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Pharm Exam 2 > Autonomic Nervous System Agents > Flashcards

Autonomic Nervous System Agents Flashcards

1
Q

Organization of the Nervous System

A
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2
Q

Relationship between CNS and PNS

A
  • CNS interprets stimuli
  • PNS recieves the stimuli and initiates responses to these stimuli
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3
Q

PNS organization

A

Divided into:

  • Autonomic: involuntary
  • Somatic: voluntary
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4
Q

ANS Organization

A

Divided into:

  • Sympathetic
  • Parasympathetic
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5
Q

ANS is also known as….

A

visceral system

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6
Q

ANS acts on..

A

smooth muscles and glands

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7
Q

ANS functions

A

Controls and regulates:

  • heart
  • respiratory system
  • GI tract
  • bladder
  • eyes
  • glands
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8
Q

Sympathetic and Parasympathetic act on..

A

the same organs, but produce opposite responses to provide homeostasis/balance.

  • they either stimulate or depress
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9
Q

Fight or Flight

A

Sympathetic

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10
Q

Adrenergic system

A

Sympathetic

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11
Q

Neurotransmitter for Sympathetic

A
  • USED to be thought it was: adrenaline
  • However, it is: NOREPINEPHRINE
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12
Q

Adrenergic receptor organ cells

A
  • alpha1
  • alpha2
  • beta1
  • beta2
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13
Q

Rest and Digest

A

Parasympathetic

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14
Q

Cholinergic system

A

parasympathetic

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15
Q

neurotransmitter for parasympathetic

A

acetylcholine

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16
Q

Cholinergic receptor organ cells

A
  • nicotinic
  • muscarinic
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17
Q

Sympathetic effect on eyes

A

dilates pupils

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18
Q

Sympathetic effect on lungs

A

dilates bronchioles

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19
Q

Sympathetic effect on heart

A

↑ HR

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20
Q

Sympathetic effect on blood vessels

A

contricts blood vessels

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21
Q

Sympathetic effect on GI

A

relaxes smooth muscles of GI tract

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22
Q

Sympathetic effect on bladder

A

relaxes bladder muscle

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23
Q

Sympathetic effect on uterus

A

relaxes uterine muscle

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24
Q

Parasympathetic effect on eyes

A

constricts pupils

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25
Q

Parasympathetic effect on lungs

A

constricts bronchioles and ↑ secretions

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26
Q

Parasympathetic effect on heart

A

↓ HR

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27
Q

Parasympathetic effect on blood vessels

A

dilates blood vessels

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28
Q

Parasympathetic effect on GI

A

↑ peristalsis

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29
Q

Parasympathetic effect on bladder

A

constricts bladder

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30
Q

Parasympathetic effect on uterus

A

relaxes uterine muscle

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31
Q

Parasympathetic effect on salivary gland

A

↑ salivation

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32
Q

Categories of Sympathetic Agents

A
  • Adrenergic blockers
  • Adrenergic agonists
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33
Q

How do drugs stimulate the sympathetic nervous system

A

they mimic sympathetic neurotransmitters (norepinephrine and epinephrine)

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34
Q

What happens when Alpha1 is stimulated

A
  • ↑ force of heart contraction (↑ HR)
  • Vasoconstriction (↑ BP)
  • Mydriasis
  • ↓ salivation
  • bladder relaxes, sphincter contracts (↓ micturition)
35
Q

What happens when Alpha2 is stimulated

A
  • REVERSE sympathetic activity
  • inhibits release of norepinephrine
  • Dilates blood vessels
  • Produces hypotension
  • ↓ GI motility and tone
36
Q

What happens when Beta1 is stimulated

A
  • ↑ HR ( +chronotropic)
  • ↑ force of contraction (+ inotropic)
  • ↑ impulses ( + dromotropic)
  • ↑ renin production (increased BP)
37
Q

↑ renin secretion leads to…

A

↑ BP

38
Q

What happens when Beta2 is stimulated

A
  • Dilates bronchioles
  • Promotes GI relaxation
  • Uterine relaxation
  • ↑ glycogenolysis (↑ BG)
  • ↑ blood flow in skeletal muscles
39
Q

