The Nervous System

Central Nervous System Peripheral Nervous System Somatic Nervous System Autonomic Nervous System

D IV IS IO N S O F N E R V O U S S Y S TE M

Consists

of the brain and spinal cord Regulates body functions Interprets information sent by the peripheral nervous system (PNS ) and then sends stimuli back to the PNS

The Central Nervous System (CNS)

Peripheral Nervous System

Somatic

NS acts on skeletal muscles to produce locomotion & respiration Autonomic NS visceral system; controls and regulates functioning of the heart, respiratory system, digestive system & glands
Sympathetic Parasympathetic

nervous system nervous system

Features of Autonomic Nervous System

2 neuron system Synaptic transmission
Synapse

Comparison of SNS and PSNS

SYMPATHETIC Origin of fibers Length of fiber Receptors NT Responses General Thoracolumbar Preganglionic: short Postganglionic:long Alpha, beta, dopamine NE, EPI, dopamine Fight, flight, fright
PARASYMPATHETIC

Craniosacral Long Short Muscarinic, Nicotinic Acetylcholine Rest and digest

- space between neurons or between neuron and its target organ collection of nerve cell bodies outside

Presence of Ganglion/ganglia
Ganglia

CNS

Receptors
1.

N eurotransm itters
1. 2. 3. 4. 5.

2. 3.

Nicotinic receptors are located on the cell bodies of all postganglionic neurons of the PSNS and SNS (& adrenal m edulla) Muscarinic receptors are located in all organs regulated by the PSNS Adrenergic receptors are located in all organs regulated by SNS except sweat glands

All preganglionic neurons of the PSNS and SN release ACh as their transm S itter. All postganglionic neurons of the PSN S release AC as their transm h itter. M postganglionic neurons of the S S ost N release N E EPI is the principal transm itter released by adrenal m edulla All m otor neurons to skeletal m uscles realese AC as their transm h itter

The Sympathetic NS
Fight

The Parasympathetic NS
Rest

or flight response the bear prepares the body for stress by increasing metabolism, diverting blood to larger muscles and increasing cardiac and respiratory functions

and digest response increases digestion, absorption and slows metabolism to save energy the pig

Sympathetic Nervous System

SNS vs. PNS Effects on Tissues

SNS Effects Dilates pupils Relaxes smooth muscles of the GIT Dilates bronchioles Increases heart rate Constrict blood vessel Relaxes bladder & uterine muscle

PNS Effects Constricts pupils Increases peristalsis Constricts bronchioles & increases secretions Decreases heart rate Dilates blood vessels Increases salivation

Also called the adrenergic system (adrenaline) The neurotransmitter is norepinephrine Drugs thatmimic the effects of norepinephrine are the adrenergics sympatho , mimeticsor adreno mimetics Because they initiate a response they are called adrenergicagonists Drugs whichblock the SNS are called sympatho lytics or adreno lytics, anti-adrenergicsand the alpha and beta adrenergic blockers because they block a ; response, they are adrenergicantagonists

Parasympathetic Nervous System

Also called the

cholinergic system The neurotransmitter is acetylcholine Parasympathomimetics , cholinomimetics and cholinergics stimulate the PNS Called cholinergic agonists because they initiate a cholinergic response Parasympatholytics, anticholinergics and cholinergic blocking drugs inhibit the PNS; called cholinergic antagonists because they block a response

Comparison of SNS & PNS Drugs

Sympathetic Parasympathetic

Response the bear

Agonist
Sympathomimetics Adrenergic drugs

Response the pig

Agonist
Parasympathomimetic Cholinergic drugs

Antagonist
Sympatholytics Adrenergic blockers

Antagonist
Parasympatholytic Anticholinergic drugs Cholinergic blockers

Adrenergic Drugs: Review

Functions of P eripheral A drenergic R eceptor

Alpha 1

Eye Arterioles Sex organ, m ale

B ladder neck, prostatic capsule

Alpha 2 Beta 1

Presynaptic nerve term inal

H eart Kidney Arterioles Bronchi U terus Liver

Beta 2

M ydriasis C onstriction E jaculation C ontraction B locks N release E +Inotropic,C hronotr opic, drom otropic R enin release D ilation D ilation R elaxation G lycogenolysis

