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PHARMACOLOGY > Autonomic Nervous System > Flashcards

Autonomic Nervous System Flashcards

1
Q

Major involuntary unconscious, automatic portion of the nervous system.

A

autonomic nervous system

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2
Q

(3) Major divisions

A
  1. Sympathetic ANS
  2. Parasympathetic ANS
  3. Enteric nervous system
    - Consists of myenteric plexus (of Auerbach) &submucous plexus (of Meissner
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3
Q

Spinal Roots of Origin

Sympathetic:

Parasympathetic:

A

Sympathetic: Thoracic (T1-T12) and Lumbar (L1-L5) segments of the spinal cord

Parasympathetic: CN III, VII, IX, X, and sacral segments of the spinal cord.

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4
Q

Location of Ganglia

Sympathetic:

Parasympathetic:

A

Sympathetic:
Paravertebral chains that lie
along the spinal column,
some along the anterior
aspect of the abdominal
aorta

Parasympathetic:
Most are located in the
organs innervated, more
distant from the spinal cord

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5
Q

Preganglionic Fibers

Sympathetic:

Parasympathetic:

A

Sympathetic: Short

Parasympathetic: Long

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6
Q

Postganglionic Fibers

Sympathetic:

Parasympathetic:

A

Sympathetic: Long

Parasympathetic: Short

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7
Q

Organ: Pupils

Sympathetic:

Parasympathetic:

A

Sympathetic: Mydriasis (a1)

Parasympathetic: Miosis (M3)

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8
Q

Organ: Heart Rate

Sympathetic:

Parasympathetic:

A

Sympathetic: Tachycardia (B1)

Parasympathetic: Bradycardia (M2)

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9
Q

Organ: Blood Vessles
A. Skin, splanchnic

Sympathetic:

Parasympathetic:

A

Sympathetic: Constriction (α1)

Parasympathetic: NO EFFECT

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10
Q

Organ: Blood Vessles
B. Skeletal

Sympathetic:

Parasympathetic:

A

Sympathetic: Dilation (B2, M3)

Parasympathetic: NO EFFECT

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11
Q

Organ: Bronchi

Sympathetic:

Parasympathetic:

A

Sympathetic: Dilation (B2)

Parasympathetic: ConSTRICTion (M3)

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12
Q

Organ: GIT walls

Sympathetic:

Parasympathetic:

A

Sympathetic: Relaxation (a2, B2)

Parasympathetic: ConTRACTion (M3)

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13
Q

Organ: GIT sphincters

Sympathetic:

Parasympathetic:

A

Sympathetic: Contraction (a1)

Parasympathetic: Relaxation (M3)

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14
Q

Organ: GIT secretion

Sympathetic:

Parasympathetic:

A

Sympathetic: NO EFFECT

Parasympathetic: Increased (M1, M3)

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15
Q

Organ: Bladder Wall

Sympathetic:

Parasympathetic:

A

Sympathetic: Relaxation (B2)

Parasympathetic: Contraction (M3)

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16
Q

Organ: Bladder Sphincter

Sympathetic:

Parasympathetic:

A

Sympathetic: Contraction (a1)

Parasympathetic: Relaxation (M3)

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17
Q

Organ: Uterus

Sympathetic:

Parasympathetic:

A

Sympathetic: Contraction (a1) Relaxation (B2)

Parasympathetic: Contraction (M3)

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18
Q

Organ: Penis

Sympathetic:

Parasympathetic:

A

Sympathetic: Ejaculation (a)

Parasympathetic: Erection (M)

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19
Q

Sympathetic Nerovus system in adrenergic system are composed of (2) Neurotransmitters hormones:

A
  1. Norepinephrine
  2. Epinephrine
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20
Q
  • Primary transmitter at the sympathetic postganglionic neuron-effector cell synapses in most tissues.

-Exceptions: Eccrine sweat glands and Vasodilator in the sympathetic fibers of skeletal muscles

A

Noripinephrine

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21
Q
  • For severe anaphylactic reactions
  • Bronchodilator effects
A

Epinephrine

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22
Q

What adrenergic pharmacology drug is this pertaining to?

