.
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16254037.doc 4/6/2009 5
Sympathetic Nervous System in Relation to the Entire
Nervous System
Nervous System
Central Peripheral
Parasympathetic Sympathetic
(Cholinergic) ACh (Adrenergic)
Alpha Beta
1 2 1 2
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NERVOUS SYSTEM TRANSMITTERS
2. The sympathetic/adrenergic hormone is EPINEPHRINE (EPI). It travels from the adrenals through the blood stream to
the junction with the organ.
_____________________________________
///\\\EPI _____________________________________ OOO
Adrenal Blood vessel Organ
Gland
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CATECHOLAMINES (MONOAMINES)
CENTRAL (brain) PERIPHERAL (body)
NEUROTRANSMITTERS: NEUROTRANSMITTERS:
Dopamine Norepinephrine at post-ganglionic sites
Norepinephrine Epinephrine Epinephrine from the adrenal medulla
NEUROTRANSMITTER SEQUENCE:
Phenylalanine becomes Tyrosine becomes Dopamine becomes Norepinephrine becomes Epinephrine
(Tyramine is synthesized by the body from tyrosine and found in aged meats, ripe cheese; it has action like epinephrine, but weaker.)
ALPHA1 stimulation causes ALPHA2 stimulation BETA1 stimulation affects BETA2 stimulation affects the
actions blocks actions the heart lungs
1. Constricts peripheral 1. Inhibits further release of 1. Stimulates the heart; 1. Dilates the bronchioles
vessels in the skin, kidney, norepinephrine at the increases rate and
and viscera, to raise BP in nerve terminal, dilating strength
the heart and brain. peripheral blood vessels
to lower blood pressure
2. Constricts vessels in nasal 2. Shunts blood from
mucous mem branes, to peritoneal cavity to mucosa,
relieve a stuffy nose skeletal muscle, brain, and
heart
3. Contracts the radial muscle
of the eyes, dilating the
eyes (mydriasis).
Agonist drugs: Agonist drug: Agonist drug: Agonist drugs:
epinephrine/Adrenalin, clonidine/Catapres, an epinephrine/Adrenalin epinephrine/Adrenalin and
oxymetazoline/Afrin, & "alpha2 stimulator" albuterol/Proventil
pseudoephedrine/Sudafed hypotensive.* Albuterol/Proventil is more
lung-specific than epinephrine.
They both dilate the bronchi.
Antagonist drug: No antagonist drugs are Antagonist drugs are "beta No antagonist drugs are
terazosin/Hytrin commonly used. blockers." commonly used. There is no
Propranolol/Inderal and reason to constrict the
atenolol/Tenormin bronchi. Propranolol does
(cardiospecific) are both have antagonist activity as an
hypotensives. undesirable side effect. It is
Timolol/Timoptic decreases not used as a hypotensive for
aqueous humor in glaucoma. asthmatics.
O88/691/793/899
* Clonidine/Catapres acts in the medulla of the brain to stimulate alpha2-receptors that inhibit sympathetic vasomotor
centers. (The action is comparable to "stimulating" a car's brakes to "inhibit" its motion.) Clonidine/Catapres causes
sedation, a central (brain) action. It does not interfere with fine control of peripheral vessels, a peripheral action, so does
not cause orthostatic hypotension.
Serotonin (SE) is a naturally occurring derivative of tryptophan found in platelets, intestine, and brain. It is a potent
vasoconstrictor, stimulates intestinal smooth muscle contraction, and is a brain neurotransmitter. It is also called 5-
hydroxytryptamine (5-HT). Fluoxetine/Prozac is a selective serotonin reuptake inhibitor to treat depression;
amitriptyline/Elavil blocks reuptake of NE and SE to treat depression; lithium increases reuptake of NE and SE to treat
mania, risperidone/Risperdal blocks receptors for dopamine and SE, to treat schizophrenia; sumatriptan/Imitrex is a
selective serotonin agonist (vasoconstrictor) to treat migraines.
