Autonomic Nervous System
Classification and Action
Drugs
Therapeutic Uses
Adverse Effects
Adrenergic Agonist
 Activates the adrenergic receptors
 Enhancing the actions of the SNS
Mimics the sympathetic nervous system
Sympathomimetic
*Epinephrine
 IV
 SQ
 Inhalation
 Paired with Lidocaine
o Prolong effects
o Treat allergy if PT
allergic to Lidocaine
Alpha₁ & Alpha₂
Beta₁ & Beta₂
1. Anaphylactic Shock
 Epi-pen for allergies
2. Local Anesthesia
3. Treat Heart Block
 Not typically
4. Restore cardiac function in
arrest
 Get some electrical impulse
back – out of asystole
 V-fib
5. Bronchodilation (asthma)
 Not receptor site specific
Alpha₁
Vasoconstriction
 Blood vessels
 Skin
 Mucous membranes
Constricts:
 Arterioles
 Veins
Constricts trigone & bladder sphincter
Contracts the radial muscle of iris
 Causes the pupil to dilate
Norepinephrine
 IV
Alpha₁ & Alpha₂
Beta₁
1. Hypotensive states
2. Cardiac arrest
↑ cardiac excitation:
Chest pain
Tachycardias
Dysrhythmias
Hypertensive crisis
Tissue Necrosis due to
extravasation
 Typically NOT placed in a
peripheral vein
o Central line
o Chest
 Watch IV sites – clear tape
o Swelling
o inflammation
o Redness
o Fever
Hypertension
Chest pain
Tachycardias
Dysrhythmias
ICU PT
 Ventilator
 Very close observation
o Drug efficacy
o Side effects
**ALL meds can be used to
treat:
 Heart Failure
 Hypotensive states
Contracts prostate capsule
 Causes ejaculation
Alpha₂ - not clinically significant
Beta₁
Causes an ↑ in:
 Heart rate
 Force of contraction
o Pump
 AV conduction
o Speed that electricity goes
through AV node
Release of renin
Isoproterenol
Pure Beta stimulant
 IV
 IM
Beta₁ & Beta₂
Beta₂
Dilation of:
 Arterioles
 Bronchi
Relax the uterus
Glycogenolysis of liver
Contract skeletal muscle
Limitations:
 Diabetics
 Asthmatics
“electrical improvement”
1. Treat AV Heart Block
2. Improve outcomes in cardiac
arrest
 PT not perfusing
o Causes pain
 PT with no pulse
3. ↑ cardiac output in states of
shock
Strictly used for cardiac reasons
o ↓ BP
 Cardiac arrest
 Cardiac electrical
problems
o Heart block
Chest pain
Tachycardias
Dysrhythmias
Dopamine
Work on the dopaminergic receptors in
the kidney
 Dilation of kidney vasculature
Receptor specific at different doses
 Low
o Dopamine
 Medium
o Dopamine
o Beta₁
 High
o Alpha₁
o Beta₁
o Dopamine
Dopamine
 IV
Alpha₁ Beta₁
Dopamine
1. Shock
2. Heart Failure
Chest pain
Tachycardias
Dysrhythmias
Making the heart work harder,
stronger, more forceful
 Creating unstable situation
 Making unstable situation
worse
PT more at risk for CV side
effects along with having more
cardiac effect
 Non-selective at ↑ doses
 Affects Alpha₁ & Beta₁
Catecholamines
 Short duration of action
 MUST be parenteral
o Except Epinephrine inhalation
 Cannot cross BBB
 ALL used for critical issues
Dobutamine
 IV
Beta₁ selective
1. Heart Failure
 Failure to perfuse
 Unable to meet perfusion
demands of the body
 Not able to get enough
blood to the periphery to
perfuse
o Brain
o Kidney
o Periphery
Does the PT respond neurologically
 Can they understand what’s
being said
 Can they squeeze my hand
What does the PT feel like
 Warm & dry
 Sweaty & clammy
Color
 Gray
 Cyanosis
Too much excitation & stimulation
Tachycardia
Assess the PT
 How they are tolerating
it
 See drug efficacy
With ALL meds we must
monitor:
 HR
 BP
 Chest pain
 Dysrhythmias
Classification and Action
Drugs
Therapeutic Uses
Adverse Effects
Adrenergic Antagonists
Cause direct blockade of the adrenergic
receptors
Blocks the stimulation from the SNS
Phenoxybenzamine
Pheochromocytoma
 Rare, potentially fatal tumor on
the adrenal medulla
 Send out potent catecholamines
o Epinephrine
o Norepinephrine
o Vasoconstrict
 ↑ BP
 Get BP stabilized
o Surgery to remove the
tumor
Orthostatic Hypotension!!
