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AutonomicNervous System

DrugsJoy N. Bautista, RN, MPH, DRDM, MAN

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Drugs affecting the

Autonomic Nervous System

Sympathetic Nervous System

Actionstress response

Neurotransmitternorepinephrine

Drug classadrenergic or sympathomimetic drugs

Drugs that inhibit adrenergicsadrenergic blocking

agents

Parasympathetic Nervous System

Actionenergy-preservation response

Neurotransmitteracetylcholine

Drug classcholinergic or parasymathomimetic drugs

Drugs that inhibit cholinergicsanticholinergics

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Adrenergics

Catecholamines

epinephrine, norepinephrine, dopamine

Alpha receptors1 and 2

Beta receptors1 and 2

Dopaminergic receptors

Non-catecholaminessimilar to catecholamines but more

selective and have longer duration of action

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Adrenergic Effects

Alpha-1 receptors

Vasoconstriction

Mydriasis

GI relaxation

Anal sphincter contraction

Decreased bronchial

secretions

Urinary bladder

contraction

Uterine contraction

Alpha-2 receptors

Negative feedback loop to

prevent further release of

NE

GI relaxation

Anal sphincter contraction Urinary bladder contraction

Uterine contraction

Dopaminergic receptors

Improved Parkinsonian

symptoms

Increased UO

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Adrenergic Effects

Beta-1 receptors

Tachycardia

Detrusor muscle

relaxation

Renal vasodilation

GI relaxation Ciliary muscle relaxation

for far vision

Tachycardia and

increased force of MC

contraction

Beta-2 receptors

Bronchodilation

Coronary, renal, skeletal

muscle, vein vasodilation

Uterine relaxation

Vasodilation Detrusor muscle relaxation

Ciliary muscle relaxation for

far vision

Increased bronchial secretions

Glycogenloysis

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Adrenergics

Indications

Bronchodilation, vasoconstriction, cardiac stimulation,allergic reactions, uterine relaxation, vasopressor

Expected side effects

Palpitations, tachycardia, skin flushing, dizziness, tremors

Orthostatic hypotension

Side effects to report

Arrythmias, chest pain, severe hypotension

Hypertension, anginal pain, nausea and vomiting

Drug interactions

Increased effectsMAOIs, TCAs, guanethidine, atropine,cyclopropane, halothane

Decreased effectsBeta blockers, alpha blockers,

guanethidine, reserpine, bretylium

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Adrenergic Drugs

Alpha-1 agonists

Norepineprine

Dopamine

Phenylephrine

Alpha-2 agonists

Clonidine

Guanabenz

Guanfacine

Methyldopa

Beta-1 agonists

Dopamine

Isoproterenol

Dobutamine

Beta-2 agonists

Isoproterenol

Terbutaline

Ritodrine

Metaproterenol Albuterol

Dopaminergics

Dopamine

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Adrenergic-Blockers

Actionsinhibition of alpha- or beta- receptor binding Non-selective Beta blockersequal affinity for B1

and B2 receptorspropranolol, nadolol, pindolol,

penbutolol, carteolol, sotalol, timolol

Selective Beta blockers

Beta-1blocks cardio-selective receptorsesmolol, metoprolol, acebutolol, betaxolol,

bisoprolol, atenolol

Good for respiratory problems

Uses Vasodilation, bronchoconstriction, uterine contraction

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Adrenergic-Blockers

Alpha-1 antagonists

Phenoxybenzamine

Tolazoline

Carvedilol

Labetalol

Prazosin

Haloperidol

Chlorpromazine

Beta-1 antagonists

Acebutolol

Atenolol

Betaxolol

Bisoprolol

Carvedilol

Esmolol

Labetalol

Metoprolol

Nadolol

Penbutolol

Pindolol

Propranolol

Sotalol

Timolol

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Adrenergic Blockers

Beta-2 antagonists

Labetalol

Carvedilol

Nadolol

Pindolol

Propranolol

Timolol

Dopaminergic blocking agent

Haloperidol

Chlorpromazine

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Cholinergic Drugs

Indications Treatment of myasthenia gravis

Reversal of anticholinergic toxicity

Decrease IOP

Expected side effects Nausea, vomiting, diarrhea, abdominal cramping, dizziness,

hypotension

Side effects to report

Bronchospasm, wheezing, bradycardia

Drug interactions

Antagonisticatropine, antihistamines

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Cholinergic Drugs

Ambemonium

Bethanechol

Edrophonium

Guanidine

Neostigmine

Physostigmine

Pilocarpine

Pyridostigmine

Carbachol

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Anticholinergic Drugs

Actions Mydriasis of pupils to decrease IOP

Inhibition of salivation and bronchial secretions

Decreased GI secretions and motility

Increased heart rate Decreased sweating

Uses

GI and ophthalmic disorders, bradycardia

Parkinsons, genitourinary disorders

Preoperative drying agent

Prevent vagal stimulation

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Anticholinergic Drugs

Expected side effects Blurred vision, constipation, urinary retention, dry mouth

nose and throat

Side effects to report

Confusion, depression, nightmares, hallucinations,

orthostatic hypotension, palpitations, arrhythmias,

glaucoma

Drug interactions

Potentiation by amantadine, TCAs, phenothiazines

Agents Atropine, Belladona, Clidinium bromide, Dicyclomine,

Glycopyrrolate, Mepenzolate, Propantheline