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PHARM > NS 112 - PHARM - ANS > Flashcards

NS 112 - PHARM - ANS Flashcards

1
Q

Divisions of the PNS

A

Motor (efferent) and sensory (afferent)

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2
Q
  1. What does the Somatic nervous system innervate
  2. what are its actions
A
  1. Skeletal muscles
  2. controls voluntary movements
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3
Q

What does the ANS (autonomic nervous system) control

A

Involuntary activity in smooth muscle, secretary glands and the visceral organs of the body

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4
Q

What are the two divisions of the ANS - autonomic nervous system

A

Sympathetic and parasympathetic

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5
Q

What direction do efferent nerve impulses move

A

They “exit“ - move away the CNS toward smooth muscle and visceral organs and glands

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6
Q

What is the function of the ANS - Autonomic nervous system

A

+ Maintain constant internal environment
+ respond to stress
+ repair body tissues.

  • involuntary control of smooth muscle, heart, exocrine glands
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7
Q

What does adrenergic mean

A

+ “working on adrenaline (epinephrine) or noradrenaline (norepinephrine),” or on their receptors

*enhancing or mimicking the effects of epinephrine and norepinephrine in the body.

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8
Q

What does cholinergic mean

A

relating to nerve cells in which acetylcholine acts as a neurotransmitter.

**The parasympathetic nervous system, which uses acetylcholine almost exclusively to send its messages, is said to be almost entirely cholinergic.

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9
Q

Which part of the ANS uses epinephrine or norepinephrine as a neurotransmitter

A

Sympathetic nervous system - SNS

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10
Q

Which part of the ANS uses acetylcholine as a neurotransmitter

A

Parasympathetic nervous system - PSNS

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11
Q

What action or ‘reaction’ is the SNS (Sympathetic nervous system) responsible for

A

Fight or flight

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12
Q

What action or ‘reaction’ is the PSNS (parasympathetic nervous system) responsible for

A

Rest and digest

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13
Q

What neurotransmitter does the PSNS use

A

Acetylcholine

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14
Q

What neurotransmitter/s does the SNS use

A

Epinephrine and norepinephrine

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15
Q

What are examples of adrenergic responses in the body/Effector organs

A

+Pupils dilate
+salivary glands secrete thick fluid
+heart rate rises
+coronary arteries dilate
+ trachea and bronchioles dilate
+ blood vessels in skin and mucous membranes constrict + sweat produced
+G.I. motility and tone decreases
+ sphincter‘s contract
+ ureters/bladder relaxes
+ uterus relaxes
+ ejaculation stimulated in men

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16
Q

What are examples cholinergic reactions in the body/Effector organs

A

+ Pupils constrict + tears flow + salivary glands secrete watery fluid + trachea and bronchioles constrict and secretions increase + heart rate slows + coronary arteries constrict + G.I. glands produce more secretions + G.I. motility increases + lower colon contracts + ureters and bladder contract + penile erection stimulated in men

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17
Q

 How are the PSNS & the SNS of the ANS stimulated

A

Neuro transmitters and synaptic transmission

  • Neurotransmitters bind with receptors on “effector organs and tissues” to bring about an action
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18
Q

What are Neuro transmitters (primary)

A

Chemicals that originate inside the body that transmits signals across a synapse from one neuron to the next along a chain to a target cell

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19
Q

What are the primary neurotransmitters in the ANS

A

+ epinephrine (Epi)
+ norepinephrine (NE)
+ acetylcholine (ACh)

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20
Q

What is the simple explanation of “adrenergic”

A

“Like adrenaline”

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21
Q

Norepinephrine – main bullet points

A

+ Most common NT of SNS
+ both NT and hormone
+ + Acts mostly on ALPHA receptors
 + + + Specific action is to increase and MAINTAIN BP
+ ++ Continuously released in circulation at lower levels as hormone!!!!

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22
Q

What circulates continuously in the SNS at low levels as a hormone

A

Norepinephrine

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23
Q

Epinephrine – a.k.a. adrenaline - main bullet points

A

+ Both NT and hormone
+ acts more like a hormone
+ acts on both alpha and beta receptors
+ has wide ranging actions/affects: treats low BP assoc/septic shock, ER/allergic reactions, eye surgery/maintain dilation
+ + + ONLY RELEASED during times of stress!!!

