DRUGS AFFECTING THE

AUTONOMIC NERVOUS
SYSTEM

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 Nicotinic - skeletal
Muscarinic - organ
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 Peripheral Nervous System

 Somatic: Voluntary
 Innervates skeletal muscles
 Controlled through conscious thought

 Neurotransmitter
 Acetylcholine

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 Autonomic Nervous System
 Autonomic or visceral division –
not controlled by conscious
 Controls
• Blood pressure
• Heart rate
• Gastrointestinal activity
• Glandular secretions

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 SUBDIVISIONS OF THE
AUTONOMIC NERVOUS SYSTEM
 Sympathetic nervous system
 Fight or Flight
 Useful in highly stressful or emergency
situations
 Parasympathetic nervous system
 Maintains homeostasis
 Works in “opposition” of the Sympathetic
nervous system
 “Rest and Digest”

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 VOCABULARY
“SYNONYMOUS” TERMS
 SYMPATHETIC
 AKA ADRENERGIC
 SYMPATHOMEMETIC
• MIMICS THE SYMPATHETIC SYSTEM
 PARASYMPATHETIC
 AKA CHOLINERGIC
 PARASYMPATHOMEMETIC
• MIMICS THE PARASYMPATHETIC NERVOUS
SYSTEM

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 Adrenergic/Sympathetic
NEUROTRANSMITTERS (neurohormones)
CATECHOLAMINES
 Epinephrine (prototype) – secreted by
Adrenal gland, direct response at nerve
ending
 Norepinephrine – secreted by Adrenal gland.
Stored in the axon, direct response at the
nerve ending
RECEPTORS / RECEPTOR SITES
ALPHA 1
ALPHA 2
BETA 1
BETA 2

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 RECEPTOR Responses to Stimulation
(ADRENERGIK AGONIS)

 ALPHA I (located on the target cells)

 Blood vessels Constriction

 Pupils Dilation
 Penis Ejaculation
 Uterus Contraction
 Sphincters Constriction

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 Alpha-1 Adrenergic drugs
 Isuprel (isoproterenol)
 Used for shock

 Adrenalin (epinephrine)
 Cardiac arrest
 Anaphylactic shock

 Nasal decongestants (phenylephrine –

Neo-Synephrine)
 Pseudoephedrine (Sudafed)

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 RECEPTOR Responses to
Stimulation
 ALPHA 2 (located on presynaptic terminal)
 Control the release of norepinephrine

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 ALPHA 2 Adrenergic Drugs

 CLONIDINE (Catepres)
 Decrease blood pressure
 Management of Opioid withdrawal

 METHYLDOPA
 Decrease blood pressure

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 Adrenergic blocking drugs
 Alpha and BETA blocking drugs

 Uses (Beta1 receptors are located primarily

on cardiac tissues - cardioselective)

• Cardiac dysrhythmias
• Angina
• Hypertension
• Congestive heart failure
• Prostate hypertrophy (alpha blocker)

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 Adrenergic (beta-1) blocking
drugs
 Beta-adrenergic blocking drugs

 Propranolol (Inderal)
 Nadolol (Corgard)
 Atenolol (Tenormin)
 Timolol (Timoptic)

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(Terutama Ortostatik)

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 Adrenergic blocking drugs

 monitoring
 Patient teaching

• Postural hypotension
• Signs and symptoms of Heart
Failure
• Monitor blood pressure

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 Parasympathetic
(Cholinergic)Nervous
System
 NEUROTRANSMITTER (neurohormone)

• Acetylcholine – Produced and stored in nerve

endings
• Acetylcholine (ACh) binds to Cholinergic
receptor sites and causes a response

 Stimulation results in “rest and digest’

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 Acetylcholinesterase
(aka:cholinesterase)

 Breaks down Acetylcholine or limits

response
 Maintains the balance between
acetylcholine and dopamine
 Senyawa yang menghambat asetilkolinesterase =
membiarkan asetil kolin bekerja  sifat obatnya
adalah kolinergik

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Uses – only four for cholinergic drugs:
Drugs that increase Acetylcholine in
the Synapse

 Glaucoma – Reduce intraocular pressure

 Myasthenia gravis – Disease caused by the

lack of ACh at the synapse

 Relief of urinary retention

 Increase GI motility

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 Indirect acting of Cholinergic
drugs (bekerja memblok asetilkolinesterase)
 Neostigmine (Prostigmine)
(anticholinesterase) prototype
• Primarily used to treat Myasthenia Gravis

 Pyridostimine (Mestinon)
• Myasthenia Gravis

 Donepezil (Aricept)
• Works in the CNS to inhibit synthesis of
Acetylcholinesterase
• Used to treat Alzheimer’s disease

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 Cholinergic drugs
 Direct acting Cholinergic drugs
 Directly stimulates the nerve ending to
secrete acetylcholine

 Bethanechol (Urecholine)
• Used to treat urinary retention

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 ADVERSE REACTIONS
CHOLINERGIC DRUGS

 Bradycardia
 Hypotension
 Headache, dizziness
 Increased secretions
 Abdominal cramping
 Increased respiratory secretions and possibly
bronchospasms
 Tanda-tandanya mirip keracunan
organofosfat/pestisida

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 Anticholinergic Medication
 Competitive antagonists
 Compete with ACh
 Inhibit nerve transmission

 Sites of action
 All systems except musculo-skeletal

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 Anticholinergic Medication

 EXAMPLES
 Bentyl (dicyclomine HCL)
• Antispasmotic used to decrease intestinal
cramping in IBS

 Atropine (antidotum keracunan

organofosfat/pestisida)
• Acetylcholine antagonist
• Antidysrhythmic
• Antispasmotic
• Antisecretory
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 Urinary antispasmodics AKA
anticholinergics
 OXYBUTYNIN (DITROPAN)
• Synthetic antimuscarinic
 INCREASES BLADDER CAPACITY
 DECREASES FREQUENCY OF VOIDING

 TOLTERODINE (DETROL, DETROL LA)

• Synthetic antimuscarinic
 DELAYS THE URGE TO VOID
 INHIBITS BLADDER CONTRACTIONS

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 Anticholinergic Medication
 Adverse reactions / Side effects
 Dry mouth
 Blurred vision
 Photophobia
 Urinary retention
 Constipation
 Tachycardia
 Drowsiness

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 monitor
 Monitor for signs of anticholinergic crisis
 Report changes in heart rate, blood pressure,
or development of dysrhythmias
 Provide comfort measures for dryness of
mucous membranes
 Minimize exposure to heat or cold or strenuous
exercise
 Monitor I&O
 Monitor patient for abdominal distension, and
auscultate for bowel sounds

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 Anticholinergic Crisis

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 TERIMAKASIH

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