DRUGS ACTING ON THE ANS Flashcards by michaela gail | Brainscape

Q

3 major divisions of the autonomic nervous system

A

sympathetic
parasympathetic
enteric nervous system (myenteric plexus, submucous plexus)

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Q

sympathetic:

spinal roots of origin

A

T1-T12
L1-L5

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Q

parasympathetic:

spinal roots of origin

A

CN 3, 7, 9, 10
sacrum

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Q

sympathetic:

location of ganglia

A

paravertebral chains of spinal column

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Q

parasympathetic:

location of ganglia

A

organs innervated, more distant from spinal cord

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Q

sympathetic:

preganglionic and postganglionic fibers

A

short, long

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Q

parasympathetic:

preganglionic and postganglionic fibers

A

long, short

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Q

primary transmitter at the sympathetic postganglionic neuron-effector cell synapses in most tissues

A

norepinephrine

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Q

exceptions of norepinephrine

A

eccrine sweat glands
vasodilator in the sympathetic fibers of skeletal muscles

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Q

primary transmitter in all autonomic ganglia and at the synapses between parasympathetic postganglionic neurons and their effector cells

A

acetylcholine

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Q

primary transmitter at the somatic skeletal muscle neurotransmitter junction

A

acetylcholine

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Q

direct activation of adrenoceptors
indirect activation by increasing concentration of available catecholamines in the synapse

A

sympathominetics

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Q

alpha-1 or alpha-2 adrenergic effect:

contraction of MOST vascular smooth muscle

A

alpha-1

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Q

alpha-1 or alpha-2 adrenergic effect:

stimulates glycogenolysis in the liver

A

alpha-1

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Q

alpha-1 or alpha-2 adrenergic effect:

stimulates aggregation of platelets

A

alpha-2

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Q

alpha-1 or alpha-2 adrenergic effect:

contraction of pupillary dilator muscle (mydriasis)

A

alpha-1

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Q

alpha-1 or alpha-2 adrenergic effect:

inhibits transmitter release in adrenergic and cholinergic nerve terminals

A

alpha-2

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Q

alpha-1 or alpha-2 adrenergic effect:

inhibits insulin release of pancreatic b cells

A

alpha-2

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Q

alpha-1 or alpha-2 adrenergic effect:

contraction of SOME vascular smooth muscle

A

alpha-2

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Q

alpha-1 or alpha-2 adrenergic effect:

contraction of pilomotor smooth muscle (erects hair)

A

alpha-1

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Q

alpha-1 or alpha-2 adrenergic effect:

inhibits lipolysis of fat cells

A

alpha-2

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Q

beta-1 or beta-2 adrenergic effect:

relaxes the airway, uterine, and vascular smooth muscle

A

beta-2

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Q

beta-1 or beta-2 adrenergic effect:

stimulates rate and force of heart

A

beta-1 and beta-2

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Q

beta-1 or beta-2 adrenergic effect:

stimulates glycogenolysis of liver

A

beta-2

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Q

beta-1 or beta-2 adrenergic effect:

causes tremors in the somatic motor neuron terminals

A

beta-2

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Q

beta-1 or beta-2 adrenergic effect:

stimulates renin release from juxtaglomerular cells of kidney

A

beta-1

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Q

beta-1 or beta-2 adrenergic effect:

stimulates insulin release from the pancreatic b cells

A

beta-2

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Q

6 classifications of sympathomimetics

A

non-selective alpha agonist
alpha-1 selective
alpha-2 selective
non-selective beta agonist
beta-1 selective
beta-2 selective

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Q

sympathomimetic (non-selective)
activates alpha and beta adrenergic receptors
for cardiac arrest, anaphylaxis, asthma, copd, hemostasis

SE: HTN, tachycardia, ischemia, hyperglycemia

A

epinephrine

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Q

a1: vasoconstriction, increases BP
b1: increased HR, conduction and contractility
b2: bronchodilation

A

epinephrine

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Q

sympathomimetic (non-selective)
activates alpha, beta, and D1 adrenergic receptors
for cardiogenic shock and heart failure

SE: cardiovascular disturbance, arrythmias

A

dopamine

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Q

a1: vasoconstriction, increases BP
b1: increased HR, conduction and contractility
D1: vasodilation in splanchnic and renal vessels

A

dopamine

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Q

sympathomimetic (alpha-2 selective)
activates a2 adrenergic receptors
decreases central sympathetic outflow
for HTN, cancer pain , opioid withdrawal

SE: sedation, rebound HTN, dry mouth

A

clonidine

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Q

in using clonidine, what should you do to avoid rebound hypertension

A

taper / gradually decrease use prior to discontinuation

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Q

what is the treatment for rebound HTN after using clonidine?