Alpha-adrenergic receptors are located

A
  • blood vessels
  • eye
  • bladder
  • prostate
40
Q

Epinephrine

  • Class/Category
  • Indications
  • Actions
  • Side effects/ADR
  • Contraindications
  • Use Caution
A
  • Adrenergic Agonist
  • indicated in cardiac arrest, anaphylaxis, and bronchospasm
  • actions: peripheral vasoconstriction which ↑ BP, cardiac stimulation which ↑ HR, inotrope, and electrical conduction
  • S/E and ADR: tremors, palpitations, tachycardia, dyspnea, ventricular fibrillation, pulmonary edema
  • contraindicated in hypersensitivity to adrenergic amines, bisulfites, or fluorocarbons
  • use caution: cardiac dz, HTN, hyperthroidism, diabetes, benefit > risk for OB
41
Q

Is Epinephrine selective or non-selective?

A

non-selective

(alpha1, alpha2, beta1, beta2)

42
Q

Albuterol Sulfate

  • Class/Category
  • Indications
  • Actions
  • Side Effects/ADR
  • Contraindication
  • Use Caution
A
  • Proventil
  • Adrenergic Agonist
  • Indicated for bronchodilation
  • action: bind to beta2 adrenergic receptors in airway causing smooth muscle relaxation
  • S/E and ADR: tachycardia, nervousness, tremors, restlessness, high doeses ay lead to beta1 and CNS stimulation, paradoxical bronchospasm
  • contraindicated in hypersensitivity to adrenergic amines
  • use caution: cardiac dz, HTN, hyperthroidism, diabetes, glaucoma
43
Q

General side effects for Adrenergic Agonists

A

CNS stimulation

  • nervousness, tremors, HA, palpitations, tachycardia, HTN, hyperglycemia, cardiac dysrhythmias
44
Q

General contraindications/cautions for Adrenergic Agonists

A

cardiac dysrhythmias, narrow angle glaucoma

45
Q

Adrenergic Blockers on alpha1

A
  • vasodilation
  • ↓ BP
  • reflex tachycardia
  • miosis
  • ↓ ejaculation
  • ↓ contraction of smooth muscles in bladder neck and prostate gland
46
Q

Adrenergic Blockers on beta1

A
  • ↓ HR
  • ↓ force of contraction
47
Q

Adrenergic blockers on beta2

A
  • constrict bronchioles
  • contract uterus
  • inhibits glycogenolysis which ↓ BS
48
Q

Doxazosin Mesylate

  • Class/Category
  • Indication
  • Action
  • Side effect and ADR
  • Contraindication
  • Caution
A
  • Adrenergic Blocker/Alpha Blocker
  • indicated in HTN, BPH
  • actions: vasodilation of peripheral arterioles and veins by blocking alpha1 receptors causing ↓ preload, ↓ afterload and ↓ BP
  • Side effects/ADR: orthostatic hypotension, reflex tachycardia, peripheral edema, nasal congestion
  • contraindicated in hypersensitivity
  • use caution in hepatic dysfunction and GI narrowing

*****ON BEERS LIST

49
Q

The “Sins”

A

S: Syncope; sexual dysfunction

I: ↑ drowsiness, orthostatic hypotension, HR

N: Need to be recumbent for 3-4 hrs after initial dose

50
Q

General indications for Beta Blockers

A

HTN, MI, angina pectoris, cardiac dysfunction

51
Q

General side effects for Beta Blockers

A

hypotension, bradycardia, dizziness, weakness, depression, ↓ libido, impotence

52
Q

General contraindications/cautions for Beta Blockers

A

CHF, asthma/COPD

53
Q

Selective Beta Blocker

A

(Beta1) —> ↓ HR & ↓ BP

Atenolol

54
Q

Non-selective Beta Blocker

A

(Beta1 and Beta2) —-> ↓ HR, ↓ BP, and bronchoconstriction

Sotalol

55
Q

The “LOL” team

A

refers to the beta blocker drugs. They all end in “lol”

  • The “LOL” team blocks HTN by “blocking” (↓) the contractiability in the heart, renin release from the kidneys, and the sympathetic output from the vasomotor center of the brain.
  • think of football (LOL) team “blocking”
56
Q