Mode of Action
1. Direct activation of adrenoceptors
★ Adrenoreceptors: Norepinephrine

  1. Indirect activation by increasing concentration of available catecholamines in the synapse
    ★ Catecholamines: Amphetamine, Dobutamine, Isoproterenol
    ● Release of stored catecholamines
    ● Inhibition of reuptake
A

Sympathomimetics

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23
Q

Review of Classification of Adrenergic Pharmacology:

  1. Non - Selective Alpha Agonist
    ○ Non-selective means (?)
  2. Alpha 1 - (?)
  3. Alpha 2 - (?)
  4. Non - (?)
  5. Beta 1 - (?)
  6. Beta 2 - (?)
A
  1. Non - Selective Alpha Agonist
    ○ Non-selective means the drug acts on both alpha-1 and alpha-2 receptors; it is non-specific..
  2. Alpha 1 - Selective
  3. Alpha 2 - Selective
  4. Non - Selective Beta Agonist
  5. Beta 1 - Selective (HEART FUNCTION)
  6. Beta 2 - Selective (LUNG FUNCTION)
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24
Q

Sympathomimetics

(ALPHA-1 ADRENERGIC EFFECTS)

TISSUE: Most Vascular Smooth Muscle

Action: (?)

A

TISSUE: Most Vascular Smooth Muscle

Action: Contracts (increase vascular resistance)

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25
Q

Sympathomimetics

(ALPHA-1 ADRENERGIC EFFECTS)

TISSUE: Pupillary Dilator Muscle

Action: (?)

A

TISSUE: Pupillary Dilator Muscle

Action: Contracts (Mydriasis)

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26
Q

Sympathomimetics

(ALPHA-1 ADRENERGIC EFFECTS)

TISSUE: Pilomotor smooth muscle

Action: (?)

A

TISSUE: Pilomotor smooth muscle

Action: Contracts (Erects hair)

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27
Q

Sympathomimetics

(ALPHA-1 ADRENERGIC EFFECTS)

TISSUE: Liver

Action: (?)

A

TISSUE: Liver

Action: Stimlates glycogenesis

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28
Q

Sympathomimetics

(ALPHA-2 ADRENERGIC EFFECTS)

TISSUE: Adrenergic and cholinergic nerve terminals

Action: (?)

A

TISSUE: Adrenergic and cholinergic nerve terminals

Action: Inhibits transmitter release

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29
Q

Sympathomimetics

(ALPHA-2 ADRENERGIC EFFECTS)

TISSUE: Platelets

Action: (?)

A

TISSUE: Platelets

Action: Stimulates aggregation

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30
Q

Sympathomimetics

(ALPHA-2 ADRENERGIC EFFECTS)

TISSUE: Some vascular smooth muscle

Action: (?)

A

TISSUE: Some vascular smooth muscle

Action: Contracts

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31
Q

Sympathomimetics

(ALPHA-2 ADRENERGIC EFFECTS)

TISSUE: Fat cells

Action: (?)

A

TISSUE: Fat cells

Action: Inhibits lpolysis

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32
Q

Sympathomimetics

(ALPHA-2 ADRENERGIC EFFECTS)

TISSUE: Pancreatic B cells

Action: (?)

A

TISSUE: Pancreatic B cells

Action: Inhibits Insulin release

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33
Q

Sympathomimetics

(BETA-1 Adrenergic Effects)

TISSUE: Heart

Action: (?)

A

TISSUE: Heart

Action: Stimulates rate and force

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34
Q

Sympathomimetics

(BETA-1 Adrenergic Effects)

TISSUE: Juxtaglomerular cells of kidney

Action: (?)

A

TISSUE: Juxtaglomerular cells of kidney

Action: stimulates renin release

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35
Q

Sympathomimetics

(BETA-2 Adrenergic Effects)

TISSUE: Airway, uterine, and vascular smooth muscle

Action: (?)

