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PHARMACOLOGY > Autonomic Nervous System drugs > Flashcards

Autonomic Nervous System drugs Flashcards

1
Q

What is Autonomic Nervous System?

A
  • The autonomic nervous system (ANS) is a component of the peripheral nervous system. It is a network of neurons that regulates the activity of numerous organs, including the stomach, heart, and lungs.
  • Involuntary motor control of organs and body functions.
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2
Q

The two subsystems of ANS:

A
  • Sympathetic nervous system (SNS)
  • Parasympathetic nervous system (PNS)
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3
Q

What is Sympathetic Nervous System?

A
  • Adrenergic
  • SNS neurons generally prepare the body to respond to something in its environment. Physiological responses to an immediate response.
  • Fight or flight response
  • Stress response of the body
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4
Q

What are Adrenergic Drugs?

A
  • Adrenergic drugs stimulate the nerves in your body’s sympathetic nervous system (SNS). This system helps regulate your body’s reaction to stress or emergency.
  • They do this either by mimicking the action of the chemical messengers epinephrine and norepinephrine or by stimulating their release.
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5
Q

Origin of the Sympathetic Nervous system

A
  • Thoracolumbar division
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6
Q

Sympathetic Nervous System: Pre-ganglionic Neurotransmitter

A
  • Shorter pre-ganglionic neurotransmitter
  • Acetylcholine (ACh)
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7
Q

Sympathetic Nervous System: Post-ganglionic/Terminal Neurotransmitter

A
  • Long pre-ganglionic neurotransmitter
  • Norepinephrine
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8
Q

Sympathetic Nervous System: Receptor organ cells

A
  • Alpha [1 & 2]
  • Beta [1 & 2]
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9
Q

What are the physical effects of Sympathetic Nervous System?

A

a) Dilates pupil
b) Dilates bronchioles
c) Increase heart rate
d) Constricts blood vessels
e) Relaxes smooth muscles of the G.I
f) Relaxes uterine muscle

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10
Q

What is Norepinephrine (N.E)?

A
  • Substance that is primarily released from the ends of sympathetic nerve fibers, also known as noradrenaline.
  • Classified structurally as a catecholamine
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11
Q

What is adrenergic agonist?

A
  • Stimulate the SNS
  • Sympathomimetic
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12
Q

What is Sympathomimetic Drugs?

A
  • Agents which in general mimic responses due to stimulation of sympathetic nerves. These agents are able to directly activate adrenergic receptors or to indirectly activate them by increasing norepinephrine and epinephrine (mediators of the sympathoadrenal system) levels.
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13
Q

Adrenergic Antagonist

A
  • Inhibit the SNS
  • Parasympatholytic
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14
Q

What is Parasympatholytic Drugs?

A
  • Inhibit the activity of the sympathetic nervous system which is mediated by epinephrine and norepinephrine

.

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15
Q

What is the therapeutic uses of the receptor: Alpha 1

A
  • Hypotension
  • Nasal congestion
  • Dilation of pupils
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16
Q

What is the therapeutic uses of the receptor: Alpha 2

A
  • Hypertension
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17
Q

What is the therapeutic uses of the receptor: Beta 1

A
  • Heart failure
  • Cardiac Arrest
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18
Q

What is the therapeutic uses of the receptor: Beta 2

A
  • Asthma
  • Premature labors of contractions
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19
Q

What is Parasympathetic Nervous System?

A
  • Cholinergic
  • It functions to conserves the body’s natural activity, and relaxes the individual once an emergency has passed. The parasympathetic nervous system leads to decreased arousal.
  • Rest and Digest Response
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20
Q

What are Cholinergic Drugs?

A
  • Cholinergic drugs stimulate the parasympathetic nervous system by copying the action of acetylcholine (ACh), a neurotransmitter released from nerve endings that bind on the receptors of cell membranes of organs, tissues, and glands.
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21
Q

What is the main neurotransmitter that cholinergic drugs mimic in the body?

