15+16: Pharm for the Nervous System Flashcards
2 main parts of the nervous system
- central (brain and spinal cord)
- peripheral (everything else)
2 parts of the peripheral nervous system
- somatic (skeletal muscle)
- autonomic (involuntary)
NT for sympathetic system
adrenergic -> NE
NT for parasympathetic system
cholinergic -> ACh
receptor sites for parasympathetics
- nicotinic (neuromuscular)
- muscarinic (smooth muscle)
receptor sites for sympathetics
- Alpha 1 and 2
- Beta 1 and 2
sympathetic effects on the body
- dilate pupils
- dilate bronchioles
- increase HR
- constrict blood vessels
- relax smooth muscle and GI tract
- relax bladder muscle
- relax uterine muscle
parasympathetic effects on the body
- constricts pupils
- constrict bronchioles and increases secretions
- decrease HR
- dilate blood vessels
- increase peristalsis
- constricts bladder
- increase salivation
drugs that stimulate the SNS
adrenergic agonists
chemical structure of a substance that can produce a sympathomimetic response
catecholamines
3 classifications of adrenergic antagonists
- direct: directly stimulates adrenergic receptor
- indirect: stimulate the release of NE
- mixed-acting: act at receptor site and increase production of NE
3 endogenous catecholamines
- NE
- Epi
- Dopamine
1 synthetic catecholamine
dobutamine
4 locations of alpha 1 receptors and their effects
- blood vessels: vasoconstriction (increase BP and contractility of heart)
- eye: mydriasis (pupil dilation)
- bladder: relaxation
- prostate: contraction
2 locations of alpha 2 receptors and their effects
- blood vessels: decreased BP (reduced NE)
- smooth muscle (GI tract): decreased GI tone and mobility
2 locations of beta 1 receptors and their effects
- heart: increased HR and contraction
- kidney: increased renin and angiotensin -> increased BP
4 locations of beta 2 receptors and their effects
- smooth muscle (GI tract): decreased GI tone and mobility
- lungs: bronchodilation
- uterus: relax uterine muscle
- liver: activate glycogenolysis -> increased blood sugar
What type of drug is Epinephrine
adrenergic agonist (sympathomimetic)
MOA of epinephrine
actions on alpha 1, beta 1, and beta 2 receptors
uses of epinephrine
- allergic reaction and anaphylaxis
- asthma and bronchospasm
- angioedema
- status asthmaticus
- cardiac arrest and resuscitation
Side effects/adverse effects of epinephrine
- tachycardia
- hypertension
- tissue necrosis if IV infiltrates
- agitation
- hyperglycemia
- Vfib
- pulmonary edema
administration of epinephrine
- IV
- IM
- subcut
- topical
- inhalation
- NOT given orally (rapidly metabolized)
contraindications of Epi
- dysrhythmia
- glaucoma
- cardiogenic shock
What to monitor when giving Epi
- for cardiac arrest: 1mg every 3-5 minutes -> monitor IV site for necrosis
- ECG and vital signs
- urine output for urinary retention
- glucose levels for elevation
pt teaching for Epi
- Epipen should be available at all times
- use at onset of symptoms
What type of drug is Albuterol
beta-adrenergic agonist
MOA of albuterol
stimulates beta 2 adrenergic receptors in the lungs -> relaxes bronchial smooth muscle and causes bronchodilation
uses of albuterol
asthma and prophylaxis for bronchospasm
Side effects/adverse effects of albuterol
- tremors
- dizziness
- palpitations/tachycardia
- HTN
- anxiety
- HA
- insomnia
- hyperglycemia
- dysrhythmia
- angioedema
- SJS
what to monitor with giving albuterol
- VS
- O2 sat
- lung sounds
pt teaching for albuterol
- keep available at all times
- proper administration (possibly w/ spacer)
- report side effects
What type of drug is Clonidine
Central-acting alpha agonist
MOA of clonidine
- stimulates alpha 2 receptors in the CNS
- decrease release of NE from nerves and decrease peripheral adrenergic receptor activation
use of clonidine
HTN
side effects/adverse effects of clonidine
- HA
- nasal congestion