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24
Q

What is the most prevalent neurotransmitter in the body

A

Acetyl choline

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25
Q

What transmits all PSNS signals to end organs

A

Acetylcholine

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26
Q

What hormone or NT is CRUCIAL for arousal, learning, memory, motor function

A

Acetylcholine

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27
Q

What receptors does acetylcholine bind to and where

A

+ Muscarinic receptors in muscles with muscarinic transmitters
+ Nicotinic receptors as excitatory neurotransmitters in skeletal muscle, controls muscle contractions in these areas

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28
Q

What receptors is acetylcholine attaching to to bring about parasympathetic response

A

Muscarinic

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29
Q

What receptor is acetylcholine attaching to to bring about excitatory response

A

Nicotinic

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30
Q

 Meds that cause effects in the body similar to those produced by ACh are called…

A

+ cholinergic agonists
+ cholinergic
+ Parasympathomimetics
+ cholinomimetic
(Interchangeable)

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31
Q

Meds that cause effects similar to those produced by the adrenergic Neurotransmitter norepinephrine see called…

A

+ Adrenergic
+ adrenergic agonists
+ alpha or beta adrenergic agonists
+ sympathomimetics
(Interchangeable)

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32
Q

What is the main function of an agonist drug molecule

A

Bind to SPECIFIC receptors and cause a process in the cell to become more ACTIVE

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33
Q

What is the main function of an antagonist drug molecule

A

To BLOCK something else from attaching and causing an effect

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34
Q

The Function of direct acting drugs

A

To DIRECTLY stimulate receptor

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35
Q

The function of indirect acting drugs

A

To STIMULATE Neurotransmitters to be released and attached to receptor sites to illicit parasympathetic response

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36
Q

 Controls heart rate in the sympathetic and parasympathetic systems (2 things, 1 each system)

A

+ Sympathomimetics
+ para sympathomimetics

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37
Q

Function of alpha-1 Adrenergic receptor

A

+ VASOCONSTRICTION
+ NorEpi – “potent vasoconstrictor”
+ Sympathetic response

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38
Q

Function of alpha-2 adrenergic receptor

A

+ to STOP vasoconstriction from occurring
+ STOP nor epi
+ give alpha-2 agonist to lower blood pressure

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39
Q

Two alpha adrenergic receptors

A

Alpha-1 & Alpha-2

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40
Q

Two beta adrenergic receptors

A

Beta-1 and beta-2

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41
Q

Function of beta-1 receptors

A

HEART - ⬆️ HR

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42
Q

 Function of beta-2 receptors

A

LUNGS - Bronchodilation

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43
Q

Why are alpha-2 agonist drugs so important? Why and when do you want to give an alpha-2 agonist drugs

A

Stops vasoconstriction of norepinephrine at alpha-1 receptors.
* Alpha-2 receptors are antagonist against alpha one.
** Alpha-2 agonist lower blood pressure by blocking norepinephrine, a vasoconstrictor 

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44
Q

Class of drugs affecting adrenergic function

A

+ Alpha and beta adrenergic agonist drugs
+ Sympathomimetics – mimic SNS

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45
Q

Example of how an alpha adrenergic agonist drug is used

A

+ In the ER – given IV for rapid onset, short duration
+ Action – stimulate heart rate, dilate bronchi, constrict blood vessels

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46
Q

What happens when you cross an adrenergic drugs with an adrenergic antagonist drug

A

+ The adrenergic drug loses effectiveness
+ Increase risk of hypertension including from OTC an herbal therapies like caffeine

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47
Q

Prototype of a nonselective adrenergic Agonist

A

Epinephrine 

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48
Q

Prototype of alpha-2 adrenergic agonist drug

A

Clonidine – stops NorEpi, vessels dilate and blood pressure drops

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49
Q

Prototype of beta-2 adrenergic agonist

A

Albuterol

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50
Q

Epinephrine is what classification of adrenergic agonist

A

Nonselective

51
Q

Pharmacotherapeutics of Epinephrine

A

+ Allergic reactions
+ treatment of low blood pressure associated with septic shock
+ during eye surgery to maintain dilation

52
Q

What are the pharmacodynamics of Epinephrine

A

+ Stimulates all adrenergic receptors and causes increased blood pressure
+ increased heart rate and force of contraction
+ hyperglycemia
+ bronchodilation
+ vasoconstriction of arterials in skin
+ mucosa and most viscera
+ CAUSES: nervousness, restlessness, tremors, insomnia, angina, arrhythmias, hypertension, tachycardia

53
Q

What is the classification of norepinephrine – Levophed

A

Adrenergic agonist with predominant alpha agonist affects

54
Q

What are the pharmacotherapeutic‘s of Norepinephrine - Levophed

A

+ Severe hypotension
+ It is a strong vasoconstrictor

55
Q

What are the pharmacodynamics of norepinephrine – Levophed

A

Predominantly alpha agonist affects:
+ POTENT peripheral arterial vasoconstriction
+ increaseS blood pressure
+ causes reduced renal flow