A
  • Cholinergic drugs mimic the function of the neurotransmitter acetylcholine, which is the most critical neurotransmitter of the parasympathetic nervous system.
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22
Q

Origin of the Parasympathetic Nervous System?

A
  • Craniosacral division
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23
Q

Parasympathetic Nervous System: Pre-ganglionic Neurotransmitter

A
  • Longer pre-ganglionic neurotransmitter
  • Acetylcholine (ACh)
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24
Q

Parasympathetic Nervous System: Post-ganglionic/Terminal Neurotransmitter

A
  • Short post-ganglionic neurotransmitter
  • Acetylcholine (ACh)
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25
Q

What are the two types of cholinergic receptors?

A
  • Nicotinic [2]
  • Muscarinic [5]
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26
Q

What are Nicotinic receptors?

A
  • Nicotinic receptors are found in the central, sympathetic, and parasympathetic nervous systems and, when stimulated, trigger the rapid depolarization of cells.
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27
Q

What are Muscarinic receptors?

A
  • Muscarinic receptors are located in the smooth muscles and when stimulated, trigger contraction.
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28
Q

What is acetylcholinesterase?

A
  • An enzyme that inactivates acetylcholine before reaching organ cells [breaks down / digest acetylcholine]
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29
Q

What are the physical effects of Parasympathetic Nervous System?

A

a) Constrict pupils
b) Constrict bronchioles
c) Increase secretions of salivary enzymes (Increases salivation)
d) Decreases heart rate
e) Dilates blood vessels
f) Increases peristalsis

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30
Q

What are cholinergic agonist drugs?

A
  • Stimulates the PNS
  • Parasympathomimetic
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31
Q

What is the main functions of our nervous system?

A
  • Monitoring the external and internal environment of the body.
    (Afferent and Efferent neurons)
  • Process and integrate the environmental changes to determine the response.
  • Responded by using an actional response
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32
Q

What is afferent/sensory neurons?

A
  • Detect the changes inside of the body
  • Impulses going Outside to Inside
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33
Q

Involuntary Control

A
  • Dominated by Autonomic Nervous System
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34
Q

Voluntary Control

A
  • Dominated by Somatic Nervous System
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35
Q

What is the three major function of ANS?

A
  • Regulates heart rate
  • Regulation of secretory glands [working with endocrine system]
  • Regulation of smooth muscles
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36
Q

Alpha and beta adrenergic drugs will affect what system?

A

Sympathetic Nervous System

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37
Q

Anti-Cholinergic drugs will affect what system?

A

Parasympathetic drugs

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38
Q

What is the neuron that sends impulses to the CNS?

A

Afferent/Sensory Neuron

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39
Q

What are all these pre-ganglionic neurotransmitters?

A

Acetylcholine (ACh)

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40
Q

Where is epinephrine produced?

A

Adrenal Medulla

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41
Q

What is the biological process by which a neuron communicates with a target cell across a synapse?

A

Synaptic Transmission [from the neuron to effector organ]

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42
Q

What are the 5 processes involved in Synaptic transmission?

A
  • Synthesis of the neurotransmitters [Synthesized by neurons]
  • Storage of neurotransmitter inside the vesicles
  • Releasing neurotransmitter because of action potential [when there is a stimulus the vesicle will fuse results discharging contents in the synaptic gap]
  • Action at the receptor [neurotransmitter bind into the receptor]
  • Termination of the transmission
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43
Q

What are the two terminals involved in Synaptic transmission?

A

Pre-synaptic terminal
Post-synaptic terminal

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44
Q

Where is the origin of neurotransmitter in synaptic transmission?

A

Pre-synaptic nerve terminal

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45
Q

Which terminal receives neurotransmitter and this is where receptors are located?

A

Post-synaptic cell

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46
Q

What are the three termination ways in the synaptic transmission?

