Autonomic Nervous System (pharm test)

Question 1

Neurotransmitters

Answer 1

Chemical messengers that travel between neurons, stimulates the receptor site, and brings about a response

Question 2

Ligands

Answer 2

-Neurotransmitters, hormones, and medications that can bind to receptors in the ANS
-Agonists—
-Antagonists—
-Signal transduction—cascade of intracellular events that occur when receptors located on target tissues are stimulated by a ligand

Question 3

Inactivation of neurotransmitters

Answer 3

-By reuptake of the transmitter back into the neuron

-By enzymatic transformation or degradation

-By diffusion away from the receptors

Question 4

Autonomic Nervous System: Sympathetic (Fight or Flight)

Answer 4

Neurotransmitters: norepinephrine, dopamine
-Increased heart rate, arterial blood pressure, and cardiac output​
-Increased blood glucose​
-Pupil dilation​
-Increased rate of cellular metabolism​
-Increased blood flow to brain, heart, and skeletal muscles​
-Increased rate and depth of respiration​

Question 5

Autonomic Nervous System: Parasympathetic(Rest and Digest)

Answer 5

Neurotransmitter: acetylcholine
-Dilation of blood vessels in the skin​
-Decreased heart rate​
-Increased secretion of digestive enzymes​
-Pupil constriction​
-Contraction of smooth muscle in the urinary bladder​
-Contraction of skeletal muscle

Question 6

Adrenergic or Sympathomimetics

Answer 6

-Stimulate the sympathetic nervous system
-Effects of adrenergic agonists on receptor sites:
Alpha1 & Alpha2
Beta1 & Beta2
-Neurotransmitters (or catecholamines):
Epinephrine
Norepinephrine
Dopamine

Question 7

Classification of Adrenergics/Sympathomimetics

Answer 7

Direct-acting sympathomimetics
-Epinephrine
-Norepinephrine
-Dopamine

Indirect-acting Sympathomimetics
-Amphetamine

Mixed-acting sympathomimetics
-Ephedrine

Question 8

epinephrine: Adrenaline

Answer 8

-Classification: Sympathomimetic
-Action: Stimulates alpha- and beta-adrenergic receptors
-Uses:
Anaphylaxis
Bronchospasm
Cardiogenic shock, cardiac arrest
Severe asthma
-Contraindications and Caution:
Cardiac dysrhythmias, hypertension (HTN)
Hyperthyroidism

Question 9

Epinephrine (cont’d)

Answer 9

-Adverse reactions:
-Palpitations, tachycardia, hypertension (HTN), nausea/vomiting (N/V), dyspnea, nervousness, headache (H/A), tremors, agitation & insomnia
-Life-threatening
Ventricular fibrillation, MI & pulmonary edema
-Drug interaction
-Beta-blockers
Decreases epinephrine action
-Digoxin
Causes cardiac dysrhythmias

Question 10

Epinephrine: Nursing Interventions

Answer 10

-Monitor BP, pulse, urine output
-Report signs of adverse reaction
-Monitor IV site for infiltration
-Antidote: phentolamine mesylate (Regitine)

Question 11

epinephrine (Adrenaline)

Answer 11

-Classification: Sympathomimetic
-Indications: Anaphylaxis, severe asthma, cardiogenic shock, cardiac arrest
-MOA: Stimulates alpha- and beta-adrenergic receptors
-Adverse Effects: Anorexia, nausea/vomiting (N/V), nervousness, headache (H/A), tremors, agitation & insomnia, palpitations, tachycardia, hypertension & dyspnea
-Life-threatening: Ventricular fibrillation, myocardial infarction (MI) & pulmonary edema
-NC: caution with cardiac dysrhythmias, hypertension (HTN), hyperthyroidism, monitor BP, pulse, urine output, report signs of adverse reaction, monitor for drug interactions with beta-blockers, digoxin

Question 12

albuterol (Proventil, Ventolin)

Answer 12

-Classification: Beta-2 Agonist
-Mechanism of Action:
Acts on beta2-adrenergic receptors
Relaxes airway smooth muscle to promote bronchodilation
-Indications:
Treats bronchospasm, asthma, bronchitis, COPD

Question 13

albuterol (Proventil, Ventolin), (cont’d)

Answer 13

-Caution
Severe cardiac disease, HTN, hyperthyroidism, diabetes mellitus
-Adverse Reactions
Tremors, nervousness, restlessness, dizziness & headache (H/A), tachycardia, seizures, palpitations & HTN, cardiac dysrhythmias

Question 14

Nursing Interventions for albuterol

Answer 14

-Record VS
-Monitor ECG for dysrhythmias
-Report signs of adverse reaction (tachycardia, ↑ B/P, palpitations)
-Check urinary output- renal vasoconstriction
-Avoid doses close to bedtime.
-Check blood sugar (BS)
-Teach self administration

