Chapter 13- ANS Flashcards
Basic functions of the nervous system
- balance
- survival
- control
- pleasure and enjoyment
- cognitive ability
Divisions of peripheral nervous system
Sympathetic and parasympathetic
Sympathetic division
- fight or flight
- heart rate and blood pressure increase
- more blood goes to skeletal muscles
- liver produces more glucose
- bronchi dilate=more air into lungs
- pupils dilate=better vision
- ADRENERGIC
Parasympathetic division
- nonstressful conditions
- rest and digest response
- heart rate and blood pressure decline
- bronchi constrict
- CHOLINERGIC
explain process of synaptic transmission
AND
The neurotransmitters important to the autonomic nervous system
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What is the response when a drug activates alpha-1&2 receptors?
- arteriole constriction
- pupil dilation
- GI smooth muscle relaxation
What is the response when beta 1 receptors are activated?
- increased heart rate and force of contraction
- release of renin
What is the response when beta 2 receptors are activated?
- bronchodilation
- arteriole constriction
- glycogenolysis (breakdown of glycogen to glucose)
Therapeutic uses of adrenergic drugs
- bronchospasms
- asthma
- nasal and sinus congestion
Contraindications for ADRENERGIC agents
- narrow angle glaucoma
- heart disease,CAD, arrhythmias, CHF, peripheral vascular disease
Examples of ADRENERGIC drugs
- epinephrine/norepinephrine
- phenylphrine
- dopamine
- albuterol
- sudafed
ADRENERGIC agents mechanism of action
- mimic SNS
- work directly or indirectly or both via receptor sites and neurotransmitters
- generally the emergency medication (to maintain life during a crisis)
Adverse effects of ADRENERGIC agents
- nervousness
- dysrhythmias
- hypertension
- cardiac ischemia
- elevated glucose levels
- pupil dilation
- tissue necrosis
- headache, insomnia
- GI and bladder involvement
Responses that occur when drugs activate nicotinic receptor
- Stimulation of smooth muscle and gland secretions
- brain (memory learning)
Responses that occur when drugs activate muscarinic receptors
- Decreased heart rate and force of contraction
- stimulation of smooth muscle and gland secretions
Classification and naming of autonomic drugs based on 4 possible actions
- Stimulation of the sympathetic nervous system- these drugs are ADRENERGIC agents or sympathomimetics (produce fight or flight response)
- Inhibition of the sympathetic nervous system- ADRENERGIC blocking agents or adrenergic antagonists; opposite effects of sympathomimetics
- Stimulation of parasympathetic nervous system- CHOLINERGIC agents or parasympathomimetics; produce rest and digest response
- Inhibition of the parasympathetic nervous system- cholinergic BLOCKING agents or anticholinergics; produce effects opposite of cholinergic agents
Adrenergic agents nursing implications
- mostly given as IV drip, NOT push
- infiltration can be serious
- titration necessary
- monitor BP, heart rate and anginal pain
- teach patients with CAD to watch OTC meds
adrenergic ANTAGONIST action
- blocks epi and norepinephrine at receptor sites
- not generally found in body
- they are called adrenergic blockers or sympatholytic agents
Therapeutic uses of adrenergic antagonists
- treat cardiac conditions- hypertension (alpha and beta1&2); tachycardia (beta 1); congestive heart disease (beta 1); angina (beta 1)
- pupil constriction (beta)
- increase peripheral blood flow (alpha, beta 2)
- BPH (alpha)
- migraine headache (alpha)
Adrenergic antagonist medications
- ANTENOLOL- hypertension, AMI, arrhythmia
- Inderal (migraines)
Contraindications of adrenergic antagonists
- ischemic heart disease
- hypotension
- asthma
- diabetes
- some dysrhythmias
Adverse reactions of adrenergic antagonists
- hypotension
- bradycardia
- bronchoconstriction
- hypoglycemia
- fatigue/weakness
- GI upset (increased motility)
Nursing implications and teaching for adrenergic antagonists
- do not discontinue abruptly
- monitor for orthostatic hypotension (changes positions slowly)
- avoid alcohol, sedatives
- watch BP, HR, RR, until med dose and effects are stable
- evenly dose around the clock
- report GI or sexual adverse effects
- report breathing difficulties
CHOLINERGIC agents action
- parasympathetic response
- receptor sites include muscarinic and nicotinic
- direct action- stimulates muscarinic receptor sites (cholinergic agonist)
- indirect action- prevents Ach degradation at synapses (cholinesterase inhibitor)
Therapeutic uses of cholinergic agents
- direct acting- urinary retention; GI tract symptoms
- indirect acting- restore skeletal muscle function; treatment and diagnosis of myasthenia gravis; differentiates between myasthenia and cholinergic crisis
- slowing of Alzheimer’s disease
Cholinergic meds
- bethanechol (urinary retention)
- metoclopramide (raglan) (GI motility)
- edrophonium chloride (tensilon) (diagnose myasthenia gravis)
drug interactions of cholinergic agents
-atropine is the antidote for cholinergic overdose
Adverse effects of cholinergic agents
- sedation and drowsiness
- hypotension with tachycardia
- excessive salivation
- GI symptoms, diarrhea, cramping, abdominal pain
- life threatening pulmonary effects
Nursing implication/teaching for cholinergic agents
- when treating GI symptoms, give 30 min before meal
- watch for cholinergic overdose
- have atropine at bedside when doing tensilon test
- watch for respiratory complications (report any to MD)
- tolerance to cholinesterase inhibitor can occur
ANTIcholinergics action
- parasympatholytic, anti muscarinic agents
- mimic sympathetic effects
- blocks Ach at muscarinic receptors
Therapeutic uses for anticholinergics
- dry up secretions
- decrease motility (GI and GU)
- dilation of pupils
- Parkinson’s disease symptom control
- treat bronchospasms
- treat cholinergic crisis
Adverse effects of anticholinergics
- dryness (mouth, eyes)
- decreases GI&GU motility
- hypertension
- drowsiness
- nervousness
- blurred vision
- palpitations
- confusion
Nursing implications/teaching for anticholinergics
- give antacids one hour between anticholinergics
- provide oral care
- watch for sedative reaction
- watch for urinary retention&constipation
- know how to properly give atropine
