LP 4

Question 1

Autonomic Nervous System

Answer 1

• Definition: involuntary or visceral nervous system
• Function: little conscious awareness of it’s internal function, regulate and integrate the the body’s internal functions, integrate of the CNS and PNS to react to changes in the internal and external environment
• Bodily functions regulated: BP, HR, respiration, temp, water balance, urinary excretion, and digestive function.

Question 2

Two divisions of the ANS

Answer 2

• Sympathetic

- Parasympathetic

Question 3

Sympathetic Nervous System

Answer 3

• Adregenic System
• Fight or Flight
• Actions dominated in times of physical or emotional stress
• Neurotransmitter: Norepinephrine

Question 4

Parasympathetic System

Answer 4

• Cholinergic System
• Rest and digest
• Neurotransmitter: Acetylcholine
• Aimed at conserving energy

Question 5

Alpha 1 receptors

Answer 5

• Division: SNS
• Location: peripheral blood vessels
• Action: increase BP

Question 6

Alpha 2 Receptors

Answer 6

• Division: SNS
• Location: presynaptic neurons
• Action: decrease in neurotransmitter release, therefore resulting in an antiandregenic effect

Question 7

Beta 1 Receptors

Answer 7

• Division: SNS
• Location: heart and kidney
• Action: increase heart rate and force of contraction, promoter release of renin, breakdown of stored fat into fatty acids

Question 8

Beta 2 Receptor

Answer 8

• Division: SNS
• Location: bronchial smooth muscle and blood vessel walls, brain scan heart
• Action: bronchodilation, uterus relaxes, increase blood flow to the heart, brain, and skeletal muscles

Question 9

Adrenergic Agonist

Answer 9

• Definition: sympathomimetic- mimic the effects of the SNS
• Uses: ophthalmic preps for dilating pupils and shock
• Nursing Considerations: assess for allergy and underlying disease, monitor BP, pulse, respirations, and urinary output, monitor labs, renal function, blood glucose, electrolytes, monitor cardiac status, ECG, monitor GI and GU status, avoid caffeine containing products and Ephedra

Question 10

Alpha- and Beta- Adregenic Agonist

Answer 10

• Nonselective
• Actions: HR increases, bronchi dilate, vasoconstriction, intraocular pressure decreases (simulate stimulating the SNS system)
• Indications: Treatment of hypotensive shock, bronchospasm, Pharmacokinetics: rapidly absorbed after injected or passage through the mucous membranes, metabolized in the liver and extremes in the kidneys.
• Contraindications: MI, tachyarrhythmias or ventricular fibrillation (too much stimulation), hypovolemia, Pheochromocytoma (hormone secreting tumor that is in the adrenal glands). CAUTION: peripheral vascular disease
• Adverse reactions: Arrhythmias, hypertension, palpitations, angina, dyspnea, nausea, vomiting, headache and sweating.
• Drug- to- Drug interactions: Tricyclic antidepressants, MAOI’s

Question 11

Alpha Adregenic Agonist

Answer 11

• Specific
• Definition: bind primarily to alpha and not beta receptors
• Actions: stimulation of Alpha receptors
• Adverse Reactions: (CNS) anxiety, restlessness, depression, fatigue, strange dreams, personality changes, blurred vision, sensitivity to light (CV) arrhythmias, ECG changes, BP changes, peripheral vascular problems (GI) nausea, vomiting, anorexia (GU) decreased urine output, difficulty urinating, dysuria, changes in sexual function (Other) do not suddenly stop these drugs- can lead to tachycardia, hypertension, arrhythmias, flushing and even death

Question 12

Beta Adrenergic Agonist

Answer 12

• Specific
• Actions: stimulate beta receptors, increase heart rate and contractility, bronchodilation, increase blood flow to skeletal muscles, relaxation of the uterus
• Adverse effects: restlessness, anxiety, fear, tachycardia, angina, MI, palpitations, difficulty breathing, cough, bronchspasm, nausea, vomiting, anorexia

Question 13

Adrenergic Antagonist

Answer 13

• Definition: Sympatholytic- lose or block the effects of the SNS
• Selective or Non-selective
• Action: prevent norepinephrine from activating the receptor

Question 14

Alpha 1 Selective Anti- Adrenergic Agents

Answer 14

• Specific
• Action: dilate blood vessels, decrease peripheral vascular resistance, relaxes smooth muscle
• Use: HTN, BPH (benign prostate hyperplasia), migraines
• Adverse reactions: hypotension, orthostatic hypotension, angina, MI, CVA, arrhythmia, weakness and dizziness

