Autonomic Nervous System

Parasympathetic nervous system functions

constrict pupils, stimulate salivation, constrict bronchi, decrease HR, inhibition of adrenaline production

sympathetic nervous system functions

dilatate pupils, inhibit salivation, relaxes bronchi, increase HR, stimulates epi and norepi release

Sympathetic Stimulants

Sympathomimetic, Adrenergic, Adrenomimetic ,Adrenergic Agonist

Parasympathetic Depressants

Parasympatholytic , Anticholinergic, Cholinergic Antagonist , Antispasmodic

Parasympathetic Stimulants

Parasympathomimetic, Cholinergic, Cholinergic Agonist

Sympathetic Depressants

Sympatholytic , Adrenergic Blocker , Adrenolytic , Adrenergic Antagonist

Sympathetic Adrenergic releases

Norepinephrine

Sympathetic Receptors

Alpha 1, 2 Beta 1, 2

Parasympathetic/ Cholinergic release

Acetylcholine

Parasympathetic Receptors

Nicotinic Muscarinic

Alpha receptors are located in

the smooth muscles

Alpha1

vasoconstriction

Alpha2

less vasocontraction bring bp down

Alpha1 Agonists Have a

vasoconstricting effect

Midodrine (proamatine)

Alpha Adrenergic Agonist, ↑ blood pressure

Alpha2 agonists

vasodilating effect

Catapres (clonidine)

Alpha2 agonists Reduces BP

Catapres (clonidine) Monitor for

Fatigue, take at night, call light, dry mouth, candy ice chips

If discontinuing catapres Clonidine

do not just stop taking it – gradually taper off over several days

Minipress (Prazosin)

Alpha1 Blockers (Sympatholytic) Extended-release tablets Venous and arterial dilation

Minipress (Prazosin) Monitor for

hypotension, Dizziness, Lightheadedness, Faintness

Minipress (Prazosin) also has

Smooth muscle relaxation of the prostatic capsule and bladder neck decreasing urgency, frequency, & dysuria

Beta1 receptors are located in

heart, increase HR, BP and contractility

Beta2 are located in

lungs, uterine & skeletal muscles

Beta1 Blocker

Lopressor (Metoprolol)

Lopressor (Metoprolol)

(Heart only) ↓ HR hold if HR <60, ↓ Contractility, Chest pain, Dysrhythmias Lopressor (Metoprolol) Diabetics

Beta1&2 Blocker

Inderal (propranolol)

Inderal (propranolol)

(Heart & Bronchoconstriction) ↓ HR ↓ Contractility , bronchoconstriction

Inderal (propranolol) Avoid in clients with

asthma

What are some safety measures a nurse can take for both types of beta drugs?

watch Bp get up slowly

Assessing the Effectiveness of Beta1&2 Meds

↓ HR ↓ Chest pain ↓ Cardiac dysrhythmias ↓ Blood pressure Controls heart failure manifestations (edema, SOB, JVD)

Anticholinergics (Parasympatholytics)

Atropine

Atropine

treats bradycardia, Helpful for decreasing saliva & GI motility, Dilation of pupils (eye drops)

Atropine Administration For adults it is

1mg bolus, q 3-5 min Maximum 3 mg, FAST PUSH

Atropine is not effective in patients who

have received a heart transplant

POTS Syndrome

Is a condition characterized by too little blood returning to the heart when moving from a lying down to a standing up position (orthostatic intolerance)

POTS Syndrome S/S’s

Orthostatic intolerance, Rapid HR, low BP

POTS Diagnosis Tilt table test

IV inserted, Lies flat for 5 minutes while monitoring EKG/BP. moved to vertical position for 10-45 mins until symptoms. •

Tilt table test positive for POTS

if HR >30 bpm with tilt IV meds can be given to stimulate symptoms if necessary.

POTS Diagnosis Orthostatic blood pressure

Get BP and HR after patient lays flat for 10 minutes , Assist into sitting then BP and HR. Assist into standing and repeat VS.

POTS Treatment

increase salt intake, drink lots of water, Exercise, midodrine, Beta blockers for high heart rate, Fludrocortisone