Adapted from Baer & Williams, 1988 and Rang, Dale, Ritter, & Gardner, 1995
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PROPRANOLOL
A Hawaiian Vacation for the Heart
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AUTONOMIC NERVOUS SYSTEM RESPONSES
Flight & fight (FF) response. Feed & breed (FB) response.
Norepinephrine and epinephrine are associated Acetylcholine is associated with the
with the FF/adrenergic/sympathetic response. FB/cholinergic/parasympathetic response.
1. Pupils dilate, to see better (mydriasis) 1. Pupils constrict; pupils become smaller (miosis).
2. Bronchi dilate and respiratory rate increases, to get 2. Bronchi "constrict." Actually, bronchi return to a normal
more oxygen more quickly. state with no dilation and a normal respiratory rate.
3. Blood sugar from the liver increases, to provide more 3. Blood sugar decreases and returns to normal.
energy to run, think, or fight.
4. Heart beats faster and stronger to get more blood to 4. Heart rate slows and returns to a normal strength.
lungs, brain, and muscles. Increased blood flow/oxygen, Brain and muscle metabolism return to normal.
to the brain increases thinking and to the muscles
increases muscle strength and speed.
5. Blood clotting increases, to decrease bleeding from a 5. Blood clotting decreases to normal.
wound.
6. Cell metabolism increases, to do more cellular work 6. Cell metabolism slows and returns to normal.
when the body is running, thinking, and fighting.
7. Sweat increases, so it is easier to slip out of the grasp 7. Sweating decreases to normal.
of an enemy.
8. Stomach, bowel, and peripheral blood vessels to the 8. Stomach, bowel, and skin blood vessels dilate.
skin constrict, to shunt blood to the brain and heart and
conserve blood for brain and muscle use.
Blood pressure increases. Blood pressure decreases.
Stomach and bowel peristalsis decreases, digestion Stomach and bowel peristalsis increases, digestion
slows, and bowel function slows (constipation) to resumes, and bowel function returns to normal.
conserve blood for muscles.
Skin becomes pale and cool. Skin becomes warm and pink.
Skin wounds do not bleed as much.
9 Digestive enzymes decrease. 9. Digestive enzymes increase from minimal amounts to
normal.
10. Urinary bladder relaxes and urinary sphincter 10. Urinary bladder contracts and urinary sphincter:
contracts. There is no time to urinate now. relaxes so urination can occur.
11. Genital blood vessels constrict to conserve blood for 11. Genital blood vessels dilate to return to normal, not
vital organs. constricted; then with sexual excitement they dilate.
.......The oxygen had magically cleared her brain of every thought except the best route to get to the cave and that map was brilliantly
illustrated in her mind. Every cell in her body was functioning to one end--survival. She was ghostly pale and covered with a cold sweat
and knew that she would be able to slip out of the grasp of an enemy.
.......Suddenly, a huge roar sounded just behind her. Grrrrr! Growl! It was a saber-toothed tiger looking for his supper. He snarled as his
razor sharp claws raked down the back of her leg. Blood spurted out of the wound but stopped almost immediately because the
peripheral blood vessels had constricted and her clotting had increased. With one final burst of speed she dashed through the cave
entrance to safety.
.......As she lay panting on the cave floor she could hear the tiger growling as he paced back and forth in front of the fire at the cave
entrance and another cold shiver ran down her body. Her cave partner wrapped the wounds on her leg and after she had rested a little,
asked her to come and eat some stew. "I'm sorry, I can't eat. My stomach is hurting and I know I'll be sick if I eat anything."
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.......She rested for a while and then said, "I am feeling a little better since I've caught my breath. Maybe now I'll be able to 'pass my
water.' I needed to go while I was in the forest, but with that tiger after me, all I could do was run." My bowels feel twisted in knots. I
don't think I'll be back to normal until tomorrow."
.......A little time passed and the cave partner said, "I've just arranged all the furs on our bed. Since you don't want to eat, we might just
as well lie down and I'll hold you and keep you warm." Time passes. The cave partner can't sleep and suggests a little bedtime activity.
The cave person pushes her partner away. I'm not in the mood for that! I almost lost my life today and all you want is fun and games.
She turns her back to her partner, closes her eyes and falls into an exhausted sleep.
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