A

a) Disassociates from the receptor and reabsorbed back in the pre-synaptic nerve cells [REUPTAKE]

b) Enzymatic degradation

c) Diffusion away from the gap

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47
Q

What theory says that drugs act through receptors by binding through the receptors to initiate a response or prevent a response?

A

Receptor Theory [Lock and Key]

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48
Q

What are the drugs that blocks a response?

A

Antagonist

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49
Q

What are the drugs that fits the receptor sites?

A

Agonist

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50
Q

What do we call a drugs that degrades/blocks the effect of sympathetic nervous system?

A

Sympatholytic

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51
Q

What do we call a drugs that degrades/blocks the effect of parasympathetic nervous system?

A

Parasympatholytic

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52
Q

What is a Pharmacologic effect?

A

When autonomic drugs are given, the goal is not to treat an autonomic disorder, it is to correct disorders of target organs through autonomic nerves.

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53
Q

Beta receptors most commonly helps in what organs in the body?

A

Heart and Kidney

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54
Q

What is direct-acting sympathomimetic?

A

Directly affects your receptor organs

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55
Q

What is indirect-acting sympathomimetic?

A
  • Increase production of Norepinephrine
  • Kill enzymes that degrades the production of NE
  • Natural occurring NE will attached to the receptor sites
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56
Q

What is mixed-acting sympathomimetic?

A
  • Directly affects your receptor organs
  • Increase production of Norepinephrine
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57
Q

What kind of medication is given in an emergency?

A

Catecholamines

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58
Q

What do you call a drug that only affects one type of receptor?

A

Selective [Drug]

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59
Q

What do we call a drug that affects every receptor?

A

Non-Selective [Drug]
- Many side effects

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60
Q

What are the Alpha 1 receptor treatments?

A
  • Hypotension
  • Nasal congestion
  • Dilation of pupils
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61
Q

What are the Alpha 2 receptor treatments?

A
  • Hypertension
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62
Q

What are the Beta 1 receptor treatments?

A
  • Heart failure
  • Cardiac arrest
  • Shock
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63
Q

What are the Beta 2 receptor treatments?

A
  • Asthma
  • Premature labors of contractions
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64
Q

What receptors are affected by Epinephrine Medication?

A

A1, A2, B1, B2

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65
Q

What are the therapeutic uses of Epinephrine?

A
  • Asthma
  • Cardiac arrest
  • Anaphylactic shock
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66
Q

What receptors are affected by pseudoephedrine and phenylephrine medications?

A

A1 and B2

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67
Q

What are the therapeutic uses of pseudoephedrine and phenylephrine?

A

Nasal decongestant

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68
Q

What receptors are affected by Isoproterenol?

A

B1 and B2

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69
Q

What are the therapeutic uses of Isoproterenol?

A
  • Increase heart rate
  • Force of contraction and conduction
  • Shocks
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70
Q

What receptor is affected by Dobutamine?

A

B1

71
Q

What are the therapeutic uses of Dobutamine?

A
  • Increase heart rate
  • Force of contraction in heart failure
  • Shocks
72
Q

What receptor is affected by Albuterol?

A

B2

73
Q

What are the therapeutic uses of Albuterol?

A
  • Asthma/COPD
74
Q

Why catecholamines are only given through I.V [Parenteral route]?

A

Catechol rings can be dissolved by salivary enzymes/G.I enzymes.

75
Q

What is the therapeutic class of epinephrine?

A

Vasopressor/ Vasoconstriction

76
Q

What is the pharmacologic class of epinephrine?

A

Adrenergic Agonist

77
Q

What are the indications for epinephrine?

A

Anaphylaxis
Asthma
Cardiac stimulation
Indiction and maintenance of mydriasis during intraocular surgery.

78
Q

Tissue necrosis [Lack of blood flow in the tissues results in the death of body tissues] is a side effect of what kind of agents?

A

Adrenergic Agonists

[Check I.V sites frequently]

79
Q

What are the side effects of adrenergic agonists?