Question 15

albuterol (Proventil, Ventolin)

Answer 15

-Classification: Beta-2 Agonist
-Indications: Treats bronchospasm, asthma, bronchitis, COPD
-MOA: Acts on beta2 receptors to relax airway smooth muscle to promote bronchodilation
-Adverse Reactions: Tremors, nervousness, restlessness, dizziness & headache (H/A), tachycardia, seizures, palpitations & HTN, cardiac dysrhythmias
-NC: Record VS, monitor ECG for dysrhythmias, report signs of adverse reaction (tachycardia, ↑
-B/P, palpitations), check urinary output- renal vasoconstriction, avoid doses close to bedtime, check BS, teach self administration

Question 16

Beta-Adrenergic Blockers

Answer 16

-Uses: HTN, tachycardic dysrhythmias, angina
-Nonselective beta blockers
propranolol HCl (Inderal)
Contraindications: (COPD or asthma)
-Selective beta blockers (cardioselective)
metoprolol tartrate (Lopressor) & atenolol (Tenormin)

Question 17

atenolol (Tenormin)

Answer 17

-Classification: Beta 1 blocker (cardioselective)
-Uses: treat HTN, angina pectoris, & MI
-Adverse Effect: drowsiness, dizziness, fainting, N/V/D, cool extremities, depression
-Adverse Reaction: bradycardia, hypotension, heart failure, dysrhythmias, pulm edema)
-Caution: renal dysfunction, asthma, COPD, diabetes mellitus
-Pregnancy category: C
-CI: sinus bradycardia, heart block > 1st degree, cardiogenic shock

Question 18

atenolol (Tenormin: Nursing Interventions)

Answer 18

-Report AE
-Rise slowly (orthostatic hypotension)
-Monitor urine output
-Comply with med schedule (don’t suddenly stop)
-Monitor mood changes
-Monitor B/P & pulse (Pulse < 60 HOLD)
-Ask provider for parameters on BP and pulse

Question 19

Cholinergics/Parasympathomimetics

Answer 19

-Drugs that stimulate the parasympathetic nervous system
-Muscarinic and Nicotinic receptors
-Blockage of these receptors produces anticholinergic effects
-Stimulated by acetylcholine (ACh)

Question 20

Direct-Acting Cholinergic Agonists

Answer 20

-Selective to muscarinic receptors

-Located in smooth muscles
Heart, GI, GU, glands
metoclopramide (Reglan)
-Use: increase gastric emptying
pilocarpine (Pilocar)
-Use: constrict pupils
bethanechol chloride (Urecholine)
-Use: increase urination

Question 21

Indirect-Acting Cholinergic Drugs

Answer 21

-Also called cholinesterase (ChE) inhibitors, and acetylcholinesterase (AChE) inhibitors
-MOA: Inhibits Cholinesterase (ChE) enzyme
-Adverse Effects
↑ GI motility, bradycardia, miosis, bronchial constriction & ↑ urination
-Contraindications
Intestinal and urinary obstruction

Question 22

Anticholinergics/Parasympatholytics

Answer 22

Other names:
-Cholinergic antagonists
-Muscarinic antagonists
-Antimuscarinic agents
-Antispasmodic agents

Question 23

Effects of Anticholinergics

Answer 23

-Heart: large doses increase pulse; small doses (less than 0.5 mg) decrease pulse
-Lungs: bronchodilation, decrease secretions
-GI: relax smooth muscle tone, decrease motility & peristalsis, decrease
-GU: relax detrusor muscle, increase sphincter constriction
-Eye: dilate pupils, decrease accommodation
-Mouth: decrease salivation
CNS: decrease tremors & rigidity

Question 24

Anticholinergics (cont’d)

Answer 24

Uses:
-Dries secretions
-Treat bradycardia
-Parkinson’s disease
-Motion sickness
-Overreactive bladder
-Irritable bowel disease
-Asthma and COPD

Question 25

Anticholinergics: Atropine

Answer 25

-Classification: Anticholinergic
-Uses: Preoperative med to ↓ salivation, ↑ pulse (if > 0.5 mg), & dilate pupils
-Mechanism of Action: Inhibition of acetylcholine by occupying the receptor
-Contraindicated in glaucoma & obstructive GI disorder

Question 26

Anticholinergics: Atropine

Answer 26

-Adverse Effect
Dry mouth and skin, H/A, blurred vision, photophobia, palpitations, urinary retention & constipation
-Adverse Reaction
Tachycardia, hyperthermia, delirium
Life-threatening: Coma, paralytic ileus & ventricular fibrillation

Question 27

Atropine: Nursing Interventions

Answer 27

-Monitor vital signs, urine output, bowel sounds
-Monitor safety: bedside rails, driving motor vehicles
-Provide mouth care
-Avoid hot environments
-Avoid alcohol, cigarettes, caffeine
-Wear sunglasses in bright light