A

TISSUE: Airway, uterine, and vascular smooth muscle

Action: Relaxes

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36
Q

Sympathomimetics

(BETA-2 Adrenergic Effects)

TISSUE: Liver

Action: (?)

A

TISSUE: Liver

Action: Stimulate glycogenolysis

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37
Q

Sympathomimetics

(BETA-2 Adrenergic Effects)

TISSUE: Pancreatic (B) cells

Action: (?)

A

TISSUE: Pancreatic (B) cells

Action: Stimulates insulin release

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38
Q

Sympathomimetics

(BETA-2 Adrenergic Effects)

TISSUE: Somatic motor neuron terminals (voluntary
muscle)

Action: (?)

A

TISSUE: Somatic motor neuron terminals (voluntary
muscle)

Action: Causes tremor

39
Q

Sympathomimetics

(BETA-2 Adrenergic Effects)

TISSUE: Heart

Action: (?)

A

TISSUE: Heart

Action: Stimulates rate and force

40
Q

What are the (5) Sympathomimetic Drugs

A
  1. Methyldopa
  2. Clonidine
  3. Epinephrine
  4. Dopamine
  5. Albuterol/Salbutamol
41
Q

What symphatomimetic name of drug is this?

Classification:
- Sympathomimetic (alpha 2 selective)

MOA:
1. Activates alpha-2
adrenergic receptors
2. Alpha-2: decreases central
sympathetic outflow

Indication:
1. Preeclampisa
2. Gestational Hypertension

SE:
1. Sedation
2. Hemolytic ASnemia

A

METHYLDOPA

42
Q

What symphatomimetic name of drug is this?

Classification:
- Sympathomimetic (alpha 2 selective)

MOA:
1. Activates alpha-2
adrenergic receptors
2. Alpha-2: decreases central
sympathetic outflow

Indication:
1. Hypertension
★ Only given if BP
>160 (only for HTN
crisis)
2. Cancer Pain
3. Opioid withdrawal
4. Decreases the blood
pressure of the px

SE:
1. Sedation
2. Dry mouth
3. Rebound Hypertension

NURSING CONSIDERATIONS!!
1. Taper use prior to
discontinuation to
avoid
rebound HTN
2. To treat rebound
HTN,
administer
PHENTOALAMINE!!!

A

CLONIDINE

43
Q

What symphatomimetic name of drug is this?

Classification:
- Sympathomimetic (non-selective, direct-acting)

MOA:
- Activates alpha and beta
adrenergic receptors

  1. Alpha-1:
    vasoconstriction,
    increases BP
  2. Beta-1: increased
    heart rate,
    conduction, and
    contractility
  3. Beta-2:
    bronchodilation

Indication:
1. Cardiac arrest,
2. anaphylaxis (drug of choice),
3. Asthma
4. COPD,
5. hemostasis

SE:
1. Hypertension,
2. Tachycardia
3. Ischemia
4. Hyperglycemia

A

EPINEPHRINE

44
Q

What symphatomimetic name of drug is this?

Classification
1. Somatic motor
neuron terminals
(voluntary muscle)

MOA:
- Activates a,b, and D1 adrenergic receptors
1. α1: vasoconstriction, increases BP
2. β1: increased heart rate, conduction, and contractility
3. D1: vasodilation in splanchnic and renal vessels

USES:
1. Cardiogenic shock
2. heart failure

SE:
1. Cardiovascular Disturbance
2. Arrhythmias

A

DOPAMINE

45
Q

What symphatomimetic name of drug is this?

Classification
1. Sympathomimetic
(beta 2 - selective)

MOA:
Activates beta 2 - receptors in bronchial smooth muscle causing bronchodilationselective.