A
  • Effects on the sympathetic nervous system

a)Tachycardia
b) Palpitations
c) tremors
d) dizziness
e) Increased blood pressure
f) Urinary retention r/t high doses
g) Nausea and vomiting - offer food

80
Q

What is the antidote for adrenergic agonists side effects?

A

Phentolamine Mesylate (Regitine)
- for extravasation of Norepinephrine and Dopamine

81
Q

What are the assessment done for nursing process for patient taking Adrenergic Drugs?

A
  • V.S
  • Drug History
  • Health History for contraindications
  • Capillary Blood Glucose
82
Q

What are the possible diagnosis for patient taking Adrenergic drugs?

A
  • Disturbed sleep pattern [Palpitation]
  • Deficient Knowledge
83
Q

Why patient with glaucoma cannot take adrenergic drugs?

A
  • Increases intraocular pressure
84
Q

What monitoring will be done to a patient taking catecholamines?

A
  • ECG
  • BP
  • U/O Urinary output
  • F/e
85
Q

What are the drugs that blocks Alpha and Beta receptor blockers?

A

Adrenergic Blockers

86
Q

What are the mechanism of Adrenergic Blockers?

A
  • Direct blocking by occupying receptors
  • Indirect blocking by inhibiting release of neurotransmitters
87
Q

What are the possible causes of alpha blockers?

A
  • Relaxation of Smooth muscle
  • Vasodilation: Hypertension and PVD’s
  • Reduces contractions of smooth muscle in bladder and prostate
88
Q

What are the drugs that are included in alpha blockers?

A

Zosin Drugs

  • Terazosin
  • Doxazosin
  • Prazosin
89
Q

What are the things to watch out for when taking alpha blockers?

A
  • Dizziness
  • Orthostatic hypotension
  • Headache, nasal congestion
90
Q

What is orthostatic hypotension?

A

Something to do with the position [Supine to standing]

91
Q

What are the possible causes of beta blockers?

A
  • Decrease heart rate
  • Decreases blood pressure
  • Useful for treating mild to moderate hypertension, angina pectoris, and myocardial infarction
92
Q

What are the drugs that are included in beta blockers?

A

Olol Drugs

  • Atenolol
  • Propanolol
  • Pindolol
  • Timolol
  • Metoprolol
93
Q

What receptors are affected with phentolamine and phenoxybenzamine?

A

A1 and A2

94
Q

Therapeutic use of phentolamine and phenoxybenzamine?

A

For Hypertension

95
Q

What receptors are affected with prazosin and terazosin?

A

A1

96
Q

Therapeutic use of prazosin and terazosin?

A

For hypertension

97
Q

What receptors are affected with Tamsulosin and alfuzosin?

A

A1

98
Q

Therapeutic use of tamsulosin and alfuzosin?

A

BPH - urinary relief
Benign prostatic hyperplasia

99
Q

What receptors are affected with Propanolol (1st gen)

A

B1 and B2

100
Q

Therapeutic use of Propanolol (1st gen)?

A
  • Hypertension
  • Angina
  • Migraine
101
Q

What receptors are affected with timolol (1st gen)?

A

B1 and B2

102
Q

Therapeutic use of timolol (1st gen)?

A
  • Glaucoma
  • Decrease intraocular pressure
103
Q

What receptors are affected with atenolol and metoprolol?

A

B1

104
Q

What is the therapeutic use of atenolol and metoprolol?

A

Hypertension (2nd gen-cardioselective)

105
Q

What receptors are affected with carvedilol and labetalol?

A

B1 and B2

106
Q

What is the therapeutic use of carvedilol and labetalol?

A

Hypertension-with vasodilation

107
Q

What receptor is affected with pindolol?

A

B1 and B2

108
Q

What are the therapeutic use of pindolol?

A

Decrease CO
HR for patients with heart block

109
Q

Why adrenergic antagonist cannot be given with patient with respiratory health concerns?