Question 15

Beta Anti- Adrenergic

Answer 15

• Non- selective or selective
• Action: block beta receptors, decrease HR, decrease myocardial contraction, decrease cardiac output, decreased release of renin from the kidneys
• Adverse Reactions: bradycardia, hypotension, nausea, vomiting
• Cautious: liver impairment, CAD
• Contraindicated: asthma, heart block, hypotension
• Nursing Implications: monitor pulse, BP and orthostatic changes, monitor respiratory status.

Question 16

Beta 1 Anti- Adrenergic

Answer 16

• Uses: hypertension, angina, some cardiac arrhythmias

Question 17

Cholinergic Agonist

Answer 17

• Definition: chemicals that act as the same site as ACh (stimulate PNS)
• Action: parasymphomimetic- mimic the action of the PNS
• not limited to a specific site
• Adverse effects: hypotension, decrease HR, SOB, nausea and vomiting, abdominal cramps, diarrhea, headache, blurred vision
• Used for: glaucoma, atomic bladder, urine retention, GI atony, Myastthenia gravis, Alzheimer’s Disease
• Contraindications: urinary or GI obstruction, asthma, CAD, hyperthyroidism
• Nursing Implications: Monitor BP and pulse, assess GI and GU systems, monitor output, assess respiratory status and difficulty for breathing

Question 18

Direct- Acting Cholinergic Agonist

Answer 18

• Treat: urinary retention, neurogenic bladder atony
• Actions: mimic the effects of ACh adds parasympathetic stimulations
• Indications: increases the tone of the bladder and relax the bladder sphincter
• Adverse effects: nausea, vomiting, cramps, diarrhea, increase salivation, and involuntary dedication, bradycardia, heart block, hypotension, urinary urgency, flushing or increased sweating.

Question 19

Indirect acting Cholinergic

Answer 19

• Helps treat Alzheimer’s
• Action: delay destruction of ACh, slows neuronal degradation, delays the onset of cognitive decline, may bring a slight improvement in cognition and function
• Caution: liver impairment

Question 20

Anti- Cholinergic Agents

Answer 20

• Action: block ACh, lyse or block effects of the PNS, also called parasypatholytic. Act by blocking/ occupying receptor sites on muscarinic receptors (increase in heart rate, decrease in GI activity, decrease in urinary bladder tone and function, pupil dilation, cyclopedia, same as stimulating SNS)
• Uses: (CV) reverse heart block, bradycardia (Respiratory) relieve bronchocontriction (GI disorders) peptic ulcers, gastritis, irritable bowel (GU) overactive bladder, urinary frequency (Other) Parkinson’s disease, excessive oral, gastric and respiratory secretions
• Adverse Effects: tachycardia, dry mouth, blurred vision, constipation, drowsiness, sedation, agitation, urinary retention, decreased sweating
• Contraindication: BPH, GI obstruction, Myastenia gravis, narrow angle glaucoma, tachydysrhythmias, MI, heart failure
• Nursing Considerations: monitor for reactions that increase anti- Cholinergic effects, some herbs, keep well hydrated and room cool
• Patient Teaching: avoid over heating, drink water, rinse mouth, good oral hygiene, hard candy, void before taking, report eye pain, avoid machinery.

Question 21

Anti- spasmatics

Answer 21

• Action: GI smooth muscle relax, directly blocks ACh, decrease intestinal motility/ spasm and pain
• Use: Irritable Bowel Syndrome
• Other Action: directly relax smooth muscle and inhibits the effects of ACh
• Other Use: Overactive bladder
• Adverse effects: blurred vision, nausea and vomiting, dysphasia, urinary hesitancy, urinary retention, decreases sweating
• Caution: renal or hepatic disease
• Contraindications: hypersensitivity, glaucoma, urinary bladder neck obstruction, GI obstruction, BPH, myasthenia gravis
• Nursing Indication: prevent interactions (drug/ herb)

Question 22

SLUDGE

Answer 22

Salivation
Lacrimation
Urination
Defication
Gastrointestinal distress
Emesis
(Cholinergic Effects)

Question 23

Anti- Cholinergic Effects

Answer 23

Can’t see
Can’t pee
Can’t spit
Can’t shit