56
Q

Why is Levophed (norepinephrine) to be used cautiously for Geri patients

A

Can cause/enhance Renal impairment

57
Q

What would you teach your patience about adrenergic agonists

A

+ Diabetes – monitor glucose levels – adrenergic medication may elevate glucose
+ If using IV adrenergic drugs to ⬆️ ❤️, ⬆️ BP - frequent ❤️monitoring, ❤️rate, BP, urine output is necessary
+ Anaphylactic shock – learn how to self administer injection, carry injection kit
+ Food allergy – always ask about ingredients
+ Wear ID bracelet

58
Q

Patient teaching – adverse effects of Norepi and other adrenergic drugs

A

+ Possible diminished renal and urine output
+ possible decrease liver perfusion and damage
+ possible cardiac dysrhythmias - beta-1 activity
+ hyperglycemia, hyperkalemia
+ severe hypertension and reflex bradycardia
+ limb ischemia due to vasoconstriction

59
Q
  1. example of alpha-2 adrenergic agonist drug
  2. Example of beta-2 adrenergic agonist drug
A
  1. Clonidine
  2. Albuterol
60
Q
  1. What organ do beta-1 blockers effect
  2. what organs do beta-2 blockers effect
A
  1. Heart
  2. Lungs
61
Q

What is the common name for beta adrenergic antagonists? What letters do they end in

A

+ Beta blockers
+ lol

62
Q

What do beta blockers do, in an overall sense

A

Prevent stimulation of SNS by inhibiting catecholamines (nori and epi)

63
Q

How are beta adrenergic antagonists grouped

A

Selective or non-selective

64
Q

What is an example of a “nonselective beta blocker”

A

 Propanolol

65
Q
  1. Where are beta-1 receptor sites?
  2. Where are beta-2 receptor sites?
A
  1. Mainly in heart
  2. Mainly in lungs, blood vessels, uterus
66
Q

What drug is an example of a “selective” beta blocker (beta-1 adrenergic antagonist)

A

Metoprolol

67
Q

Do “selective” beta blockers (adrenergic antagonist) effect beta-1 or beta-2 sites? What is their primary effect?

A

+ Primarily effect beta-1 but in high doses can affect the beta-2 receptors in lungs!
+ effects on beta-1 sites are tachycardia and inotropy

68
Q

What is the pharmacotherapeutic of a beta adrenergic antagonist drug

A

+ Angina
+ MI
+ hypertension
+ heart failure
+ dysrhythmias

69
Q

What are beta blockers (adrenergic antagonists) responsible for in high doses

A

+ Even though they mainly effect BETA-1 sites, SELECTIVE beta blockers can still block BETA-2 sites in high doses causing BRONCHIAL CONSTRICTION! 

70
Q

What is the action/MOA of beta blockers

A

+ Blocks beta receptors in heart
+ ⬇️ Heart rate
+ ⬇️ force of contraction
+ ⬇️ rate of A-V conduction

71
Q

What are side effects of beta blockers (IMPORTANT)

A

+ Bradycardia
+ lethargy
+ G.I. disturbance
+ CHF
+ ⬇️⬇️⬇️ blood pressure
+ depression

72
Q

What kind of drug is metoprolol

A

Selective beta adrenergic antagonist (beta-1, effects ❤️)

73
Q

 What are the pharmacotherapeutics of Metropolol

A

+ Treatment of arrhythmias
+ hypertension
+ chronic angina
+ control heart failure

74
Q

What are the pharmacodynamics of Metoprolol 

A

+ ⬇️ heart rate and contractibility
+ slows conduction
+ Decreases cardiac output

75
Q

What kind of warning does metoprolol have: Contraindications and precautions, adverse effects

A

Blackbox warning
+ Abrupt cessation will cause exacerbation of symptoms
+ CAUTION if you have: bradycardia, asthma, diabetes
+ ADVERSE side effects: bradycardia, hypertension, depression, bronchoconstriction/bronchospasm

76
Q

Patient teaching for beta adrenergic antagonists (beta blockers)

A

+ To prevent rebound symptoms: DO NOT ABRUPTLY
stop medication
+ Prior to dose: check the apical and peripheral pulses, monitor blood pressure and cardiac rhythm
+ Teaching: take with food to decrease G.I. upset and increase bioavailability

77
Q

Beta blockers – what do you assess for?