A

phentolamine

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Q

sympathomimetic (alpha-2 selective)
activates a2 adrenergic receptors
decreases central sympathetic outflow
used for preeclampsia, GHTN

SE: sedation, hemolytic anemia

A

methyldopa

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Q

sympathomimetic (beta-2 selective)
activates beta 2 receptors in bronchial smooth muscle causing bronchodilation
used for acute asthma attack, tocolytic for preterm labor

SE: tachycardia, tremors, nervousness, restlessness, arrhythmias, loss of responsiveness

A

albuterol / salbutamol

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Q

drug choice for anaphylaxis

A

epinephrine

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Q

drug of choice for asthma attacks

A

albuterol / salbutamol

Q

albuterol / salbutamol may precipitate ___ in patients with concurrent COPD and heart disease

A

arrhythmias

Q

true or false: sympathomimetics are C/I in patients with cardiac dysrhythmias, narrow angle glaucoma, and cardiogenic shock

A

true

Q

what should you monitor when administering sympathomimetics?

A

VS and UO
SE: tachycardia, palpitations, tremors, dizziness, HPN

Q

continuous nasal spray can cause ___

A

nasal congestion rebound

Q

alpha blockers
non-selective - irreversible

A

phenoxybenzamine

Q

alpha blockers
non-selective - reversible

A

phentolamine

Q

alpha blockers
alpha-1 selective

A

prazosin

Q

alpha blockers
alpha-2 selective

A

yohimbine

Q

beta blockers
non-selective

A

propranolol

Q

beta blockers
beta-1 selective

A

atenolol

Q

beta blockers
beta-2 selective

A

butoxamine

Q

adrenergic antagonist (alpha non-selective)
irreversibly blocks alpha adrenergic receptors

A

phenoxybenzamine

Q

used for pheochromocytoma (pre-surgical)

SE: orthostatic hypotension, reflex tachycardia, GI irritation, myocardial ischemia

A

phenoxybenzamine

Q

forms covalent bond with alpha receptors = effects lasts for several days

A

phenoxybenzamine

Q

A

Q

adrenergic antagonist (alpha non-selective)
reversibly blocks alpha adrenergic receptors

SE: orthostatic hypotension, reflex tachycardia, GI irritation

A

phentolamine, tolazoline

Q

used for pheochromocytoma (pre-surgical)
antidote to a1 antagonist overdose, rebound HTN

A

phentolamine, tolazoline

Q

adrenergic antagonist (alpha-1 selective)
selectively blocks a1 adrenergic receptors
used for benign prostatic hyperplasia, HTN

SE: 1st dose orthostatic hypotension, reflex tachycardia

A

prazosin

Q

adrenergic antagonist (beta non-selective)
block b1 and b2 receptors
block sympathetic effects on heart and BP
reduce renin release

A

propranolol

Q

used for angina prophylaxis, HTN, arrhythmias, migraine, performance anxiety, hyperthyroidism

SE: bronchospasm, AV block, heart failure, CNS sedation, erectile dysfunction

A

propranolol

Q

may mask symptoms of hypoglycemia in diabetics
carvedilol and labetalol has combines alpha and beta blockade (may be used for pheochromocytoma)

A

propranolol

Q

adrenergic antagonist (beta 1 selective)
selectively block b1 receptors
blocks sympathetic effects on heart and BP
used for angina, HTN, heart failure

SE: bronchospasm, AV block, heart failure, CNS sedation, erectile dysfunction

A

atenolol

Q

when administering adrenoceptor blockers, you should monitor?

A

VS, BP, and HR

Q

when administering adrenoceptor blockers, report any complaint of ___

A

stuffy nose

Q

when administering adrenoceptor blockers:

for clients with DM, have ___ available and follow adjustment of insulin dose as ordered

A

glucagon

Q

true or false: when administering adrenoceptor blockers, quickly rise from supine to sitting / standing position

A

false - slowly rise

Q

not very useful for systemic therapy because their effects are not sufficiently selective
parasympathetic and sympathetic ganglia and somatic junctions all may be blocked

