Neurosensory Medications

Sympathetic Nervous System

• Fight or fight response: increased cardiac output, lung capacity and heartrate. Increased breakdown of glucose and adipose tissue, pupil dilation, and decreased GI motility and urinary output.

• Neurotransmitters include acetylcholine, norepinephrine, and epinephrine

• Receptors include Alpha and Beta

  • Alpha: Bind with NE and epinephrine. Medications either antagonize Alpha 1 or agonize Alpha 2 resulting in vasodilation and lowered blood pressure.

  • Stimulation of B1: increased cardiac output which increases heart rate

  • Stimulation of B2: relaxation of smooth muscles and glycogenolysis

Parasympathetic Nervous System

• Neurotransmitter involved is Acetylcholine

• Receptors are cholinergic

• Activation of receptors stimulated voluntary muscle control and “rest and digest” functions.

• Vasodilation of vessels, Increased GI and urinary function, pupil constriction, and stimulation of bronchial smooth muscle.

Baroreceptors

sense changes in blood pressure and creates a negative feedback loop

Chemoreceptors

sense changes in pH, oxygen, and carbon dioxide in the arterial blood. Stimulates respiratory centers to adjust ventilation depth and rate.

Glucose Homeostasis

Triggered by eating. Increases pancreatic output of insulin and stimulates the liver to promote glycogen synthesis.

Temperature Regulation

changes are sensed by thermoreceptors in the skin, spinal cord, visceral organs, and brain. Creates a negative feedback loop.

Adrenergic Agonists

• imitate the SNS effects

• Exampless: Albuterol and clonidine

Adrenergic Antagonists

• block SNS influence

  • Cause vasodilation and are used primarily for HTN

  • Lower heart rate, decrease cardiac output, and reduce peripheral vascular resistance

  • Examples: Propranolol and metoprolol

Cholinergic Agonists

• mimic or increase availability of Ach by preventing breakdown.

  • Cause adverse effects of organs of the PSNS

  • Examples: Bethanechol, Nicotine

Cholinergic Antagonists

• bind to cholinergic receptors to cause the opposite of parasympathetic effects

  • Used for bradycardia, overactive bladder, motion sickness, GI spasms and bronchoconstriction.

  • Examples: Atropine and Scopolamine

Antihistamines

• Used for treatment of Meniere’s Disease and BPPV

• Example is meclizine

• Blocks histamine receptors in the brain that are involved with nausea and dizziness. Also blocks dopamine and histamine receptor responsible for balance and dizziness. Approved for short term use.

• Contraindications: Asthma, glaucoma, benign prostatic hyperplasia.

• Side/Adverse Effects: dry mouth and eyes, constipation, severe drowsiness, sedation, tachycardia, irregular heart rate, and lack of sweating. Use in older adults may result in delirium and falls.

• Education: Increase fluids and fiber. Older adults should take extra precautions for fall prevention.

Anti-VEGF Therapy

• Examples: Ranibizumab, Aflibercept

• Treatment: Macular Degeneration (specifically wet)

• Medication is injected into the eye and reduces the growth of blood vessels which reduces the leakage of fluid and blood to the retina which then improves vision. Slows progression of MD.

• Side/Adverse Effects: pain, light sensitivity, redness, eye infection, retinal detachment, vision loss, blood clots