Act

on adrenergic receptor sites on the cells of smooth muscles Adrenergic receptors

Alpha1 vasoconstriction; increases cardiac contraction ; mydriasis, bladder neck and prostatic capsule contraction Alpha2 inhibits norepinephrine, dilates blood vessels ; decreases GIT tone & motility Beta1 increases rate & force of cardiac contraction; increases renal secretion of renin, increasing BP Beta2 dilates bronchioles ; glycogenolysis; increases skeletal muscle blood flow; GIT/uterine relaxation

Catecholamines
The

Indications of Adrenergic Drugs

chemical structures of a substance, either endogenous or synthetic, that can produce a sympathomimetic response Endogenous
Dopamine,

epinephrine & norepinephrine dobutamine

Synthetic
isoproterenol,

Emergency drugs inotropic drugs, vasopressors Cardiac arrest, hypotension, heart failure Asthma, URT congestion bronchodilation, vasoconstriction Allergies, bleeding vasoconstriction Hypoglycemia glucogenolysis Obstetric use stops premature labor Eye disorders causes pupil dilation

Not for patients with glaucoma

Used with local anesthetics vasoconstriction

Adrenergic Drug: Epinephrine

Alpha and beta adrenergic agonists
Epinephrine (Adrenaline Cl)

Dobutamine Dopamine Ephedrine Epinephrine Metaraminol Norepinephrine

acts indirectly by stimulating release of norepinephrine which acts directly on adrenergic receptor sites Can be given IV, IM, topical, inhalation or SQ Used to fight anaphylaxis ; rapid onset of action Potent inotropic drug ; may reduce renal perfusion Nurses must monitor vital signs carefully and watch for rapid heart rate, dizziness and increased blood pressure; ECG monitoring

Beta specific adrenergic adrenergic agonists

Albuterol Bitolterol Isoetharine Isoproterenol Salm eterol Terbutaline M etaproterenol

Isoproterenol HCl (Isuprel)

Bronchodilation & increase in heart rate Can cause severe Often used

tachycardia to treat asthma

Albuterol (Proventil, Ventolin)

Produces

Alpha specific adrenergic agonists

Clonidine

rapid bronchodilation Used to treat bronchospasms SE: tachycardia, tremors, restlessness, nervousness Caution : taken with mono amine oxidase inhibitors (MAOI), may cause hypertensive crisis

Midrodrine Phenylephrine

Clonidine (Catapres) & Methyldopa (Aldomet)

Alpha2 adrenergic drugs Treats hypertension by regulating /

Nursing Responsibilities

inhibiting the release of norepinephrine

May cause cardiovascular depression by

stimulating alpha2 receptors in the CNS SE: tachycardia, palpitations, dysrrhythmia, n/v, urinary difficulty, tremors, dizziness

Frequent VS monitoring Check urinary output , bladder distention Check for IV infiltration. Norepinephrine & dopamine may cause tissue necrosis . Antidote is Phentolamine mesylate (Regitine) Take with food to prevent N/V. Monitor labs may increase glucose level

Glycogenolysis

Read OTC labels: cold medicines, diet pills Rebound nasal congestion may occur. DO NOT give to nursing mothers.

Adrenergic Blockers
Blocks the effects of

Adrenergic Blockers
Alpha 1 blockers

neurotransmitters Alpha blockers cause a decrease in blood pressure, orthostatic hypotension Beta blockers decrease heart rate and force of cardiac contraction, cause bronchoconstriction Used in HTN, PVD, Raynaud s disease, dysrhythmias Monitor HR, BP Use with caution in patients with COPD

Prazosin HCl (Minipress), Doxazosin HCl (Cardura), Terazosin HCl (Hytrin)

Alpha 1,

Beta 1 & 2 blockers

Carvedilol (Coreg), Labetalol (Trandate)

Beta 1 blockers

Metoprolol tartrate (Lopressor), Atenolol (Tenormin)

Beta 1 & 2 blockers

Propanolol (Inderal), Nadolol (Corgard)

