autonomic pharmacology -- pharm

some medications used in the dental practice affect the ANS

- vasoconstrictors added to some local anesthetics- drugs used to increase salivary flow

ANS

- functions largely as an autonomic modulating system for many bodily functions such as: BPHRmotilitysalivary gland secretions bronchial smooth muscles urinary system- the system that affects os many things

some ANS drugs produce oral ADR's

- anticholinergics produce xerostomia

members of other drug groups have effects similar to ANS drugs

- antidepressants and antipsychotics are drug groups with autonomic side effects

ANS originates in the

central nervous system

ANS is divides into 2 parts

sympathetic nervous system parasympathetic nervous system

Nerotransmitters in each system

sympathetic: epinephrine, norepinephrine parasympathetic: acetylcholine

sympathetic nervous system stimulants (fight or flight)

sympathomimetics/adrenergic- CNS: excite, alertness, anxiety, tremors - CVS: increase HR + BP- Respiratory: relax bronchiole smooth muscle to breathe- eyes: decrease pressure - salivary glands: vasoconstriction to decrease saliva - too much CNS excitation = anxiety, tremors, tachycardia, arrhythmias, increased BP

specific sympathomimetics (adrenergic) agents

epinephrine: DOC for acute asthmatic attacks and anaphylaxis phenylephrine: mydriatic (to dilate eyes) and nose sprays to decrease nasal congestion pseudoephredrine (sudafed): treatment of a common cold, source of methamphetamine

Clinical use of sympathomimetics (adrenergics)

CNS stimulation: ADHD, obesity, narcolepsy CVS: treatment of shock and cardiac arrest Vasoconstriction: prolong the action of local anesthetics and reduce toxicity, hemostasis, nasal decongestants respiratory system: asthma treatment for bronchodilation

dental considerations of sympathomimetics (adrenergics)

tachycardia: check BP and pulse at each visit especially if epinephrine is required CNS excitation and tremors: CNS effects can be exacerbated in pt with CNS health issues, use detailed medication/health history drug interaction additive with OTC meds that have adrenergic agonists check BP and bulse

sympathetic nervous system blockers

sympatholytic/sympathetic blocker (lytic = blocker)beta adrenergic blocking drugs:typically end in ----olol block classic adrenergic actions so result in bradycardia and possible bronchoconstriction - decrease BP, HR, feel very calm ex) metoprolol, atenolol, labetalol, propanolol

parasympathetic nervous system stimulants (rest)

parasympathetic stimulants/cholinergic agents- CV: negative chronotropic and iontropic action - bradycardia, decrease in BP and cardiac out output - GI: excite, increased activity/motility/secretion - Eye: miosis and cycloplegia (paralysis of eye muscle) - SLUD (salivation, lacrimation, urination, defication) - treats urinary retention, previously used for glaucoma

dental hygiene consideration of cholinergic drugs

encourage pt's to use good oral hygiene to help with effects of increased salivation from cholinergic effects raise pt into sitting position slowly from the dental chair to help minimize hypotensive effects from cholinergic medications

parasympathetic nervous system blocker

-parasympathomimetic blocker/cholinergic blocker- prevents action of cholinergic drugs - CNS: depression or stimulation - Smooth muscle: relax respiratory and GI tracts - Exocrine glands: reduce flow and volume - CVS: tachycardia - eye: mydriasis, blurred vision - xerostomia, blurred vision, hyperpyrexia, delerium, hallucination - used for preop to inhibit saliva and bronchial mucus + reduction in parkinsons movement

dental consideration of anticholinergic drugs

encourage good oral hygiene drink plenty of water, water by bedside avoid prescription and nonprescription mouth rinses that contain alcohol caffeinated beverages can also exacerbate dry mouth fruit juices and sodas contain sugar that can place pt at increased risk of caries chew tart, sugarless gum

dental hygiene consideration cholinergic drugs

encourage good oral hygiene to help with increased salivation raise pt into sitting position slowly and rise slowly to minimize hypotensive effects

dental hygiene anticholinergic drugs

xerostomia: - minimize with meticulous OH - drink plenty of water - avoid alcohol, acggeinated, sugar tachycardia: check bp and pulse sedation: - caution if using concurrent sedating agent - have someone to drive from appointment - avoid any activity that requires thought or concentration

atropine

Anticholinergic med probably to produce a dry field while intubated