Nervous System Flashcards

1
Q

Alpha Adrenergic Agonists

A

Epinephrine, Norepinephrine, ephedrine, phenylephrine

Indication: Cardiac arrest, shock, hypotension, control bleeding anaphylaxis | nasal decongestant

Action: Activates the alpha receptors of the sympathetic nervous system → FIGHT OR FLIGHT
Results in: vasoconstriction, pupil constriction

Nursing Considerations:
● Adverse effects:
○ Hypertension, tachycardia angina, hyperglycemia, necrosis is drug extravasates
● Drug interactions
○ MAOIs
○ TCAs
○ Alpha or beta blockers
● Ephedrine/Phenylephrine - local effects of vasoconstriction used in nasal sprays for congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Alpha Adrenergic Antagonists

A

Prazosin, Doxazosin, Terazosin, Tamsulosin, Alfuzosin, Silodosin, Phentolamine

Indication: Hypertension, BPH, Raynaud’s disease, pheochromocytoma

Action: Blocks activation of alpha receptors in the sympathetic nervous system - stops fight or flight
resulting in: vasodilation, decreased BP

Nursing Considerations:
● Adverse effects: hypotension, reflex tachycardia, nasal congestion
○ First dose effect: significant orthostatic hypotension with first dose. Take at bedtime!
● Not safe in children, pregnancy, or breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Beta Adrenergic Agonists - Non-selective

A

Propranolol, nadolol, pindolol, sotalol, timolol

Indication: HTN, angina, dysrhythmias, MI

Action: Blocks activation of beta ONE and TWO receptors in the sympathetic nervous system -
stops fight or flight resulting in: decreased HR, decreased force of contraction, suppression of
impulse conduction through the AV node (𝛃-1) AND bronchoconstriction, decreased
gluconeogenesis (𝛃-2)

Nursing Considerations:
● Adverse effects:
○ Bradycardia → Avoid if client is in SB or has an AV block
○ HF → Avoid in clients with HR (it decreases the CO!)
○ Bronchoconstriction → Extreme caution in asthmatics!
○ Hypoglycemia → Caution in diabetics! Warn them will mask typical symptoms of hypoglycemia!
○ Rebound cardiac excitation → never discontinue abruptly - taper off!
○ Depression → Caution in clients with mental health conditions
● Caution in clients with life threatening allergies (if on a BB, epi will be less effective if they have a reaction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Beta Adrenergic Antagonists - Selective

A

Metoprolol, Acebutolol, Atenolol, Betaxolol, Bisoprolol, Esmolol, carvedilol, labetalol

Indication: HRN, angina, HF, MI

Action: Blocks activation of beta ONE receptors in the sympathetic nervous system - stops fight or
flight resulting in: decreased HR, decreased force of contraction, suppression of impulse conduction
through the AV node

Nursing Considerations:
● Adverse effects:
○ Bradycardia → Avoid if client is in SB or has an AV block
○ Rebound cardiac excitation → never discontinue abruptly - taper off!
● *Safer for asthma! No 𝛃-2 action = no bronchoconstriction
● *Safer for diabetics! No 𝛃-2 action = no hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cholinergics

A

Muscarinic Agonists: Bethanechol, Cevimeline, Pilocarpine

Cholinesterase Inhibitors: Pyridostigmine, neostigmine, physostigmine, edrophonium, rivastigmine

Indication: Urinary retention, GERD, MG, Alzheimer’s, Glaucoma

Action: The neurotransmitter of the parasympathetic nervous system is acetylcholine. Cholinergic
drugs stimulate cholinergic receptors or increase acetylcholine and therefore cause REST AND
DIGEST: Increase GI secretions and motility, increase urination and urinary function, pupil
constriction (miosis), decrease HR

Nursing Considerations:
● Monitor for cholinergic side effects: increased secretions, increased urination, miosis, etc.
● Monitor for bradycardia
● Contraindications: Intestinal obstruction, urinary tract obstruction, asthma, hyperthyroidism, hypotension
● Education: take on an empty stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Muscarinic Poisoning

