Autonomic

Nervous System
Drugs
Joy N. Bautista, RN, MPH, DRDM, MAN
Drugs affecting the
Autonomic Nervous System
Sympathetic Nervous System
Action stress response
Neurotransmitter norepinephrine
Drug class adrenergic or sympathomimetic drugs
Drugs that inhibit adrenergics adrenergic blocking
agents
Parasympathetic Nervous System
Action energy-preservation response
Neurotransmitter acetylcholine
Drug class cholinergic or parasymathomimetic drugs
Drugs that inhibit cholinergics anticholinergics
Adrenergics
Catecholamines epinephrine, norepinephrine, dopamine
Alpha receptors 1 and 2
Beta receptors 1 and 2
Dopaminergic receptors

Non-catecholamines similar to catecholamines but more
selective and have longer duration of action
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
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
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 effects MAOIs, TCAs, guanethidine, atropine,
cyclopropane, halothane
Decreased effects Beta blockers, alpha blockers,
guanethidine, reserpine, bretylium


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

Adrenergic-Blockers
Actions inhibition of alpha- or beta- receptor binding
Non-selective Beta blockers equal affinity for B1
and B2 receptors propranolol, nadolol, pindolol,
penbutolol, carteolol, sotalol, timolol
Selective Beta blockers
Beta-1 blocks cardio-selective receptors
esmolol, metoprolol, acebutolol, betaxolol,
bisoprolol, atenolol
Good for respiratory problems
Uses
Vasodilation, bronchoconstriction, uterine contraction
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
Adrenergic Blockers
Beta-2 antagonists
Labetalol
Carvedilol
Nadolol
Pindolol
Propranolol
Timolol
Dopaminergic blocking agent
Haloperidol
Chlorpromazine

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
Antagonistic atropine, antihistamines
Cholinergic Drugs
Ambemonium
Bethanechol
Edrophonium
Guanidine
Neostigmine
Physostigmine
Pilocarpine
Pyridostigmine
Carbachol
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
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