The body…

in its wisdom
Sedatives act here

ANS Rx act here

FIGHT OR FLIGHT:
What happens to…

o Skeletal muscle?
o BP, pulse & resps?
o Glucose?
o Smooth muscle?
o Secretions?
o Sphincters?
o Pupils?
FIGHT OR FLIGHT:

o What is the key neuro-chemical?

o Where does blood shunt to?

o What does this mean for feet?

o Where does the energy come from?

o What does this mean for diabetics?

What do adrenergics do? When are the useful?

 Open airways Asthma control

 Increase BP, pulse Shock
 Dry up secretions Sinusitis
ADHD medications
 Increase vigilance
------------------------
 Cause muscles tension
 Stall digestion
 Widen pupils
(nuisance effects)
 FIGHT OR FLIGHT
MEDICATIONS
o Solicit adrenalin (epinephrine) responses
o Are called sympathethomimetics,
catecholamines, adrenergics, α or β agonists

o α1 mimetics: increase BP, decongestants

o α2 mimetics: act centrally to calm ADHD,
support analgesia & paradoxically lower BP
o β1 mimetics: increase heart rate, increase BP
o β2 mimetics: bronchodilators, preterm labor Rx
 ADRENERG
ICS
RX ASTHMA: BETA 2 RX SHOCK: BETA 1
o Proventil (albuterol) o Dobutamine
o Brethine (terbutaline) o Dopamine
o Epinephrine
o Alupent (metaproterenol)
o Levophed
o Primatene (epinephrine)
o Cause renal constriction
o Isuprel (isoproterenol)
o increase pulse RX FOR ADHD: ALPHA 2
o Adderall (dexamphetamine)
o fuel anxiety & tremors
o Ritalin (methylphenidate)
RX RUNNY NOSE: ALPHA 1 o Clonidine
o Pseudoephedrine C5 o Cause “Attending”
o Phenylephrine not o Cause weight loss
o Meth precursor o Addictive (Gateway Rx)
o Dobutamine
> strengthens heartbeat Adrenergics used
to treat shock
o Dopamine
> elevates BP at higher doses
> helps kidney @ low doses (2-5 mcg/kg/”)
o Levophed
> aka norepinephrine
> elevates BP but hurts kidneys
o Epinephrine
> Given IV push in cardiac arrest
> Sub Q for allergic reaction (follow with steroids)
> IV drip for shock or bradycardia
o Isoproterenol (aka) Isuprel
> speeds up & strengthens heartbeat
> opens airways
>  O2 demand
ADRENERGIC BLOCKING RESPONSES (α vs
β)
Opposite of fight or flight responses

• Pupils shrink
• Pulse slows
• BP drops
• Bronchioles constrict (risk of wheezes)
• Glucose stored (hypoglycemia risk)
 Adrenergic blockers  blockers
α vs β o End in Olol (atenolol,
metoprol, pindolol)
 Blockers o Rx glaucoma (timolol)
o Endo in -osin (prazosin, o Slow pulse &
doxazosin, terazosin) reduce cardiac work
o lower BP dramatically (weakens heart beat)
o Flomax (tamsulosin) o Can help or worsen CHF
for BPH does too o Lowers BP & aortic
o Alphagan (glaucoma Rx) resistance to flow
acts like this too BUT (to ease cardiac work)
it isn’t an o Can worsen asthma
 blocker o Mask hypoglycemia
o Rx migraines
 α & β blockers
 Are adrenalin (epinephrine) blockers
 Solve for hypertension & tachycardia
 Are called sympatholytics, α or β
blockers or adrenergic antagonists

o α1 antagonists: lower BP, facilitate urine outflow

o α2 antagonists: outdated agents that increase BP
o β1 antagonists: slow heart rate, lower BP
o β2 antagonists: lower BP but can cause wheezes
REST & DIGEST:
What happens to…
o Secretions?
o Smooth muscle?
o Skeletal muscle?
o BP, pulse & resps?
o Glucose?
o Sphincters?
o Pupils?
REST &
DIGEST:
o What chemical governs “rest & digest”?

o Where does blood shunt to?

o What does this mean for the feet?

o Where does glucose go?

o What does this mean for diabetics?

CHOLINERGICS: solicit rest & digest
Promote smooth muscle contractions

•Duvoid >> bladder contraction (bethanecol)

•Reglan >> stomach emptying (metoclopramide)
•Pilocarpine >> pupil constriction (isoptocarpine)

•Prostigmin >> Reverse illeus / post-op urine retention

Cholinergics
 Cholinergics that prevent Acetylcholine breakdown are called

Acetylcholinesterase inhibitors
 Exelon (rivastigmine) Cognex, Razedyne, & Aricept limit

dropped calls in dementia but cause urgency

 Prostigmin (neostigmine) reverses paralysis post-op

but bradycardia and wheezes can occur

 Antilirium (physostigmine) reverses GI shutdown

It subdues anticholinergic impact of

tricyclic OD, but bradycardia
& wheezes can occur
ANTICHOLINERGIC RESPONSES
Effects of blocking rest & digest

Pupils dilate
Dry mouth
Heart rate speeds up
Bronchioles dilate
Gut stalls
Bladder weakens
 ANTICHOLINERGIC
S
Ipratropium (Atrovent)
--Rx for asthma

Atropine / Robinul
o Bronchioles dilate --Rx to dilate for eye exam
o Pupils dilate --Rx pre-op
o Mouth gets dry --Rx to stop bradycardia
o --Rx to stop diarrhea
Heart rate speeds up
o GI shuts down Oxybutynin (Ditropan)
o Urine is retained --Rx for spastic bladder
o Excretions dry up
o Smooth muscle weakens Cogentin
--Rx dyskinesias
Atropine effects
Can’t see Toxicity pneumonic
Can’t spit Dry as a bone
Can’t pee Red as a beet
Can’t…get rid of it Mad as a hatter
AUTONOMIC NERVOUS SYSTEM

o Is peripheral
o Is automatic (unintentional)
o Emotional response resides in ANS
FIGHT OR FLIGHT: REST & DIGEST:
 Sympathetic NS o Parasympathetic NS
 Adrenergic Rx o Cholinergic Rx
 Adrenalin driven o Acetylcholine driven

RELATED RX RELATED RX
 Airways open o Airways constrict
 BP & pulse rise o Pulse & BP drop
 Muscles get tense o Muscles relax
 Digestion stalls o Peristalsis increases
 Secretions dry up o ↑ digestive enzymes
 Pupils widen o Pupils constrict
• Adrenergics trigger “fight~flight” responses
α & β agonists are sympathomimetics
• Adrenergic blockers prevent “fight ~ flight”
α & β antagonists are sympatholytics
• Cholinergics trigger “rest & digest” responses
Muscarinic agonists are para-sympathomimetics
Nicotinic agonists reverse paralysis
Acetylcholinesterase inhibitors are cholinergics
• Anti-cholinergics prevent rest & digest responses
Muscarinic antagonists are parasympatholytics
Adrenergics Cholinergics
eg Albuterol eg bethanacol

•Increase pulse •Decrease pulse

•Open airways •Constrict airways
•Stall gut •Increase peristalsis
•Dry secretions •Increase secretions
•Increase BP •Some drop BP
•Dilate pupils •Constrict pupils
•Increase muscle tension •Increase bladder contractility

Adrenergic blockers Anticholinergics

Rx ending in OLOL eg atropine

•Decrease pulse •Increase pulse

•Constrict airways •Open airways
•Constrict pupils •Dilate pupils
•Decrease BP •Dry secretions