Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from...
-
Upload
mary-richardson -
Category
Documents
-
view
218 -
download
0
Transcript of Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from...
![Page 1: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/1.jpg)
Autonomic Nervous System
Part Dieu
![Page 2: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/2.jpg)
Atropine
Anticholinergic,
Parasympatholytic
comes from ”belladonna” plant
![Page 3: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/3.jpg)
Figure 1a Schematization of the Nervous System
Nervous System
PNSPNS
PNS
![Page 4: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/4.jpg)
How autonomic drugs work
ANS transmits nerve impulses from the CNS to the effector organs over efferent neurons (preganglionic or postganglionic)
Effector organs are the heart, smooth muscle and exocrine glands.
Neurotransmittor at effector organ determines type of neuron
norepinephrine or epinephrine=adrenergic (sympathetic)
acethylcholine = cholinergic (parasympathetic)
![Page 5: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/5.jpg)
Receptors
If receptor responds to acethylcholine
= muscarinic or nicotinic
If receptor responds to norephinephrine or epinephrine
= adrenergic
ACHNOREPI
EPI
adrenergic
muscarinic
nicotinic
![Page 6: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/6.jpg)
Sympathetic Parasympathetic
Preganglionic Preganglionic
Acetylcholine Acetylcholine
Nicotinic receptor Nicotinic receptor
Postganglionic Postganglionic
Norepinephrine Acetylcholine
Adrenergic receptor Muscarinic receptor
![Page 7: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/7.jpg)
Competitive Actions of Atropine
Atropine competes and binds the muscarinic receptor sites thus preventing ACH from binding to that site.
Atropine Acetylcholine
Muscarinic Receptor Site
![Page 8: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/8.jpg)
Theraputic Uses of Atropine
to increase the heart rate in symptomatic bradycardia
reduce hyperactivity and spasms of the GI tract and bladder
used in ophthalmology to cause mydriasis (pupil dilation)Atropine is used to treat organophosphate overdosesAtrovent (Impratropium) which is a mixture of atropine and Ventolin
(blocks muscarinic effects)
![Page 9: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/9.jpg)
Anticholinergic Overdose
Mnemonic Rationalered as a beet Peripheral ganglionic blockade of nicotinic receptorsdry as a bone Cholinergic nerves supply the sweat glands, anticholinergics can
decrease or abate their activity.blind as a bat The sphincter muscle of the iris and the ciliary muscle are
innervated by cholinergic nerve fibers. The sphincter muscle is notable to contract normally, the radial muscle causes the pupil todilate. The patient is unable to focus (accommodate).
mad as ahatter
Anticholinergics block cholinergic pathways and receptors in theCNS. This results in manic behavior and excitement.
hot as a hare The inhibition of sweat glands causes the patients body temperatureto rise.
![Page 10: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/10.jpg)
Special Prehospital Concerns
Atropine should be given in doses of 0.5mg except in cases of bradyasystolic arrest
Atropine should be used with extreme caution in the setting of myocardial infarct
second-degree type II and 3 degree heart block with wide QRS complexes, transcutaneous pacing is a preferred method of therapy
![Page 11: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/11.jpg)
Epinephrine
Adrenergic Agonist
Sympathomimetic
![Page 12: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/12.jpg)
Epinephrine
Drug Profile
naturally occurring catecholamine that is produced in the body and released by the adrenal gland
Epinephrine can be considered the emergency hormone and norepinephrine is mainly the transmitter hormone
stimulates adrenergic neurons to bring about the various effects on the body
![Page 13: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/13.jpg)
Pharmacokinetics
Both Alpha and Beta-receptors are stimulated by epinephrine. Epinephrine is a “direct acting” adrenergic agonist
It is metabolized primarily by enzymes in the synaptic cleft
![Page 14: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/14.jpg)
Pharmacokinetics of Epi
Cardiovascular Effects SVR B/P Electrical activity in the
heart cerebral and coronary
blood flow strength of myocardial
contraction MVO2 automaticity
![Page 15: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/15.jpg)
Adrenergic Receptor Response to Epi
Alpha Receptor Beta Receptor Vasoconstriction Vasodilatation (B2) Iris Dilatation Cardioacceleration (B1) Intestinal relaxation Increased myocardial strength (B1) Intestinal sphincter contraction Intestinal relaxation (B2) Pilomotor contration Uterus relaxation (B2) Bladder sphincter contraction Bronchodilatation (B2) Calorigenesis (B2) Glycogenolysis (B2) Lipolysis(B2) Bladder wall relaxation(B2)
![Page 16: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/16.jpg)
Therapeutic Uses
Most widely used drug in cardiac arrest setting refractory asthmaanaphylaxissevere hypotension unresponsive to dopamineEpinephrine is used extensively in the resuscitation of children (2-10mcg)an additive in local anaesthetic agents to help cause vasoconstriction
![Page 17: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/17.jpg)
Adverse Effects
Overdose is unlikely as the drug is quickly metabolized
Increased HR/BP,Sweating
increase MVO2 demands and have to given with caution to those patients with ischemic heart disease
![Page 18: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/18.jpg)
Dosage/Supplied
Adult- For anaphylactic reactions (1:1,000) 0.3mg subcutaneous.