Indication:
1. Acute asthmatic attacks
(drugs of choice),
2. Tocolysis for preterm
labor (terbutaline and
ritodrine)

SE:
1. Tachycardia
2. Tremors
3. Nervousness
4. Restlessness
5. Arrhythmias when used execessively
5. Loss of responsiveness (tolerance)

Nursing Considerations:
1. May precipitate arrhytmias in patient with concurrent COPD and Heart Disease

A

ALBUTEROL/SALBUTAMOL

46
Q

(4) nursing responisbilites for sympathomimetic drugs

A
  1. Monitor VS and UO
  2. Contraindicated in pt with:
    ○ Cardiac dysrhythmias
    ○ Narrow angle glaucoma
    ○ Cardiogenic shock
  3. Report S/E:
    ○Tachycardia
    ○Palpitations
    ○Tremors,
    ○ Dizziness
    ○ HPN
  4. Continuous nasal spray can cause nasal congestion rebound
47
Q

A PNS receptors and Blocks SNS

A

Adrenoceptros Blockers

48
Q

Adrenoceptors Blockers are divided into (2) types

A

Alpha and Beta Blockers

49
Q

Alpha Blockers SUMMARY Fill in the blanks

  • Non-selective
  • Irreversible (_____________)
  • Reversible (____________)
  • Alpha 1-selective (_______)
  • Alpha 2-selective (_________)
A
  • Non-selective
  • Irreversible (phenoxybenzamine)
  • Reversible (phentolamine)
  • Alpha 1-selective (prazosin)
  • Alpha 2-selective (yohimbine)
50
Q

Beta Blockers Fill in the blanks

  • Non-selective (___________)
  • Beta 1-selective (__________)
  • Beta 2-selective (__________)
A
  • Non-selective (propanolol)
  • Beta 1-selective (atenolol)
  • Beta 2-selective (butoxamine)
51
Q

Adrenoceptors have (5) Types of Receptors:

A
  1. (A1) Alpha1
  2. (A2) Alpha2
  3. (B1) Beta1
  4. (B2)Beta2
  5. (B2)Beta2
52
Q

ADRENOCEPTORS

RECEPTOR NAME:
_____________

Location: Postsynaptic effector cells, especially smooth muscle

A

(A1) Alpha1

53
Q

ADRENOCEPTORS

RECEPTOR NAME:
_____________

Location: Presynaptic adrenergic nerve terminals, platelets, lipocytes, smooth muscle

A

(A2) Alpha2

54
Q

ADRENOCEPTORS

RECEPTOR NAME:
_____________

Location: Postsynaptic effector cells, especially heart, lipocytes, brain; presynaptic adrenergic and
cholinergic nerve terminals, juxtaglomerular apparatus or renal tubules, ciliary body epithelium

A

(B1) Beta1

55
Q

ADRENOCEPTORS

RECEPTOR NAME:
_____________

Location: Postsynaptic effector cells, especially smooth muscle and cardiac muscle

A

(B2) Beta2

56
Q

ADRENOCEPTORS

RECEPTOR NAME:
_____________

Location: Postsynaptic effector cells, especially lipocytes; heart

A

(B3) Beta3

57
Q

(3) Drugs for Alpha Blockers

A
  1. Phenoxybenzamine
  2. Phentoalamine, Tolazoline
  3. Prozasin
58
Q

(2) Drugs of Beta Blockers

A
  1. Propranolol
  2. Atenolol
59
Q

ALPHA BLOCKERS

What Alpha Blocker drug is this?

Classification: Adrenergic
antagonist (alpha
non - selective)

MOA: Irreversibly blocks alpha adrenergic receptors (α1>α2)

USES: Pheochromocytoma (pre-surgical)
● Client with small
tumor in adrenal
medulla
● Unable to urinate
● Phenoxybenzamine
inhibits the
response which
helps the client to
be able to urinate

SE:
1. Orthostatic hypotension, 2. Reflex tachycardia,
3. gastrointestinal irritation, 4. myocardial ischemia

Nursing Considerations:
- FORMS COVALENT BOND with a RECEPTORS (Effects Last for Several Days)

A

PHENOXYBENZAMINE

60
Q

ALPHA BLOCKERS

What Alpha Blocker drug is this?