A
  • Bronchoconstriction
110
Q

What is the therapeutic class of Prazosin?

A

Anti-hypertensive

111
Q

What is the pharmacologic class of Prazosin?

A

Alpha Blocker

112
Q

What are the indications of Prazosin?

A

Mild to moderate hypertension

113
Q

How many receptors are there in Muscarinic receptors?

A

5 receptors that stimulate smooth muscle and slows heart rate

114
Q

What is the function of M1?

A

GenitoUrinary

115
Q

What are the function of M3?

A

For lungs and glands (may increase calcium-anticoagulant)

116
Q

What are the function of M2?

A

For heart

  • May increase potassium
  • Decrease heart rate
117
Q

How many receptors are there in Nicotinic?

A

2 Receptors

Nm
Nn

118
Q

Nicotinic affects what muscle?

A

Affects skeletal muscles

119
Q

What is the function of Nm?

A

Muscle contraction

120
Q

What is the function of Nn?

A

Transmission of cholinergic signals

121
Q

Acetylcholine are made of what?

A

Choline and Acetyl CoA

122
Q

What happen to choline after action at the receptor site?

A

re-uptake or reabsorbed back to pre-synaptic nerve cell terminal

123
Q

What happen to acetate after action at the receptor site?

A

Waste product and diffuse away

124
Q

What are the cholinergic agonists?

A
  • mimic the parasympathetic neurotransmitter acetycholine
125
Q

What is direct acting parasympathomimetic?
cholinergic drugs

A

Directly affects the receptor sites even without acetylcholine. Drug will act as a substitute in the receptor.

126
Q

What is indirect acting parasympathomimetic? cholinesterase drugs

A
  • Drugs will not directly attached to the receptor sites instead it will attached to acetylcholinesterase that will not degrade acetylcholine and will stay to the receptor sites.
  • affects acetylcholinesterase
127
Q

Direct acting parasympathomimetic drugs mostly affects what receptor?

A

Muscarinic receptor

128
Q

What are the direct acting drugs?

A
  • Acetylcholine
  • Carbachol
  • Pilocarpine
  • Betanechol
129
Q

What are the therapeutic use of Acetylcholine?

A

Non-specific cholinergic effect
Decreases CO, HR, BP
Increase GI Activity

130
Q

What are the therapeutic uses of Carbachol?

A

Not as susceptible to AChE
Use locally to constrict pupil
Decrease IOP

131
Q

What are therapeutic uses of Pilocarpine?

A

Constricts pupil
Decrease IOP for acute glaucoma

132
Q

What are therapeutic uses of Bethanechol?

A

Increase muscle tone in bladder and GIT

133
Q

What is the therapeutic class of bethanechol?

A

Urinary stimulants

134
Q

What is the pharmacologic class of bethanechol?

A

Cholinergic agonists

135
Q

What are the indication for bethanechol drug?

A
  • Acute post-operative and post-partum nonobstructive urine retention
  • Neurogenic atony of urinary bladder with urine retention
136
Q

What are the indirect acting reversible drugs?

A
  • Edrophonium
  • Physostigmine
  • Neostigmine
  • Pyridostigmine
  • Donepezil
  • Rivastigmine
  • Galantamine
137
Q

What is the therapeutic use of Edrophonium?

A

Diagnosis of MG [Myasthenia gravis (MG)]
- generalized weakness

138
Q

What is the therapeutic use of Physostigmine?

A

Overdose of atropine[sulfate an emergency drugs]

139
Q

What is the therapeutic use of Neostigmine?

A

Symptoms of MG
Reverse effects of anesthesia

140
Q

What is the therapeutic use of Pyridostigmine?

A

Symptoms of MG
Reverse effects of anesthesia

141
Q

What is the therapeutic use of Donepezil?

A

Alzheimer’s disease to improve cognitive function

142
Q

What is the therapeutic use of Rivastigmine?