- drowsiness
- ejaculation dysfunction
- elevated liver enzymes
drugs that block the effects of adrenergic NT (directly occupy receptor space or inhibit release of NT)
adrenergic antagonist (adrenergic blockers)
T/F: most adrenergic antagonists block both alpha and beta receptors
False; block either alpha or beta receptors
effects of adrenergic blockers on alpha 1 receptors
- vasodilation (possible reflex tachycardia)
- myosis: pupil constriction
- suppress ejaculation
- reduce contraction of smooth muscles in bladder neck and prostate gland
effects of adrenergic blockers on beta 1 receptors
- decrease HR
- reduce force of myocardial contraction
effects of adrenergic blockers on beta 2 receptors
- constrict bronchioles
- contracts uterus
- inhibits glycogenolysis -> decrease blood glucose
What type of drug is atenolol
beta-1 adrenergic blocker (similar to metoprolol)
MOA of atenolol
- selectively blocks beta 1 adrenergic receptor sites
- decreases sympathetic outflow to periphery
- suppresses RAAS
uses of atenolol
- HTN
- angina
- prophylaxis of acute MI
side effects/adverse effects of atenolol
- drowsiness
- dizziness
- erectile dysfunction
- hypotension
- bradycardia
- bronchospasm
- dysrhythmia
drugs that stimulate the parasympathetic nervous system (mimic actions of ACh)
cholinergic agonists
2 classifications of cholinergic agonists
- direct acting: work directly on receptors
- indirect acting: stimulate release of ACh
What type of drug is Bethanechol Chloride
Parasympathomimetic (cholinergic agonist)
MOA of bethanechol
stimulates cholinergic (muscarinic) receptors
uses of bethanechol
urinary retention and neurogenic bladder
contraindications of bethanechol
- intestinal or urinary tract obstruction
- IBS
- bradycardia
- COPD
- asthma
side effects/adverse effects of bethanechol
- hypersalivation
- sweating
- urinary urgency/frequency
- tachycardia
- weakness
- bronchospasm
- cholinergic crisis
what to monitor with bethanechol
- I&O (looking for possible obstruction)
- vital signs
- auscultate for lung rales/ronchi
- monitor for cholinergic crisis
antidote for bethanechol
atropine sulfate
pt teaching for bethanechol
- slow position changes (orthostatic hypotension)
- report breathing difficulty (bronchospasm)
symptoms of cholinergic crisis
SLUD
- salivation
- lacrimation
- urination
- defecation
drugs that inhibit the action of ACh by blocking ACh receptors
cholinergic antagonists
what type of drug is atropine
parasympatholytic (cholinergic antagonist)
MOA of atropine
inhibits ACh by occupying receptors
use of atropine
pre-op med to reduce salivation and increase HR
side effects/adverse effects of atropine
- dry mouth
- urinary retention
- tachycardia
- paradoxic bradycardia
- pulmonary edema
- laryngospasm
- anticholinergic toxicity
contraindications for atropine
- glaucoma
- BPH
- MI
- myasthenia gravis
for what conditions should you use caution with atropine
- renal or hepatic disorder
- COPD
- heart failure
what to monitor for with atropine
- VS
- I&O
- bowel sounds/constipation
- mouth care (dryness)
pt teaching for atropine
- dry mouth
- constipation
- decreased urination
symptoms of anticholinergic toxicity (5 sayings)
- blind as a bat (vision problems due to dilated pupils)
- hot as a desert (hyperthermia)
- mad as a hatter (confused)
- dry as a bone (dry mouth and urinary retention)
- red as a beet (flushed)
what type of drug is tolterodine tartrate
Anticholinergic (antimuscarinic agent)
MOA of tolterodine
blocks cholinergic (muscarinic) receptors selectively in the urinary bladder
uses of tolterodine
decrease urinary frequency, urgency, and incontinence
contraindications of tolterodine
- urinary retention
- gastric paresis
- glaucoma
- GI obstruction
side effects/adverse effects of tolterodine
- angioedema
- chest pain
- tachycardia
- peripheral edema
- dry eyes
- blurred vision
- confusion