Classification: Adrenergic
antagonist (alpha
non - selective)

MOA:
Reversibly blocks alpha adrenergic receptors (a1>a2)

Indication:
1. Pheochromocytoma (pre-surgical)
2. antidote to α1 agonist
3. overdose
4. rebound hypertension

SE:
1. Orthostatic hypotension
2. Reflex Tachycardia
3. Gastrointestinal Irritation

A

Phentoalamine, Tolazoline

61
Q

ALPHA BLOCKERS

What Alpha Blocker drug is this?

Classification: Adrenergic
antagonist (alpha 1
- selective)

MOA:
Selectively blocks alpha-1
adrenergic receptors

Indication:
1. Benign Prostatic Hyperplasia
2. Hypertension

SE:
1. First Dose Orthostatic Hypotension
2. Reflex Tachycardia (less common and less severe compared to non selective types)

A

PRAZOSIN

62
Q

BETA BLOCKERS

What beta blocker drug is this?

Classification: Adrenergic antagonist
(beta non - selective)

MOA: Blocks β1 and β2
receptors. Blocks
sympathetic effects
on heart and BP.
Reduce renin
release )

INDICATION:
●Angina prophylaxis
● Hypertension
● Arrhythmias
● Migraine
● Performance
anxiety
● Hyperthyroidism

S/E:
● Bronchospasm
● AV block
● Heart failure
● CNS sedation
● Erectile
dysfunction

NURSING CONSIDERATIONS:
- May mask symptoms of hypoglycemia in diabetes

  • Carvedilol and
    labetalol has
    combined alpha
    and beta blockade
A

PROPRANOLOL

63
Q

BETA BLOCKERS

What beta blocker drug is this?

Classifications: Adrenergic antagonist (beta 1 - selective)

MOA: Selectively blocks β1
receptors. Blocks
sympathetic effects
on heart and BP

INDICATION:
● Angina
● Hypertension
● Heart failure

SE:
● Bronchospasm
(less common)
● AV block
● Heart failure
● CNS sedation,
erectile
dysfunction

A

ATENOLOL

64
Q

(5) Nursing Intervention for Adrenoceptors Blockers:

A
  1. Monitor VS (esp BP and HR)
  2. Report any complaint of stuffy nose
  3. For clients with DM, have glucagon available and follow adjustment of insulin dose as ordered
  4. Not to stop abruptly the medication
  5. Slowly rise from supine or sitting to standing position
65
Q

Parasympathetic Nerovus system in Cholinergic are composed of (1) Neurotransmitters hormones:

A

ACETYLCHOLINE

66
Q
  • Primary transmitter in all autonomic ganglia and at the synapses between parasympathetic postganglionic
    neurons and their effector cells
  • Primary transmitter at the somatic (voluntary) skeletal muscle neuromuscular junction
A

ACETYLCHOLINE

67
Q

CHOLINERGIC DRUG EFFECTS (2)

A
  1. Not very useful for systemic therapy because their effects are not sufficiently selective
    ○ Parasympathetic and sympathetic ganglia and somatic neuromuscular junctions all may be blocked
  2. Botulinum toxin is a very large molecule and diffuses very slowly
    ○ Injection for relatively selective local effects
68
Q

CHOLINORECEPTORS

RECEPTOR NAME:
M1

LOCATION:

A

RECEPTOR NAME:
M1

LOCATION:
NERVE ENDINGS

69
Q

CHOLINORECEPTORS

RECEPTOR NAME:
M2

LOCATION:

A

RECEPTOR NAME:
M2

LOCATION: Heart, some nerve endings

70
Q

CHOLINORECEPTORS

RECEPTOR NAME:
M3

LOCATION:

A

RECEPTOR NAME:
M3

LOCATION: Effector cells, smooth muscle glands, endothelium

71
Q

CHOLINORECEPTORS

RECEPTOR NAME:
NN

LOCATION:

A

RECEPTOR NAME:
NN

LOCATION:
ANS ganglia

72
Q

CHOLINORECEPTORS

RECEPTOR NAME:
NM

LOCATION:

A

RECEPTOR NAME:
NM

LOCATION:
Neuromuscular end plate

73
Q

Choloceptor-activating and Cholinesterase inhibiting Drugs

Cholinomimetic (Cholinergic) Drugs are composed of

Direct Acting
(MCAN?)

