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Pharmacology > Autonomic Nervous System Agents (ch 18-19) > Flashcards

Autonomic Nervous System Agents (ch 18-19) Flashcards

1
Q

Autonomic Nervous System

A

“Automatic” or Involuntary

Include Afferent and Efferent neurons

Efferent pathways are divided into Sympathetic and Parasympathetic NS

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2
Q

Peripheral Nervous System

A

Located outside the CNS

Divided into Automatic and Somatic NS

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3
Q

Sympathetic NS neurotransmitter

A

Norepinephrine

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4
Q

Parasympathetic NS neurotransmitter

A

Acetylcholine

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5
Q

Sympathetic Nervous System

A

“Fight or Flight”

Activated by conditions of stress

Increases HR, BP, CO; dilate brochi, dilates pupils (mydriasis)

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6
Q

Parasympathetic Nervous System

A

“Rest and Digest”

Promotes digestive processes

Decrease HR, BP; constrict bronchi, contricts pupils (miosis)

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7
Q

Function of Alpha and Beta Adrenergics

A

“Fight or Flight”

dilates pupils and bronchioles

increses HR

contricts peripheral blood vessels

relaxes bladder.

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8
Q

Alpha1 and Alpha2

A

Alpha1: bloodvessels (constrict)

Alpha2: bloodvessels (dilate), smooth muscle

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9
Q

Beta1 and Beta2

A

Beta1: heart

Beta2: lungs

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10
Q

Inactivation of Neurotransmitters

A
  • Reuptake of the transmitter back into the neuron
  • Enzymatic transformation or degradation
  • Diffusion away from the transmitter
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11
Q

Direct-acting Sympathomimetics

A

Epinephrine

Directly stimulates

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12
Q

Indirect-acting Sympathomimetics

A

Amphetamine

Stimulate through and indirect way

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13
Q

Mixed-acting Sympathomimetics

A

Ephedrine

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14
Q

Epinephrine

A

Nonselective (Acts on more than one receptor): Alpha1, Beta1, Beta2

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15
Q

Epinephrine: Pharmacodynamics

A
  • Treats anaphylaxis
  • Increases CO, HR, and systolic BP
  • Promotes vasoconstriction
  • Bronchodilation
  • Renal vasoconstriction (decresing UO)
  • Onset of action and peak concentration are rapid
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16
Q

Epinephrine: Pharmacokinetics

A
  • ROA: Subcut, IV, topically, inhalation, intracardiac, instillation
  • Is rapidly metabolized by the GI tract and liver so it should not be given PO
  • Half-life and protein binding is unknown
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17
Q

Epinephrine: Contraindications and Cautions

A
  • Cardiac disrythmias
  • Glaucoma (aqueous humor), BPH
  • Hypertension
  • Hyperthyroidism
  • Pregnancy
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18
Q

Norepinephrine

A
  • Alpha1, Beta1
  • Used for shock, potent vasoconstrictor
  • Given IV as infusion, titrated (seen in ICU)
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19
Q

Dopamine

A
  • Alpha1, Beta1, Dopaminergic
  • Used to treat hypotension/shock
  • Increases renal perfusion (low dose)
  • Increases BP (higher dose)
  • IV infusion
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20
Q

Albuterol

A
  • Selective: Beta2
  • Used to treat bronchospasm, asthma, bronchitis, COPD
  • Oral, inhaler, nebulizer
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21
Q

Doputamine

A
  • Selective: Beta1
  • Used to treat cardiac decompensation by enhancing myocardial contractility, SV, CO; used to treat CHF
  • IV with dose titrated to achieve effect
22
Q

Terbutaline Sulfate

A
  • Selective: Beta2
  • Used to treat bronchospasm or premature labor
  • PO, SC, or IV
23
Q

Pseudoephedrine

A
  • Alpha1, Beta1
24
Q

Alpha1 Receptor Blocker Effects

A
  • Vasodilation, decrease in BP, miosis, reduction in contraction of smooth muscles in bladder neck and prostate gland
  • Used for hypertension and BPH
  • Side Effects: Cardiac disrythmias, flushing, hypotension, reflex tachycardia
25
Q

List the Alpha1 Receptor Blockers

A

-osin

Prazosin: (Minipress) hypertension, angina, CHF, BPH, vasospasms associated with Raynaud’s

Doxazosin: (Cardura) hypertension, BPH

Tamsulosin: (Flomax) BPH

Terazosin: (Hytrin) BPH

*Phentolomine: (Regitine) used to block the effects of infiltrated alpha agonists like dopamine or dobutamine

26
Q

Nonselective Beta-Adrenergic Blockers

A

-olols

Used to treat hypertension, angina, dysrythmias

Propranolol: (Inderal)

Contraindications: Allergy, bradycardia, heart block, shock, CHF, bronchspasm, COPD, asthma, pregnancy, lactation, diabetic/hypoglycemic, thyrotoxicosis, hepatic dysfunction…

Side Effects/Adverse Reactions: bradycardia, laryngospasm, dysrythmias, hypotension, headaches, hyperglycemia/ hypoglycemia, agranulocytosis, impotence, decreased labido…

Drug Interactions: almost everything!