A

TOO many muscarinic receptors are activated OR too many cholinesterase
inhibitors are breaking down cholinesterase…. Causing TOO MUCH acetylcholine.
TOO MUCH rest and digest!
Causes:
● Medication OD
● Toxic mushrooms
Treatment: Atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anticholinergics

A

Muscarinic Antagonists: Atropine, scopolamine, ipratropium bromide, dicyclomine, oxybutynin, tolterodine

Indication: Sinus bradycardia, AV block, eye exams, asthma, excessive secretions, intestinal
hypertonicity, overactive bladder

Action: Block acetylcholine in the parasympathetic nervous system thereby blocking REST AND
DIGEST functions. Causes: increased HR, pupil dilation, bronchodilation, decreased secretions,
sweating, GI motility, urinary retention

Nursing Considerations:
● Adverse effects:
○ Increased IOP (→blurry vision/photophobia) - avoid in glaucoma!
○ Urinary retention → caution in BPH
○ Bronchial plugging → caution in asthma
○ Constipation, xerostomia, tachycardia, anhidrosis
● Contraindication: MG, glaucoma, urinary or intestinal obstruction, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anticholinergic toxicity

A

Activated charcoal
○ Decrease absorption of the drug
● Physostigmine
○ Antidote
○ Cholinergic drug

Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Central Nervous System Drugs

A

Anti-Parkinson Drugs
○ Levodopa
○ Levodopa/Carbidopa
● Drugs for memory
○ Cholinesterase inhibitors
● Anticonvulsants
○ Long-term
○ Rapid acting
● Drugs for spasticity/spasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anti-Parkinson Drugs

A

Names: Levodopa, Levodopa/Carbidopa
Carbidopa inhibits the breakdown of levodopa so it lasts longer!

Indication: Parkinson’s disease

Action: Increases dopamine synthesis resulting in more dopamine, and less motor
symptoms in parkinson’s disease.

Nursing Considerations:
● Full therapeutic response takes a few months to develop
● Beneficial effects wear off over time
● Side effect: nausea/vomiting. Take with low-fat, low protein foods.
● Can cause postural hypotension/dizziness - move slowly when changing positions
● Adverse effect: psychosis (visual hallucinations, vivid dreams, paranoid ideation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cholinesterase inhibitors

A

Names: Donepezil, rivastigmine, galantamine

Indication: Alzheimer’s, Dementia

Action: Prevent breakdown of acetylcholine; increasing its’ bioavailability which results in
better transmission in central cholinergic neurons. Causes improved memory, thought, and
reasoning.

Nursing Considerations:
● These medications do not cure AD or stop it’s progression - they improve symptoms in
mild to moderate AD
● Cholinergic side effects, bronchoconstriction*, CV effects (bradycardia)
● *Caution in clients with asthma or COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anticonvulsants - Long Term

A

Names: Phenytoin, fosphenytoin, carbamazepine, phenobarbital, valproic acid

Indication: Seizures

Action: Selectively inhibits sodium channels, suppressing action potentials in hyperactive
neurons. Stops the ‘seizure-generating neurons’ activity - while leaving healthy neurons
alone!

Nursing Considerations:
● Phenytoin therapeutic level: 10-20 mcg/mL
● Side effect: gingival hyperplasia → Regular dental check-ups + Use soft bristle toothbrush
● Antacids can reduce the effect of phenytoin and should be avoided
● Serious pregnancy effects
○ Phenytoin is a known teratogen
● Interact with many drugs
○ No alcohol/other CNS depressants
○ Consult with HCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anticonvulsants - Rapid Acting/Emergent

A

Names: Lorazepam, diazepam
Indication: Seizures
Action: CNS depression
Nursing Considerations:
● Monitor for respiratory depression
● Antidote - flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Muscle Relaxer

A

Names: Baclofen, dantrolene, cyclobenzaprine, chlorzoxazone, tizanidine

Indication: Spasticity, spasms (MS, SCI)

Action: Suppresses hyperactive reflexes in the spinal cord - decreasing spasms
and resistance to passive movement

Nursing Considerations:
● CNS side effects: drowsiness, dizziness, weakness, fatigue
○ Serious hypotension can occur!
○ Avoid alcohol or other CNS depressants
● Do not discontinue abruptly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly