Autonomic Nervous System

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AUTONOMIC NERVOUS SYSTEM
PURPOSE?
–• examples ?
Primary function?

Back 1

Maintain stable internal environment by coordinating, adjusting, and regulating the body’s visceral activity
exs:digestion, body temperature, heart rate
• Primary Function - Maintain homeostasis

Front 2

AUTONOMIC NERVOUS SYSTEM
DIVISIONS-2
•

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Energy
•

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PARASYMPATHETIC
-2

Back 3

– Cranio-sacral System
– Conserve and Restore

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SYMPATHETIC
–3

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Thoraco-lumbar System
– Prepares body for stress and emergency
– Also non-stress regulation

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NEUROFIBER ANATOMY
4

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• Pre-ganglionic and post-ganglionic fibers
• Neurotransmitter vesicles
• Junctional Spaces
• Receptors

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PARASYMPATHETIC FIBER
• post-gan NT

Back 6

: acetylcholine

Front 7

PARASYMPATHETIC FIBER
• Receptor Site:

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Muscarinic

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• Activity Stopped by ?

Back 8

acetylcholine esterase

Front 9

SYMPATHETIC FIBER
• Post-ganglionic neurotransmitter:

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norepinephrine (catecholamine)

Front 10

SYMPATHETIC FIBER
Receptor Site:

Back 10

alpha, beta 1 and beta 2

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SYMPATHETIC FIBER
Activity stopped by?-2:

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-Reuptake- (primary mechanism)-
– Mono amine oxidase

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Neurohormonal Transmission-2
•

Back 12

Acetylcholine
– Released by all pre-ganglionic fibers (stimulates nicotinic receptors)
– Post-ganglionic parasympathetic fibers (stimulates muscarinic receptors)
• Norepinephrine
– Post-ganglionic sympathetic fibers (stimulates alpha, beta 1 and beta 2 receptors)

Front 13

Acetylcholine

Back 13

Released by all pre-ganglionic fibers (stimulates nicotinic receptors)

Front 14

Post-ganglionic parasympathetic fibers (stimulates ?)

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Post-ganglionic parasympathetic fibers (stimulates muscarinic receptors)

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PARASYMPATHETIC EFFECTS-eyes-4

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• EYES
– Miosis (pupil constriction)
– Lacrimation (tear secretion)
– Accommodate for near vision
– Decreased intra-ocular pressure

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Norepinephrine
– Post-ganglionic sympathetic fibers (stimulates ?receptors)

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(stimulates alpha, beta 1 and beta 2 receptors)

Front 17

PARASYMPATHETIC EFFECTS- DIGESTIVE-3

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– Saliva Secretion
– Stomach acid secretion
– Peristalsis

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PARASYMPATHETIC EFFECTS-3

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• Decrease heart rate
• Bronchial Constriction (asthmatics)
• Enhances Urination
– Bladder contraction
– Sphincter relaxation

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PARASYMPATHOMIMETIC AGENTS-2
•

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Bethanechol - stimulates GI motility and bladder

• Pilocarpine - ophthalmic - lowers intra-ocular pressure

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PARASYMPATHOMIMETIC AGENTS
• Contraindications-4
–

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Asthma
– Cardiac insufficiency
– Peptic Ulcer

– Eye drops may still be used with precaution

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Pilocarpine

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ophthalmic - lowers intra-ocular pressure
PARASYMPATHOMIMETIC AGENTS

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Bethanechol

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- stimulates GI motility and bladder
PARASYMPATHOMIMETIC AGENTS

Front 23

ACETYLCHOLINE ESTERASE INHIBITORS
-what does it do?
-pharmacolgy?

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• Blocks acetylcholine esterase enzyme from breaking down acetylcholine

• Pharmacology will be similar to parasympathomimetic agents, just mechanism of action differs

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Edrophonium- 2 uses
•
•

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Diagnose myasthenia gravis
Short acting - reversible
ACETYLCHOLINE ESTERASE INHIBITORS
INTERMEDIATE ACTING REVERSIBLE AGENTS

Front 25

Neostigmine and Pyridostigmine
treat?

Back 25

ACETYLCHOLINE ESTERASE INHIBITORS
INTERMEDIATE ACTING REVERSIBLE AGENTS
– Treatment of myasthenia gravis

Front 26

Physostigmine
– treats?

Back 26

ACETYLCHOLINE ESTERASE INHIBITORS
INTERMEDIATE ACTING REVERSIBLE AGENTS
Ophthalmic agent - lower intra-ocular pressure

Front 27

Donepezil, Galantamine, Rivastigmine
treats?