Indirect Acting
(ECO?)

A
  1. Direct-acting
    - Muscarinic
    >Choline esters
    >Alkaloids
  • Nicotinic
  1. Indirect-acting
    - Edrophonium (Short-acting)
  • Carbamates (Intermediate
    to long-acting)
  • Organophosphates (Very long acting)
74
Q

(3) Direct Acting Cholinomimetic Drugs

A
  1. Bethanechol (similar to carbachol)
  2. Pilocarpine
  3. Nicotine
75
Q

What type of Direct Acting Cholinomimetic Drug is this?

Classification:
- Cholinomimetic
(direct - acting,
muscarinic)

MOA:
Activates muscarinic (M1-M3) receptors. Act on M
receptors only
(a1>a2)

Indication:
Bladder and
Bowel atony (post
- surgery or spinal
cord injury)

SE:
1. Cyclospasm
2. Diarrhea
3. Urinary urgency
4. Vasodilation
5. Reflex
tachycardia
6. Sweating

A

BETHANECHOL

76
Q

What type of Direct Acting Cholinomimetic Drug is this?

Classification:
- Cholinomimetic
(direct - acting,
muscarinic)

MOA:
Activates M3 receptors in ciliary muscle (increasing aqueous humor outflow) and salivary glands (increasing salivation)

Indication:
1. Glaucoma
2. Sjögren syndrome
A. Xerostomia (Dry
Mouth),

B. Xerophthalmia
(Dry Eyes),
Rheumatoid
Arthritis

SE:
1. Miosis
2. Blurring of vision (due to cyclospasm)

A

PILOCARPINE

77
Q

What type of Direct Acting Cholinomimetic Drug is this?

Classification:
- Cholinometic (direct - acting, nicotinic)

MOA:
- Activates nicotinicach receptors (Nn and Nm)

Indication:
- Smoking cessation

SE:
- Generalized ganglionic
stimulation (hypertension,
tachycardia, nausea, vomiting, diarrhea)

  • Overdose leads
    to convulsion,
    paralysis, and
    coma
A

NICOTINE

78
Q

Direct Acting Cholinomimetic leads to (2) Toxicity

A
  1. Muscarinic Toxicity
  2. Nicotinic Toxicity
79
Q

About Nicotinic Toxicity

A
  1. Ganglionic stimulation
  2. Blockade of neuromuscular end plate
    depolarization
    ○ Leading to fasciculations and paralysis
  3. CNS Toxicity: stimulation (convulsion) followed
    by CNS depression
79
Q

About Muscarinic Toxicity

A
  1. CNS stimulation
  2. Eye: Miosis, spasm of accommodation
  3. Lungs: Bronchoconstriction
  4. GIT/GUT: Excessive gastrointestinal and
    genitourinary smooth muscle activity
  5. Increased secretory activity (sweat glands,
    airway, gastrointestinal tract, lacrimal glands)
  6. Vasodilation
80
Q
  • Binds to cholinesterase and undergo prompt hydrolysis.
  • No significant actions at uninnervated sites where Ach is not normally released
A

INDIRECT ACTING CHOLINOMIMETICS

81
Q

(3) Indirect Acting Cholinomimetic Drugs

A
  1. Edrophonium
  2. Neostigmine
  3. Atropine
82
Q

What drug is this under the indirect acting cholinomimetic?

Classification:
Cholinomimetic
(indirect - acting,
muscarinic) VERY SHORT ACTING UPON IV ADMINISTRATION

Mode of Action:
Inhibits acetylcholinesterase,
amplifies endogenously
released acetylcholine

Indication:
Myasthenia gravis
(diagnosis -
Tensilon test),
differentiation of
cholinergic crisis and
myasthenic crisis

SE:
1. Miosis
2. Salivation
3. Nausea
4. Vomiting
5. Diarrhea
6. Bradycardia

A

EDROPHONIUM

83
Q

What drug is this under the indirect acting cholinomimetic?

