Lecture 2 Flashcards by Amanda D

Another word for force of contraction

Inotropy

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Another word for speed of conduction

Dromotropy

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Another word for heart rate

Chronotropy

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What are catecholamines

Norepinephrine
Dopamine
Epinephrine

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What is an antagonist

Inhibits the physiological action

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What is an agonist

Imitates a physiological response

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What happen to the pupils in sympathetic and parasympathetic systems?

Sympathetic: dilates pupils

Parasympathetic: constricts pupils

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What happens to the salivary glands in sympathetic and parasympathetic systems?

Sympathetic: inhibits salivary gland secretions

Parasympathetic: simulates salivary gland secretions

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What happens to the bronchi in sympathetic and parasympathetic systems?

Sympathetic: relaxes bronchi in the lungs (dilates)

Parasympathetic: constricts bronchi in lungs

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What happens to the heart in sympathetic and parasympathetic systems?

Sympathetic: accelerates heart

Parasympathetic: slows heart down

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What happens to the stomach and intestines in sympathetic and parasympathetic systems?

Sympathetic: inhibits activity of stomach and intestines

Parasympathetic: simulates activity of stomach and intestines

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What happens to the pancreas in sympathetic and parasympathetic systems?

Sympathetic: inhibits activity of pancreas

Parasympathetic: stimulates activity of pancreas

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What happens to the gallbladder in sympathetic and parasympathetic systems?

Sympathetic: inhibits gallbladder; stimulates glucose release from liver

Parasympathetic: stimulates gallbladder

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What happens to the bladder in sympathetic and parasympathetic systems?

Sympathetic: inhibits emptying of bladder

Parasympathetic: promotes emptying the bladder

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When stimulated what does alpha 1 receptors do?

Vasoconstriction

Mydriasis

Constriction of bladder sphincter and urinary retention

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When stimulated what does beta 1 receptors do?

Increases heart rate

Increases contractibility

Increases AV conduction

Increases blood pressure

Increases renin production

+ (chronotropy, inotropy, dromotrophy)

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When stimulated what does beta 2 receptors do?

Bronchodilation

Vasodilation

Increases insulin

Decreases GI

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What happens when you block alpha 1 receptors

Vasodilation, decreased BP, miosis, improved urine outflow

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What happens when you block beta 1

Negative chronotrophy

Negative dromotrophy

Negative inotrophy

Decreased blood pressure

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What happens when you block beta 2

Bronchoconstriction

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What are cardio selective sympathomimetics used for?

Heart failure, increase BP, shock, anaphylaxis (epi) and CPR

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What is Dobutamine?

Sympathetic stimulate

+ inotrope

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Indication, receptors, and drug effect of dobutamine

Indication: heart failure (pump failure)

Receptors stimulated: B1

Drug effect: increased cardiac output

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Indication for dopamine

Shock

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Receptors stimulated with dopamine

Dopamine Beta 1 Alpha 1

Drug effect of dopamine in low, moderate, and high doses

Low dose: dilate renal, mesentery, coronary and cerebral vessels Moderate: + intropy High doses: vasoconstriction

Side effect of dopamine

Tachycardia

Indications, receptors stimulated, and drug effect of epinephrine

Indications: anaphylaxis, CPR, shock Receptors stimulated: all (alpha 1, beta 1, beta 2) Drug effect: for cardiac arrest: increased blood pressure and heart rate. For asthma attack: increased RR and increased oxygen level

Indications, receptors stimulated, and drug effect for norepinephrine

Indications: shock Receptors: alpha 1 and beta 1 Drug effect: vasoconstriction, + intrope, + dromotrope, + chronotrope

Indications, receptors, and drug effect of phenylephrine

Indications: hypotension Receptors: alpha 1 Drug effect: vasoconstriction

Adverse effects of the cardio selective sympathomimetics

Hypertension, tachycardia, dysrhythmia, chest pain, dizziness, tremors

Interactions for the cardio selective sympathomimetics

MAOIs ( Monoamine oxidase inhibitors) Thyroid medications

Administration safety and nursing considerations for the cardio selective sympathomimetics

Monitor HR, BP, SpO2 Monitor IV, IV pump, extravasation Preferred through a central line

Therapeutic effects for cardio selective sympathomimetics

Increased CO Increased HR Increased BP Increased SpO2 Increased urinary output Increased level of consciousness Colour/ temp WNL

What are the alpha blockers?