27
Q

-olol

A

Beta-Adrenergic Blockers

28
Q

-osin

A

Alpha1 receptor blockers

29
Q

Alpha-beta Adrenergic Blockers

A

Carvedilol (Coreg)

Labetalol

30
Q

Selective Beta Blockers

A

Used to treat hypertension and glaucoma

Metoprolol tartrate (Lopressor)*

Atenolol (Tenormin)

Betaxolol (Kerlone, Betoptic)

Nebivolol (Bystolic)

Contraindications, side effects, & adverse effects same as propranolol

*one of the top 15 drugs in 2009

31
Q

First Dose Hypotension

A

Given at night because of relaxed vascular system, they stand up and the blood falls to their feet.

32
Q

Are you able to suddenly discontinue any beta blocker?

A

No! Dose should be tapered off.

33
Q

Client Teaching for Beta-Blocker patients

A
  • Get out of bed slowly
  • Monitor Pulse (60-100)
  • Do not discontinue abruptly (up to 2 wks)
  • Take at the same time each day even if they feel “OK”
34
Q

Cholinergics/Parasympathomimetics

Neurotransmitter

A

Acetylcholine (Ach)

35
Q

Cholinergics/Parasympathomimetics

Receptors

A

Muscarinic receptors

Nicotine Receptors

36
Q

Cholinergics/Parasympathomimetics

Effects on body organs

A

Cholinergic nerve is Vagus Nerve

Increases Peristalisis

Contracts Bladder

37
Q

Direct-Acting Cholinergic Drugs

A

Metoclopramide HCl (Reglan): PO/IM/IV; GI stimulant, antiemetic

Pilocarpine HCl (Pilocar): opthalmic drops; reduce intraocular pressure

Bethanechol chloride (Urecholine): treats urinary retention, abdominal distension

*All are muscarinic*

38
Q

Indirect-Acting Cholinergic Drugs

Reversible

A

Myasthenia Gravis: must take meds on time

  • Ambenonium (Mytelase)
  • Endrophonium (Tensilon, Enlon)
  • Neostigmine (Prostigmine)
  • Pyridostigmine (Regonol, Mestinon)

Alzheimer’s Disease: prolong patient’s functionality

  • Donepezil (Aricept)
  • Galantamine (Razadyne)
  • Rivastigmine (Excelon)
  • Tacrine (Cognex)
39
Q

Indirect-Acting Cholinergic Drugs

Irreversible

A

Used therapeutically to produce pupillary constriction

Used in the manufacture of insecticides

Used as a WOMD

40
Q

Anticholinergics/Parasympatholytics

A

AKA: cholinergic blocking agents, cholinergic or muscarinic antagonists, antimuscularinic agents, antispasmodic agents

Used for management of bradycardia, to dry up secretion, and calm GI tract, to paralyze Parkinson’s Disease

41
Q

Anticholinergics/Parasympatholytics

Atropine

A
  • Decreases secretions in preop patients
  • Acts as antispasmodic to treat peptic ulcers (drys up secretions)
  • Increaes HR in bradycardia
  • Antidote for muscarinic agonist poisoning
  • Side & Adverse Effects: tachycardia, dry mouth, abdominal distension, palpations, nasal congestion, photophobia, blurred vision, flushing, urinary distention
42
Q

Anticholinergics/Parasympatholytics

Scopolamine

A

(Transderm Scop)

motion sickness

decrease secretions

obstetric amnesia

relief of urnary problems

IBS

43
Q

Anticholinergics/Parasympatholytics

Dicyclomine

A

(Antispas, Bentyl)

hyeperactive bowel

44
Q

Anticholinergics/Parasympatholytics

Hyoscyamine SO4

A

(Levsin)

peptic ulcers

IBS

45
Q

Anticholinergics/Parasympatholytics

Glycopyrrolate

A

(Robinul)

decrease secretions

antidote for neuromuscular blockers

46
Q

Anticholinergics/Parasympatholytics

Propantheline

A

(Pro-Banthers)

ulcers

antisecretory

antispasmodic

47
Q

Anticholinergics/Parasympatholytics

Cyclopentolate HCl

A

(Cyclogyl)

for mydriasis and cycloplegia for eye exams (dilation)

48
Q

Anticholnergics used for Tx of Parkinson’s Dz

A

Bentropine mesylate (Cogentin)

Biperiden lactate (Akineton)

Trihexphyenidyl HCl (Artane)

49
Q

Acetylcholinesterase

A

Breaks down Ach, increasing the amt of Ach in the body.

50
Q

Adverse Effects of Anticholinergics

A

Red as a beet

Dry as a bone

Mad as a hatter

Hot as a hare

Can’t see…Can’t pee

Can’t spit…Can’t shit!

Pharmacology (5 decks)

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