Classification:
Cholinomimetic (Inidrect - acting)

MOA: inhibits
acetylcholinesterase,
amplifies
endogenously
released acetylcholine

Indication:
1. Myasthenia gravis
(treatment),
2. Reversal of
nondepolarizing
neuromuscular
blockade
3. Glaucoma
(Physostigmine,
echothiophate,
demecarium)

SE:
1. Miosis
2. Salivation
3. Nausea
4. Vomiting
5. Diarrhea
6. Bradycardia

Muscarinic effects are blocked by atropine

A

NEOSTIGMINE

84
Q

What drug is this under the indirect acting cholinomimetic?

Classification:
Prototype
nonselective
muscarinic
blocker

MOA:
1. Found in Atropa
belladonna
2. Tertiary amine
that readily
crosses
membrane
barriers
3. Cholinergic
antagonist
(muscarinic)
4. Competitively
blocks all muscarinic receptors

Indication:
1. Mydriatic
2. Cycloplegic
3. Antidote for
organophosphate
poisoning (first
choice)
4. Bradycardia
5. Hypersalivation

SE:
1. Tachycardia
2. Mydriasis
3. Cycloplegia
4. Skin flushing
5. Delirium
6. Hallucinations

A

ATROPINE

85
Q

Autoimmune destruction of nicotinic Ach receptors characterized by:

  1. Fluctuating muscle weakness
  2. Ocular symptoms
  3. Bulbar symptoms
  4. Proximal muscle weakness
A

MYASTHENIA GRAVIS

86
Q

Acute worsening of symptoms due to infection,
stress or under medication

A

MYASTHENIC CRISIS

87
Q

Excessive activation of cholinoreceptors (skeletal
muscle weakness and parasympathetic signs) due to overmedication

A

CHOLINERGIC CRISIS

88
Q

How does edrophonium differentiate myasthenic crisis from cholinergic crisis?

A
  1. improves muscle strength in myasthenic crisis
  2. weakens muscle strength in cholinergic crisis
89
Q

● Malathion and Parathion: Insecticide
● Sarin, Tabun, Soman: Nerve gasses
● Signs and symptoms: (DUMBBELSS)
○ Diarrhea
○ Urination
○ Miosis
○ Bronchospasm
○ Bradycardia
○ Excitation
○ Lacrimation
○ Sweating
○ Salivation
● Antidote: Pralidoxime (ASAP, Not >36 Hours)

  1. Nursing Consideration/s:

● WOF for bronchospasms, wheezing, bradycardia
● Rise slowly from supine or sitting position to avoid
dizziness or fall
● Monitor VS

A

ORGANOPHOSPHATE POISOINING

90
Q

● Side effects:
1. Atropine fever (Hyperthermia)
2. Atropine flush (cutaneous vasodilation)
3. Decreased secretions (saliva, sweat,
bronchiolar)
4. Tachycardia
5. Arrhythmias (Intraventricular conduction blocks)
6. Constipation
7. Blurred vision
8. CNS toxicity

A

Atropine Toxicity

91
Q

Atropine Toxicity

MNEMONIC

A
  1. Hot as a hare (Increased Temp)
  2. Dry as a bone (Thirsty, decreased secretions)
  3. Red as a beet (Flushed Face)
  4. Blind as a bat (Blurred Vision)
  5. Mad as a hatter (Confusion, delirium)
92
Q

Atropine toxicity

Nursing Considerations

A
  1. WOF for Confusion, Depression, Hallucination,
    Palpitation
    Nursing Consideration/s:
    2.Assess for bladder distention
  2. Provide adequate fluid intake
  3. Provide comfort and safety
93
Q

(3) Contraindications to Muscarinic Blockers

A
  1. Cautious use in infants
    - Hyperthermia due to decreased swelling
  2. Acute angle closure glaucoma
  3. Benign Prostatic Hyperplasia

PHARMACOLOGY (6 decks)

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