Phentolamine Prazosin Tamsulosin

Indications for prazosin

Hypertension

Drug effects for prazosin

Decreased BP, vasodilation

Therapeutic effects for prazosin

HTN: lowers BP Dysrhythmias: lowers HR, regular rhythm. Angina: lowers chest pain BPH: improved emptying bladder

Considerations for prazosin

High risk for fall First dose phenomenon Take first dose at night Do not abruptly stop

Indication for tamsulosin

BPH ( benign prostatic hyperplasia)

Drug effects of tamsulosin

Improve urinary outflow

Consideration for tamsulosin

No sildenafil (viagra)

What are the beta blockers?

Metoprolol Labetalol Esmolol Carvedilol Propranolol

What are the hold parameters for beta blockers

HR< 60 SBP< 100

What is the indication for the selective cardio B1 (metoprolol)

Hypertension Dysrhythmias Angina MI (myocardial infarction)

What is the receptor blocked for metoprolol and what is this drugs effect

Receptor blocked: B1 Drug effect: decrease BP, decrease workload of the heart, decrease conduction

What is the indication for the non selective propranolol

HTN, dysrhythmias, angina, MI, migraines.

Receptors blocked for propranolol

B1 B2

Therapeutic effect for propranolol

Negative chronotrope Negative dromotrope Negative intotrope Bronchoconstriction

Adverse effects of beta blockers

At risk for fall, monitor for SOB, dizziness, hypotension, bradycardia, conduction issues (AVB), depression.

Main adverse effect for alpha blockers

First dose hypotension

Beta blockers interactions

CV drugs, diuretics, alcohol

Teachings for beta blockers.

Don’t stop taking abruptly Teach about orthostatic hypotension Report weight gain (heart failure) over 2 pounds in 24 hours, 5 pounds in a week

What happens to the CV and GI system when parasympathetic system is stimulated?

CV: decreased HR, vasodilation GI: increased motility and secretions

What happens to the GU system and the eyes when parasympathetic system receptors are stimulated?

GU: increase urinary frequency Eye: miosis (constrict)

What happens to the glands and respiratory system when parasympathetic system is stimulated?

Glands: increased secretions Respiratory: bronchoconstriction, increased secretions

What happens to the CV when parasympathetic receptors are blocked

Small doses: HR decreases Large doses: HR increases

What happens to the CNS when parasympathetic receptors are blocked?

Small doses: decrease in muscle rigidity and tremor. High doses: hallucinations and drowsiness

What happens to the eyes, GI, and GU when parasympathetic receptors are blocked?

Eyes: mydriasis (dilation) GI: decrease motility GU: decrease frequency

What happens to the glands and respiratory system when parasympathetic receptors are blocked?

Glands: decreased secretions Respiratory system: bronchodilation, decreased secretions

What is the cholinergic drug?

Bethanechol

What is the indications for bethanechol

Post procedural atony of the bladder

What is the drug effect and evaluation for bethanechol

Drug effect: increases tone and motility of the bladder and G.I. tract. Evaluation: patient is able to urinate.

What are the Alzheimer’s drugs?

Donezepil, Galantamine, Rivastigmine

What are the indications, drug effects, and considerations of Alzheimer’s drugs

Indications: Alzheimers Drug effect: inhibit cholinesterase Considerations: improvement of symptoms

Adverse effects of Alzheimer’s drugs?

G.I. symptoms and bronchoconstriction

What is the cholinergic crisis?

Circulatory collapse Hypotension Bloody diarrhea Shock Cardiac arrest

Early signs of the cholinergic crisis?

Abdominal cramps Excessive salivation Flushing Syncope (LOC) Transient AVB Orthostatic hypotension

How do you treat the cholinergic crisis?

Early: Atropine (0.5 or 1) Late: Epinephrine

What is atropine

Anticholinergic used to increase HR

What are the indications for atropine?

Symptomatic bradycardia (low BP, cool, clammy, decreased level of consciousness)

Considerations atropine

Pupillary dilation

Therapeutic effect for atropine

Increased heart rate Improves breathing Lowers secretions

Drug effect and indications for glycopyrrolate

Drug effect: reduce secretions Indications: peri op

Indications and considerations for scopolamine

Indications: motion sickness, post op N/V Considerations: dry mouth, drowsiness

Adverse effects for anticholinergics

Dysrhythmias, constipation, urinary retention, decreased sweating

Drugs that stimulate beta 1

Dobutamine, dopamine, epi, norepinephrine

Drugs that stimulate beta 2

Epi

Drugs that stimulate alpha 1

Dopamine, epi, norepinephrine, phenylephrine