For Cardiac arrest 1:10,000 1mg IV q 3-5 mins. 2mgs ETT q 3-5 mins.
Pediatric- For anaphylactic reactions (1:1,000) 0.01mg/kg max 0.3mg
For severe hypotension (shock) 2-10mcg/min IV
![Page 19: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/19.jpg)
Special Prehospital Concerns
Epinephrine can be administered in via IV, ETT, SC, bolus or infusionideal dose of epinephrine epinephrine infusion,. and titrate to effect
Epinephrine is light sensitive
![Page 20: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/20.jpg)
Salbutamol
Adrenergic agonist (beta-2)
Bronchodilator
![Page 21: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/21.jpg)
Drug Profile (FYI – Do not memorize!)
beta agonists are thought to work is by increasing the intracellular concentrations of cAMPcauses epithelial chloride channels to open As the chloride ions move they draw sodium ions along with them. The in sodium ions create a gradient to draw water along with them. This in water acts to lubricate the mucous
![Page 22: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/22.jpg)
How it works
#2Increase in cAMP
#3Activates chloride channels. Aschannels open Chloride ions enter.Sodium is drawn in to maintain ionicbalance.
#1Ventolin
#4H2O followssodium
![Page 23: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/23.jpg)
Therapeutic Uses
Therapeutic UsesVentolin is used to treat bronchospasm brought about from a number of factors.
The fact that Ventolin is predominantly a beta 2 receptor stimulator, the effects on the beta 1 receptors of the heart are minimal.
![Page 24: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/24.jpg)
Adverse EffectsAdverse Effects•nervousnessnervousness• tremorstremors• agitationagitation• dizzinessdizziness• palpitationspalpitations• headacheheadache• tachycardia tachycardia •nauseanausea.•allergic reactions include angioedema, allergic reactions include angioedema, urticaria, bronchospasm, hypotension, rash urticaria, bronchospasm, hypotension, rash and anaphylaxisand anaphylaxis•Overdosage may cause tachycardia, cardiac Overdosage may cause tachycardia, cardiac arrhythmias, hypertension, hypokalemia and arrhythmias, hypertension, hypokalemia and in extreme cases, sudden deathin extreme cases, sudden death
![Page 25: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/25.jpg)
Dose: Salbutamol via Nebulizer: <10kg – 1.25 mg 10 – 30 kg – 2.5 mg >30 kg – 5.0 mg
Salbutamol via MDI0-2 years: 1 puff followed by 4 breaths, repeat this 3 times2-5 years: 1 puff followed by 4 breaths, repeat this 4 times
5-8 years: 1 puff followed by 4 breaths, repeat this 6 times
> 8 years: 1 puff followed by 4 breaths, repeat this 8 times
Dosage -Adult and Pediatric
![Page 26: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/26.jpg)
Special PreHospital Concerns
administered by MDI (metered dose inhaler) or by nebulizer mask driven by oxygen or air. Aerochamber is betterTo test how full an MDI container is -see figure
![Page 27: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/27.jpg)
Drug Profile
Barbituates act by suppressing impulses to the limbic system and the RASAlso act by augmenting GABA inhibitory effect throughout the entire brainResult can be a profound depression in consciousness
![Page 28: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/28.jpg)
Adverse Effects
Low doses –euphoria, Respiratory depressionDiminished reflexes and motor responseUnconsiousnessDeathHypotension
![Page 29: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/29.jpg)
Other CNS Depressants
Alcohols – common use Methanol, ethanol, choral hydrate
Paraldehyde – older use, ETOH withdrawalAntihistamines – Benadryl, Gravol (side effects)Side effects of many non-CNS drugs
![Page 30: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/30.jpg)
Prehospital Administration
Versed
Phenobarb
Ativan
Gravol
Valium
Narcotics
![Page 31: Autonomic Nervous System Part Dieu Atropine Anticholinergic, Parasympatholytic comes from ”belladonna” plant.](https://reader036.fdocuments.us/reader036/viewer/2022062322/56649ec75503460f94bd3895/html5/thumbnails/31.jpg)
For Next Class
Please read Chapter 7 pages 82-95Stimulants (antidepressants) Chapter 9 – 114-131
Common prescription Drugs Do YOU know your drugs?