Cholinergic Drugs
Nursing Responsibilities
VS monitoring; ECG for baseline Assess for respiratory problems Observe for and prevent orthostatic

hypotension Advise clients to avoid abruptly stopping a beta -blocker & to monitor blood sugar Dose -related changes in male sexual function may occur

Cholinergic stimulants, cholinergic agonists, parasympathomimetics - they mimic acetylcholine Stimulate the PNS. Major action is to stimulate bladder and GI tone, constrict pupils (miosis) and increase neuromuscular transmissions to receptor sites Acetylcholine (ACh) neurotansmitter located at the ganglions and parasympathetic nerve endings Two cholinergic receptors: Muscarinic receptors stimulate smooth muscle (eye, GIT, urinary system) and slow heart rate Nicotinic receptors - affect skeletal muscle

Acetylcholine (ACh) & Cholinesterase (ChE)

Acetylcholine (ACh) Cholinesterase (ChE)

Direct -acting Cholinergics

Bethanecol

- neurotransmitter promotes breakdown

of ACh Cholinesterase destroys acetylcholine. More cholinesterase, less acetylcholine available. Inhibit cholinesterase, more acetylcholine available.

(Urecholine ) increases urination Metoclopramide HCl (Reglan) treats gastro -esophageal reflux disease (GERD) by increasing gastric emptying time Pilocarpine causes miosis; used in treating glaucoma

Bethanechol Cl (Urecholine)

Reversible Cholinesterase Inhibitors

Produces

Treats urinary retention and abdominal distention ; promotes micturition and increases peristalsis in the GIT Poorly absorbed in the GIT. Given on empty stomach. Voiding occurs 30 minutes 1 hrs after po administration and 15 minutes after SC SE: N/V, hypotension, bradycardia , diarrhea, salivation, sweating, flushing, frequent urination, rash, miosis, blurred vision Contraindication: intestinal or urinary tract obstruction, asthma

miosis to treat glaucoma

Increases muscle strength in myasthenia

gravis
Neostigmine (Prostigmine ), Pyridostigmine bromide (Mestinon ), Edrophonium Cl (Tensilon ) CAUTION : bradycardia , asthma, PUD, hyperthyroidism CONTRAINDICATION: intestinal / urinary tract obstruction

Nursing Responsibilities
Assess

Anticholinergics
Parasympatholytics, cholinergic blocking They

urine output, bowel & breath sounds Assess for asthma, PUD, urinary & intestinal obstruction Monitor BP, pulse orthostatic hypotension Give 1 hour ac or 2 hours pc Check serum lipase, amylase Cholinergic overdose: sweating, salivation, flush, abdominal cramps Antidote: Atropine sulfate (0.6mg)

agents inhibit the actions of acetylcholine Major responses are to decrease GI motility and salivation , to dilate pupils and to increase pulse rate; may cause decreased bladder contraction Used to treat the early stages of Parkinson s disease and to decrease tremors and rigidity & to decrease salivation and drooling CONTRAINDICATION: Glaucoma

Atropine sulfate
Derived from the belladonna plant Vagolytic

Anticholinergic Drugs
Belladona Hyoscyamine sulfate Scopolamine hydrobromide
Patch used for prevention of

inhibits vagal stiumulation Used as a pre -op med, anti -spasmodic, treatment of bradycardia; for mydriasis & cycloplegia Give IV undiluted or with 10 cc sterile water at 0.6 mg/min SE: dry mouth, decreased perspiration, blurred vision, tachycardia, constipation, urinary retention

n/v among

adults with motion sickness

Antiparkinson - Anticholinergic Drugs

Used to treat the early stages of

Nursing Responsibilities
Assess

Parkinson s disease and to decrease tremors and rigidity & to decrease salivation and drooling Used in the treatment of pseudoparkinsonism in psychotropic drugs Trihexyphenidyl HCl (Artane) Biperiden HCl (Akineton) Benztropine mesylate (Cogentin)

PR, UO, bowel sounds void before taking medication Maintain adequate fluid intake Encourage to eat foods high in fiber Encourage activity. Avoid hot environment. Oral care. Ice chips. Hard candy. Avoid caffeine, alcohol, cigarettes, aspirin before bedtime Safety precautions drowsiness is common
Encourage