A

Alzheimer’s disease to improve cognitive function

143
Q

What is the therapeutic use of Galantamine?

A

Alzheimer’s disease [progressive dementia] to improve cognitive function

144
Q

What kind of cholinergic agonist drug that is not used for medicinal purposes?

A

Indirect acting irreversible

  • Paralysis
145
Q

What is an indirect acting irreversible cholinergic agonist drug?

A

Famous for military use as nerve gasses that can cause paralysis [world war 2]

146
Q

Echothiopate drug is used for?

A

Treatment of open glaucoma

147
Q

What is the mnemonic for adverse reactions of Cholinergic agonists?

A

D.U.M.B.B.E.L.S

148
Q

D.U.M.B.B.E.L.S stands for

A

D- diarrhea
U- urination
M- Miosis and muscle weakness
B- bronchorrhea
B- bradycardia
E- emesis
L- lacrimation
S- salivation/ sweating

149
Q

What is the cause of cholinergic crisis?

A

Overdose of cholinergic agonists drugs

150
Q

Myasthenic crisis

A

low level of acetylcholine

151
Q

Neostigmine (Tensilon test)

A

Increased weakness

Use to differentiate Myasthenic crisis and cholinergic crisis

152
Q

Anti-cholinergic drugs

A

produces sympathetic effects

153
Q

What are the anti-muscarinic agents?

A
  • Atropine
  • Cyclopentolate
  • Tropicamide [emergency drugs]
  • Scopolamine
  • Ipratropium
  • Oxybutynin
  • Benztropine
154
Q

What is the therapeutic use of Atropine?

A

Mydriasis
Psychoplegia prior to an eye surgery or Exam

Blocks M3- Reduces G.I motility
Blocks M2- SA and AV node, tachycardia in high doses

155
Q

What is the therapeutic use of Cyclopentolate?

A

Same as atropine but with less duration of action

156
Q

What is the therapeutic use of Tropicamide?

A

Same as atropine but with less duration of action

157
Q

What is the therapeutic use of Scopolamine?

A

Motion sickness
Post op nausea
vomiting as patches

158
Q

What is the therapeutic use of Ipratropium?

A

COPD
Rhinorrhea as inhalation to bronchodilation
Decrease secretion

159
Q

What is the therapeutic use of Oxybutynin?

A

Bladder function

160
Q

What is the therapeutic use of Benztropine?

A

Parkinson’s like disorders

161
Q

What is the therapeutic class of Atropine?

A

Anti-arrhythmic

162
Q

What is the pharmacological class of atropine?

A

Anti-cholinergic belladonna alkaloids

163
Q

What is the mnemonic for adverse reactions of anti-cholinergic agonists drugs?

A

A.B.C.D.S

164
Q

A.B.C.D.S stands for?

A

A- agitation
B- blurred vision
C- constipation, confusion
D- dry mouth
S- stasis of urine and sweating

165
Q

What is nicotine?

A
  • Not used in clinical practice
  • Stimulate and blocks cholinergic function
    Increase production of neurotransmitter [cause: bronchoconstriction]
    -CNS stimulation: Causes addiction
166
Q

What are the two subdivision of neuro-muscular blockers?

A

Non-depolarizing agent
Depolarizing agent

167
Q

What agents that binds to ACh receptors but do not induce ion channel opening?

A

Non-depolarizing agent [Curium-Coronium]

168
Q

Facilitates ECT

A

Succinylcholine

169
Q

What are the adverse effect of anti-cholinergic drugs?

A
  • Prolong apnea
  • Hyperkalemia [fluids and electrolytes]
  • Malignant hyperthermia
170
Q

Sympathomimetic and Parasympatholytic

A

Synergic

171
Q

Sympatholytic and Parasympathomimetic

A

Synergic

172
Q

Sympathomimetic and Parasympathomimetic

A

Antagonistic

173
Q

Sympatholytic and Parasympatholytic

A

Antagonistic

PHARMACOLOGY (6 decks)

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