 Opening the vessels
 BP is ↓
 Take PT BP:
o Supine
o Sitting
o Standing
st
 1 dose Hypotension
o Administer at
bedtime
o Sleep through
transition
phentolamine
Treatment of extravasation of
Alpha Agonists
 Inject local area with medication
Nonselective Alpha Blockers
 BLOCKS Alpha₁ & Alpha₂ receptors
o DILATES arterioles & veins
Reverse effects of local anesthesia
with Epinephrine
Reflex Tachycardia
 Vasodilation ↓ BP
 Baroreceptors sense ↓ BP &
try to restore back to normal
↑ HR
Pheochromocytoma ONLY
Nasal congestion
Inhibition of ejaculation
Na⁺ retention
Alpha₁ Blockers
 BLOCKS Alpha₁ receptors
o DILATES arterioles & veins
Prazosin (Minipress)
Doxazosin (Cardura)
HTN & BPH
 Main reasons we use Alpha
blockers
Orthostatic Hypotension!! Most
common adverse effect
Reflex Tachycardia
 RELAXES smooth muscle in bladder
neck & prostate
o Relieves urinary symptoms
o Helps BPH PT with improved
voiding
 Taken at night
o 1st dose Hypotension
 Avoid driving for 12 – 24
hours
o PT sleeps through transition
Terazosin (Hytrin)
o Initial dose should be ↓
Tamsulosin (Flomax)
 ↑ as needed
Pheochromocytoma
Nasal congestion
Vasodilate PT with vascular disorder
 Raynaud’s Disease
o Vasospasm of vessels
 Inadequate
perfusion
 Causes severe
pain
 Necrotic tissue
Inhibition of ejaculation
Na⁺ retention
↑ fluid retention
 Edema
 Diuretic to counteract
Sexual Dysfunction
BPH – Benign Prostatic Hyperplasia
 Overgrowth of prostate tissue
that pushes on urinary system
to cause:
o Urinary frequency
o Urinary hesitancy
o Urinary urgency
o Dribbling
o Incontinence
o UTIs
Report ADEs concerning to the
PT
Beta₁ Blocking effects: ↓
 ↓ Heart rate
o Negative chronotropic
o Beating too fast
 ↓ Conduction through AV node
o Negative dromotropic
 ↓ Contractility
o Ionotropic
o Heart pumps less
 Renin release
Beta₂ Blocking effects:
 Arterial dilation (vasoconstriction)
 Bronchodilation (causes
bronchoconstriction)
1st Generation
Blocks:
 Beta₁
 Beta₂
 Non-selective
Bets Blockers are one of the
most widely used groups of
drugs. Multiple approved uses,
does have several side effects:
bradycardia, fatigue,
hypotension
Propranolol (Inderal)
Nadolol (Corgard)
Pindolol (Visken)
Timolol
Angina
 ↓ cardiac workload
Bradycardia
 PT feels sluggish
 No energy
HTN
Dysrhythmias
 Treat acute dysrhythmias
 Prevent cardiac
dysrhythmias
o Maintenance
 Atrial
 Ventricular
AV block
 Affects conduction
Heart Failure
 PT has preexisting
pulmonary issues i.e.,
asthma
Rebound cardiac excitation
MI
Migraine prophylaxis
CNS effects
 Depression
2nd Generation
 Cardioselective
o Normal doses, selective
o ↑ dose, non-selective
 BLOCKS Beta₁
o Safe for asthmatic PT
o Will not affect lungs
Metoprolol (Lopressor)
Atenolol (Tenormin)