A

cholinergic drugs

Q

location of M1 cholinoreceptor

A

nerve endings

Q

location of M2 cholinoreceptor

A

heart, some nerve endings

Q

location of M3 cholinoreceptor

A

effector cells, smooth muscle glands, endothelium

Q

location of Nn cholinoreceptor

A

ANS ganglia

Q

location of Nm cholinoreceptor

A

neuromuscular end plate

Q

cholinergic (direct-acting)
similar to carbachol
active muscarinic receptors
act on M receptor only

A

betanechol

Q

used for bladder and bowel atony (post-surgery or spinal cord injury)
SE: cyclospasm, diarrhea, urinary urgency, vasodilation, reflex tachycardia, sweating

A

betanechol

Q

cholinomimetic (direct-acting)
activates M3 receptors in ciliary muscle and salivary glands
used for glaucoma, sjogren syndrome
SE: miosis, blurring of vision

A

pilocarpine

Q

autoimmune disorder characterized by triad of:
- xerostomia (dry mouth)
- xerophthalmia (dry eyes)
- rheumatoid arthritis

A

sjogren syndrome

Q

cholinomimetic (direct-acting)
activates nicotinic ACH receptors (Nn and Nm)
used for smoking cessation
SE: generalized ganglionic stimulation

A

nicotine

Q

nicotine overdose leads to?

A

convulsion, paralysis, coma

Q

CNS stimulation
eye: miosis, spasm of accommodation
lungs: bronchoconstriction
GIT/GUT: excessive smooth muscle actiivity
increased secretory activity
vasodilation

A

muscarinic toxicity

Q

ganglionic stimulation
blockade of neuromuscular end plate depolarization
fasciculation and paralysis
CNS toxicity: stimulation (convulsions) followed by CNS depression

A

nicotinic toxicity

Q

bind to cholinesterase and undergo prompt hydrolysis
alcohol portion is released
acidic portion is retained and release slowly

A

indirect-acting cholinomimetics

Q

prevents the binding and hydrolysis of endogenous acetylcholine
amplify acetylcholine effects wherever ACH is released

A

indirect-acting cholinomimetics

Q

cholinomimetic (indirect-acting)
inhibits acetylcholinesterase, amplifies endogenously released acetylcholine
used for myasthenia gravis, differentiation of cholinergic crisis and myasthenic crisis
SE: miosis, salivation, NV, diarrhea, bradycardia

A

edrophonium

Q

true or false: edrophonium is known to be very short acting upon IV administration

A

true

Q

how is myasthenia gravis diagnosed?

A

tensilon test

Q

cholinomimetic (indirect-acting)
inhibits acetylcholinesterase, amplifies endogenously released acetylcholine
used for myasthenia gravis, reversal of nondepolarizing neuromuscular blockade, glaucoma
SE: miosis, salivation, NV, diarrhea, bradycardia

A

neostigmine

Q

muscarinic effects caused by neostigmine are blocked by ___

A

atropine

Q

autoimmune destruction of nictonic ACH receptors characterized by:
- fluctuating muscle weakness
- ocular symptoms
- bulbar symptoms
- proximal muscle weakness

A

myasthenia gravis

Q

acute worsening of symptoms due to infection, stress or undermedication

A

myasthenic crisis

Q

excessive activation of cholinoreceptors (skeletal muscle weakness and parasympathetic signs) due to overmedication

A

cholinergic crisis

Q

how does edrophonium differentiate myasthenic crisis from cholinergic crisis?

A

myasthenic - IMPROVES muscle strength
cholinergic - WEAKENSS muscle strength

Q

prototype non-selective muscarinic blocker
found in atropa belladona
tertiary amine that readily crosses membrane barriers

A

atropine

Q

cholinergic antagonist
competitively blocks all muscarinic receptors
used for mydriatic, cycloplegic, antidote for organophosphate poisoning, bradycardia, hypersalivation
SE: tachycardia, mydriasis, cycloplegia, skin flushing, delirium, hallucination

A

atropine

Q

drug of choice for organophosphate poisoning

A

atropine

Q

these can cause what?

malathion and parathion (insecticide)
sarin, tabun, soman: nerve gases

A

organophosphate poisoning

Q

signs and symptoms of organophosphate poisoning

DUMBBELSS

A

diarrhea
urination
miosis
bronchospasm
bradycardia
excitation
lacrimation
sweating
salivation

Q

atropine fever
atropine flush
decreased secretion
tachycardia
arrhythmias
constipation
blurred vision
CNS toxicity

A

atropine toxicity

Q

use cautiously in infants, may cause hyperthermia
C/I: acute angle-closure glaucoma, benign prostatic hyperplasia

A

muscarinic blockers