Back 27

– Temporarily lessen symptoms of Alzheimer’s Disease

Front 28

• Echothiophate and Isofluorphate

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LONG ACTING IRREVERSIBLE AGENTS

– Organophosphate toxic agents
– Must use precaution when administering by placing pressure on the corner of the eye
– Only utilized as an ophthalmic agent

Front 29

ANTICHOLINERGICS
• Blocks?

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muscarinic receptor so that acetylcholine cannot bind and stimulate

Front 30

ANTICHOLINERGICS
Eye effects

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– Dry eye
– Accommodate for far vision
– Mydriasis - dilate pupil
– Increased intra-ocular pressure

Front 31

ANTICHOLINERGICS
DIGESTION-3

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– Decreased saliva production
– Decreased acid production
– Decreased peristalsis

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ANTICHOLINERGICS
Misc.-3

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INCREASED HEART RATE
• URINARY RETENTION - especially in BPH
• BRONCHODILATION (asthmatics)

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ANTICHOLINERGIC ORDER OF SENSITIVITY

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• Secretory (saliva, sweat, stomach acid)
• Eye
• Heart
• GI Motility

Front 34

THERAPEUTIC USE
• NATURAL ALKALOIDS-4

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– Prior to procedure (decrease aspiration)
– Sinus Bradycardia
– Motion Sickness
– GI Cramping

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THERAPEUTIC USE
• -2 misc

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ANTISPASMODIC (bladder or GI)
• MYDRIATIC AND CYCLOPLEGIC - ophthalmic exam

Front 36

ANTICHOLINERGIC CONTRAINDICATIONS-4

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• Myasthenia gravis
• Narrow angle glaucoma
• Unstable cardiovascular system
• Intestinal atony

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SYMPATHETIC (ADRENERGIC)-recptors

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• ALPHA
– Vasoconstriction
– Stimulate sweat and salivary gland
– Decrease intra-ocular pressure
• BETA 1
– Increase heart rate and force of contraction
• BETA 2
– Bronchodilation, Smooth muscle relaxation

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SYMPATHETIC (ADRENERGIC)
• ALPHA- 3 effects
–

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Vasoconstriction
– Stimulate sweat and salivary gland
– Decrease intra-ocular pressure

Front 39

SYMPATHETIC (ADRENERGIC)
BETA 1
– 1 effect

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Increase heart rate and force of contraction
•

Front 40

SYMPATHETIC (ADRENERGIC)
BETA 2
– 1 effect

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Bronchodilation, Smooth muscle relaxation

Front 41

EPINEPHRINE
-effects which receptors and how ?

Back 41

• ALPHA - decrease IOP
– Prolong action of local anesthetics and decrease bleeding
– Increase blood pressure in shock
• BETA 1
– Increase blood pressure in shock
• BETA 2
– Relieve bronchospasm

Front 42

ISOPROTERENOL
-effects which receptors and how ?

Back 42

• BETA 1
– Increase blood pressure
• BETA 2
– Bronchodilation

Front 43

DOPAMINE
-effects which receptors and how ?

Back 43

• DOPAMINE
– Renal Artery Dilation
• BETA 1
– Increase blood pressure
• ALPHA
– Very strong vasoconstriction (dose rate dependent)

Front 44

DOBUTAMINE
-effects which receptors and how ?

Back 44

• BETA 1
– Cardiogenic shock

Front 45

BRONCHODILATORS

Back 45

• BETA 2 STIMULATION
• BETA 1 SPILL OVER
– best avoided by giving via inhaled route and utilizing a beta 2 specific agent (e.g. albuterol)

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ALPHA STIMULANTS

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• OPHTHALMIC DECONGESTANT

• NASAL DECONGESTANT
– Oral products may also increase blood pressure
– Topical nasal sprays should not be used for more than 3 days

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ALPHA BLOCKING AGENTS-2

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• PHEOCHROMOCYTOMA

• REVERSE ALPHA PROPERTIES OF LEVARTERENOL
– phentolamine

Front 48

BETA BLOCKERS
used to block? used for?

Back 48

• Utilized to block beta 1 receptors
• All will have beta 2 spillover, some more than others
• Use
– arrhythmia (tachycardia)
– Hypertension (decrease renin release)
– angina
– post-myocardial infarction
– migraine

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BETA BLOCKER CAUTION-3

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• ASTHMA - use beta 1 specific
• INSULIN DEPENDENT DIABETIC - masks symptoms of hypoglycemia
• PERIPHERAL VASCULAR DISEASE

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Summary Comparison

Back 50

Parasympathetic

• Acetylcholine esterase inhibitors

• Alpha/Beta Blockers
• Sympathetic

• Anticholinergics