Bethanechol Chloride

A

Cholinergic

  • nonobstructive urinary retention
57
Q

Metoclopramide

A

Cholinergic

  • GERD
58
Q

Donepezil

A

Cholinergic

  • Alzheimer’s
59
Q

Pilocarpine HCL

A

Cholinergic

  • Open Angle Glaucoma
60
Q

General Cholinergic Side Effects and ADRs

A
  • hypotension
  • dizziness
  • bradycardia
  • bronchoconstriction
  • N/V/D
  • gastric pain
  • ↑ bronchial/salivary secretions
61
Q

General contraindications/cautions for Cholinergics

A
  • GU obstruction
  • GI ulcer/obstruction
  • Intestinal obstruction
  • Asthma
62
Q

Cholinergic antidote

A

Atropine Sulfate

63
Q

Where are cholinergics sometimes found?

A

insecticides

64
Q

Atropine Sulfate

A
  • **Antidote for cholinergics
  • Anticholinergic
  • preoperative agent to ↓ secretion
65
Q

Ipatropium bromide

A

Anticholinergic bronchodilator

66
Q

Benztropine

A

Antiparkinsonian-Anticholinergic

67
Q

General indications for Anticholinergics

A
  • GI hypermotility
  • Preop and preanesthesia to ↓ secretions
  • Opthalmic exam (mydriatic)
  • Bronchospasm
  • Emergency treatment of bradycardia
  • ↓ tremors and rigidity
68
Q

General Side effects and ADR of Anticholinergics

A
  • Dry mouth
  • Confusion
  • Blurred vision, drowsiness
  • Hypotension or HTN
  • Urinary retention
  • Constipation
  • Palpitations, tachycardia, nervousness
69
Q

How to remember Side effects of Anticholinergics

A
70
Q

General Contraindications/cautions for Anticholinergics

A
  • narrow angle glaucoma
  • obstructive GI, paralytic ileus
  • myasthenia gravis
  • BPH
  • antidepressants, phenothiazines, and antihistamines potentiate anticholinergic effects
71
Q
A
72
Q

Dopaminergic

A
  • Sympathetic
  • Located in the following arteries:
    • Renal
    • Mesenteric
    • Coronary
    • Cerebral
73
Q

What is caused by stimulation of dopaminergic

A

dilation and ↑ blood flow

74
Q

Dopaminergic receptors are activated by…

A

ONLY dopamine

75
Q

Method of classification for Sympathetic drugs

A
  • Pharmacologic - Adrenergic, Adrenergic blocker
    • Selective vs. Non-selective
  • Therapeutic - bronchodilators, vasopressors, etc…
76
Q

NON-Selective Adrenergic drugs

A
  • some medications stimulate or block more than one adrenergic receptor
  • ↑ side effects noted with nonselectivity
77
Q

Nursing Implications/Patient Education for Adrenergics

A
  • Report side effects
  • Give with food to avoid N/V
  • Cold and wt loss meds have adrenergic properties
  • Do not take if HTN, diabetes, coronary artery disease
  • Rebound congestion with continuous use of nasal spray
78
Q

Cholinergic Agonist Method of Classifications

A
  • Direct vs. Indirect
  • Reversible or Irreverside
79
Q

Direct acting cholinergic agonist

A

act on receptors to initiate a tissue response

80
Q

Indirect acting cholinergic agonist

A

block enzyme cholinesterase so that acetylcholine is left in place to work longer

81
Q

reversible cholinergic agonist

A

binds with enzymes for several minutes to hours

82
Q

irreversible cholinergic agonist

A

binds with enzymes permanantly

83
Q

Nursing Implications/ Patient Teaching for Cholinergics

A
  • Report side effects
  • Monitor VS, lung sounds
  • Rise from sitting/supine slowly
  • Assess for changes in muscle strength
84
Q

Nursing Implications / Patient Education

A
  • Risk for falls in elderly
  • ↑ fluid intake to prevent constipation
  • Monitor bowel sounds
  • Oral hygiene, ice chips, hard candy, sugarless gum for dry mouth
  • Void vefore taking medication. Monitor output

Pharm Exam 2 (2 decks)

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