Nervous System Flashcards by Kevin Park

What drugs are considered as Adrenergic Agonists?

Epinephrine

Albuterol

Clonidine

Atenolol

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What do Adrenergic agonists do?

Drugs that stimulate the SNS

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What is the primary neurotransmitter that is responsible for most of the adrenergic activities?

Norepinephrine

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What are the two different classifications of Adrenergic Agonists?

Direct = Directly stimulating receptors

Indirect = Stimulates release of norepinephrine

Mixed-Acting = Both direct and indirect

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What is Catecholamine?

A chemical structure of a substance that can produce a sympathomimetic response.

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What do Alpha 1 Receptors do and what do they affect?

Causes blood vessels to vasoconstriction = Increased BP

Causes Mydriasis (pupil dilation) in the eyes

Causes Bladder relaxation

Causes prostate to contract.

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What do Alpha 2 Receptors do and what do they affect?

Affects blood vessels by reducing norepinephrine which causes decreased BP

Causes decreased GI tone and motility by affecting smooth muscle of GI

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What do Beta 1 Receptors do and what do they affect?

Affects the heart by increasing heart contraction and heart rate.

Affects kidney by increasing renin and angiotensin production which increases blood pressure

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What do Beta 2 Receptors do and what do they affect?

Decreases GI tone and Motility

Causes bronchodilation

Causes Uterine smooth muscles to relax

Activates glycogenolysis in the liver which then increases Blood sugar.

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`What is the MOA of Epinephrine?

Acts on Alpha 1, Beta 1, and Beta 2 Receptors

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What is Epinephrine used for?

Nasal congestion

Allergic reaction

anaphylaxis

asthma

bronchospasm

angioedema

status asthmaticus (asthma attack)

cardiac arrest

Cardiac resuscitation

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What is the SE and ASE of Epinephrine?

Tachycardia

Hypertension

Tissue necrosis if IV infiltrates

Agitation

Hyperglycemia

V-fib

pulmonary edema

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Route of Administration of Epinephrine?

Inhalation

Topical

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True or false? Epinephrine is considered as an emergency response medication?

True

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What are the contraindications for Epinephrine?

Dysrhythmia, glaucoma and cardiogenic shock

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What should be monitored when patient is on epinephrine?

Monitor EKG

Monitor VS

Monitor Urine output for Urinary retention

Monitor glucose levels for elevation

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What should taught to a patient about epinephrine?

Epi-pen should be available at all times

Use at onset of symptoms

Make sure epi-pen is not expired.

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When administrating Epinephrine through IV, what are the nursing considerations?

IV for cardiac resuscitation should only be at 1 mg every 3-5 minutes

Monitor IV site for extravasation of drugs. Extravasation can cause tissue necrosis.

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What is class is Albuterol considered?

Beta-adrenergic agoinist

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What is the MOA of albuterol?

Stimulates Beta 2 adrenergic receptors in the lungs.

This causes bronchodilation by relaxing bronchial smooth muscles.

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What is Albuterol used for?

Asthma and prophylaxis fore bronchospasms.

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What are the SE/ASE of Albuterol?

Tremors

Dizziness

Palpitations/Tachycardia

HTN

Anxiety

Headache

Insomnia

Hyperglycemia

Dysthymia

Angioedema

Stevens-Johnson Syndrome

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What should patients on albuterol know?

Have albuterol available at all times

Exercise can induce asthma so you may have to take some albuterol prior to exercising.

Tremors, dizziness, palpitations and tachycardia are common side effects of albuterol.

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What should the nurse assess the patient on albuterol for?

Oxygen saturation

Lung sounds (any airway constrictions? )

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True or false? A nurse should assess VS and lungs before and after giving albuterol?

True

What drug class is Clonidine?

Central-acting alpha agonist.

What is the MOA of Clonidine?

Stimulates Alpha 2 receptors in the central nervous system. Decreases Release of NE from sympathetic nerves Decreases peripheral adrenergic receptor activation

What is Clonidine used for?

Hypertension

What is the Off-Label use of Clonidine?

ADHD

What are the SE/ASE of Clonidine?

Headache Nasal Congestion Drowsiness Ejaculation dysfunction Elevated liver enzymes

What are the Nursing Considerations for Clonidine?

Monitor VS and BP Monitor CBP for elevated liver enzymes

What do Adrenergic Antagonists/Blockers do?

Blocks effects of adrenergic transmitters. It does this either directly occupying receptor space or inhibits release of neurotransmitters.

True or false? Most Adrenergic antagonists block either alpha or beta receptors?

True

Blocking Alpha 1 receptors produces what kinds of response?

Miosis (constriction of the pupils) Vasodilation (decreases BP, reflex tachycardia may occur) Suppress ejaculation Reduce contraction of smooth muscles in bladder neck and prostate gland.

Blocking Beta 1 receptors produces what kinds of response?

Decreases HR Reduces force of myocardial contraction

Blocking Beta 2 receptors produces what kinds of response?