Acebutolol (Sectral)
Esmolol (Brevibloc)
Anxiety
 Making a speech
 Stage fright
 Sleep disturbances
 Suicidal thoughts
Monitor VS
Detrimental to diabetic PT:
 Blocking Beta₂ receptors in
muscle & liver
o Suppress
glycogenolysis
o Will NOT correct
insulin-induced
hypoglycemia
 Blocking Beta₁ receptors
o Suppress
tachycardias
o Suppress
perspiration
o Suppress tremors
o Warning signal that
BP or blood glucose
level is too ↓
Angina
HTN
MI
Heart Failure
SAME
3rd Generation
Blocks:
 Beta₁
 Beta₂
 Alpha₁
o Has an additional
vasodilation effect
Carvedilol (Coreg)
Labetalol (Trandate,
Normodyne)
Nebivolol (Bystolic)
HTN
MI
Angina
Heart Failure
SAME
Beta Blockers
One of three medication used for Heart
Failure
 ↓ hospitalizations
 ↓ progression of HF
 ↑ LV ejection fraction
 ↑ exercise tolerance
Metoprolol (Lopressor)
Bisoprolol (Zebeta)
 2nd generation
 Cardioselective
Carvedilol (Coreg)
 3rd generation
Heart Failure
 Improve outcomes in PT
SAME
 Start at ↓ dosage
Monitor for symptoms of ↑ HF
3 groups used to treat HF:
 Diuretics
 ACE – Inhibitors
 Beta blockers
NONE of these 3 will be used
for BPH or BP
 Too radical
Muscarinic Agonists
 Activates muscarinic receptors also
called Cholinergic
Heart
 Bradycardia
Exocrine glands
Increase
 Sweating
 Salivation
 Bronchial secretions
 Secretion of gastric acid
Smooth muscles:
Contraction in lung
 Constriction
GI tract
 Increased tone/motility
Bladder
 Contraction of detrusor muscle
o Composes bladder wall
Vascular
 Relaxation
 Vasodilation
 Hypotension
Eye
 Pupillary constriction
 Ciliary contraction
Bethanechol
(Urecholine)
Relieve urinary retention
 Activates the muscarinic
receptors of urinary tract
Primary reason for
using:
 “selective”
reasons
Relaxes trigone and sphincter
muscles
 ↑ voiding pressure
Hypotension
Bradycardia
Alimentary System excessive
effects
Do NOT use in PT with urinary
obstruction or bladder weakness
 Could rupture bladder
Can exacerbate asthma
Can cause cardiac dysrhythmias
in hyperthyroid PT
Muscarinic Poisoning!!
 Over dosage of
muscarinic agonist
Muscarinic Antagonist
 BLOCKS muscarinic receptors
Anticholinergic
 Against the above actions
Atropine
Preoperative medication
 Protect heart from
bradycardias
 ↓ respiratory secretions
o Mouth
o Lungs
 PT must take deep breaths
o Cough
o Incentive spirometer
Dry mouth
Blurred vision photophobia
↑ intraocular pressure
 Avoid in glaucoma PT
Urinary retention
Constipation
Treat symptomatic bradycardia
Blocks sweat glands
Paralyze the ciliary muscle & dilate
the pupil for eye exams/surgery
Treat hypertonicity/motility of GI
tract
 Not the best choice
To reverse effects of Muscarinic
poisoning
Tachycardia
Thickens & dries bronchial
secretion
 Use in asthma may be
harmful