Constricts bronchioles Contracts uterus Inhibits glycogenolysis = Decrease Blood Glucose.

What class drug is Atenolol?

Beta 1 Adrenergic blocker.

What is the MOA of Atenolol?

Selectively blocks Beta-1 Adrenergic receptor sites. Decreases sympathetic outflow to the periphery Suppresses RASS

What is Atenolol used for?

HTN Angina Prophylaxis of AMI

What are the SE/ASE of Atenolol?

Drowsiness Dizziness ED Hypotension Bradycardia Bronchospasm Dysrhythmia Bronchospasm

What do Cholinergic agonist drugs do?

Stimulate the parasympathetic nervous system Mimics the action of acetylcholine

What are the two types of cholinergic receptors?

Muscarinic (affects smooth muscle) NIcotinic ( neuromuscular)

What are the two types of Cholinergic agonists?

Direct acting = Directly binds to receptors Indirect acting = Binds to acetylcholinesterase to slow down breakdown of acetylcholine, which means more acetylcholine

What class drug is Bethanechol chloride?

Parasympathomimetic Cholinergic drug

What is the MOA of Bethanechol chloride?

Stimulates cholinergic (muscarinic) receptors

What is Bethanechol chloride used for?

Urinary retention and neurogenic bladder

What are the contraindications for Bethanechol chloride?

Intestinal or urinary tract obstruction IBS (irritable Bowel syndrome) Bradycardia COPD Asthma

What are the SE/ASE of Bethanechol chloride?

Hypersalivation Sweating Urinary urgency/frequency Tachycardia Weakness Bronchospasm Cholinergic crisis

What should the nurse assess for in a patient with Bethanechol chloride?

VS Urine output Heath history (asthma, urinary obstruction)

What is the antidote for Bethanechol chloride?

Atropine sulfate

What needs to be monitored for a patient on Bethanechol chloride?

I&O Lung sounds rales/ronchi Signs of cholinergic crisis

What should be taught to a patient on Bethanechol chloride?

Slow position changes due to orthostatic hypotension Report any breathing difficulty and urinary problems

What does SLUD stand for in cholinergic crisis?

Salivation Lacrimation Urination Defection

What do Cholinergic Antagonists do?

Inhibit actions of acetylcholine by blocking acetylcholine receptors

What do Cholinergic Antagonists affect?

Heart Respiratory Tract GI tract Urinary system Eyes Exocrine glands

What class drug is Atropine?

Anticholinergic

What is the MOA of Atropine?

Inhibits acetylcholine by occupying receptors

What is Atropine used for?

Pre-op med to reduce salivation Increase Heart rate Dilate pupils

What is the SE/ASE of Atropine?

Dry mouth Urinary retention Tachycardia Paradoxic bradycardia Pulmonary Edema Laryngospasm ANTICHOLINERGIC TOXICITY

What are the contraindications of Atropine?

Glaucoma BPH MI Myasthenia Gravis

What precautions should a nurse know about with Atropine?

Renal or hepatic disorder COPD HF

What should nurses monitor for?

VS I&O Bowel sounds/constipation Mouth care.

What should a patient on Atropine do if they have dry mouth? What if they have constipation?

For dry mouth, suck on hard, sour candy and suck on ice chips to decrease salivation For Constipation, encourage more fluid intake and exercise

What are the signs of Anticholinergic Toxicity?

Dilated Pupils (mydriasis) Confusion Dry mouth Urinary retention haking Flushed skin tachycardia Absent bowel sounds Hyperthermia Grabbing invisible objects

What class drug is Benztropine?

Antiparkinson, Anticholinergic Agent

What is the MOA of Benztropine?

Blocks cholinergic (muscarinic) receptors Decreases acetylcholine to reduce excess cholinergic activity Blocks dopamine reuptake

What is Benztropine used for?

Decrease involuntary symptoms of Parkinsonism like tremors and muscle spasms

What are the contraindications of Benztropine?

Glaucoma Myasthenia gravis Tardive dyskinesia (involuntary and abnormal movements of the jaw, lips and tongue)

What are the SE/ASE of Benztropine?

Urinary retention Ocular hypertension Ileus Hyperthermia Hallucinations (esp with older patients) paresthesia

What are some things nurses need to know about Benztropine?

It has little effect on mobility and muscle weakness Can only be used in early stages of parkinsonism. Remember that ileus is life threatening and the intestines no longer moves.

What class drug is Tolterodine Tartrate?

Antimuscarinic; Anticholinergic Agent.

What is the MOA of Tolterodine Tartrate?

Blocks cholinergic (muscarinic) receptors selectively in the urinary bladder

What is Tolterodine Tartrate used for?

Decrease urinary frequency, urgency, incontinence

What are the contraindications of Tolterodine Tartrate?

Urinary retention Gastric paresis Glaucoma GI obstruction

What are the SE/ASE of Tolterodine Tartrate?

Angioedema Chest pain tachycardia peripheral edema dry eyees blurred vision confusion