A

+ Blood pressure
+ heart rate/apical pulse
+ respiration rate
+ blood glucose – can mask signs of hypoglycemia in diabetic patients

78
Q

Side effects of adrenergic antagonists a.k.a. beta blockers

A

+ Hypotension
+ symptoms of CHF +bradycardia
+ drowsiness/depression

79
Q

Two examples of adrenergic antagonists a.k.a. beta blockers

A

Propanolol and metoprolol 

80
Q

What are 3 drugs from the lecture that affect cholinergic function

A

+ Bethanechol
+ nicotine
+ neostigmine
+ atropine

81
Q

What drug is used for myasthenia gravis - cholinergic

A

Neostigmine

82
Q

Do cholinergic agonists attach to receptors on the parasympathetic or the sympathetic nervous system

A

 parasympathetic

83
Q

What type of drug is bethanechol as a cholinergic agonist

A

Direct acting muscarinic agonist

84
Q

What type of drug is nicotine/clonidine as a cholinergic agonist

A

Direct-acting nicotinic agonist

85
Q

What do direct acting nicotinic agonists do

A

They are muscle contractors

86
Q

What type of drug is neostigmine as a cholinergic agonist

A

Indirect acting cholinergic agonist

87
Q

What is an example of a direct acting muscarinic agonist drug

A

Bethanechol

88
Q

What is an example of a direct acting nicotinic agonist drug

A

Nicotine/clonidine

89
Q

What is an example of an indirect acting cholinergic agonist drug

A

Neostigmine

90
Q

What is an example of a cholinergic antagonist drug
(IMPORTANT). What does this drug do?

A

Atropine
+ Blocks function of cholinergic response!!!

91
Q

What do indirect acting cholinergic agonists do

A

STIMULATE Neuro transmitter acetylcholine

92
Q

What type of receptor does acetylcholine always attached to

A

It ALWAYS attaches to cholinergic receptors

93
Q

What happens when acetocholine is released

A

+ Travels across synapses
+ binds to cholinergic receptors on target organs
+ + brings about parasympathetic effects

94
Q

What is a cholinergic receptor

A

A receptor that is stimulated by acetylcholine (ACh)

95
Q

Name two cholinergic receptors

A

+ Muscarinic (M 1-5)
+ Nicotinic
- Nicotinic–N: Neuron
- nicotinic–M: Muscle

96
Q

What happens when a nicotinic-N receptor is stimulated

A

Epinephrine is released

97
Q

What happens with a nicotinic – M receptor is stimulated

A

skeletal muscles contract

98
Q

What part of the ANS do cholinergic drugs impact

A

PSNS - parasympathetic nervous system

99
Q

What do drugs classified as cholinergic agonists do

A

Stimulate cholinergic receptors

100
Q

What do drugs classified as cholinergic antagonists do (aka anticholinergics)

A

Block cholinergic receptors and prevent ACh from attaching to receptor

101
Q

What drug is an example of a cholinergic antagonist

A

Atropine

102
Q

Does atropine, a cholinergic antagonist, cause SNS effects

A

NO!!! Atropine/cholinergic antagonists only bring body back to baseline!!

103
Q

What enzyme inhibits cholinergic response

A

Cholinesterase

104
Q

How do drugs effect the PSNS (basic explanation, not signs/symptoms)

A

+ By stimulating cholinergic receptors
+ by blocking cholinergic receptors so ACh cannot attach to the receptor

105
Q

What do cholinergic antagonistic drugs do

A

 + Block the effects of acetylcholine ACh
+ Most are antagonists directly at the nicotinic or muscarinic receptors

106
Q

What do cholinergic agonist drugs do

A

Mimic the action of acetylcholine ACh

107
Q

Drugs that stimulate parasympathetic receptors are called… (interchangeable)

A

+ Parasympathetic agonists
+ para sympathomimetics
+ cholinergic agonist
+ cholinergics stimulant
+ cholinomimetic

108
Q
  1. 3 drugs that affect cholinergic function?
  2. Which of the 3 is considered to be an anticholinergic/cholinergic antagonist? 
A

+ Neostigmine
+ bethanechol
+ atropine

ATROPINE is a cholinergic antagonist

109
Q

What are the pharmacotherapeutic‘s for Bethanechol

A

Treatment of urinary retention

110
Q

What are the pharmacodynamics for bethanechol

A

+ Increased muscle tone in the bladder
+ Promotes bladder emptying due to increase muscle tone

111
Q

What would you teach your patient about bethanechol

A

+ Take on an empty stomach, one hour AC or two hours PC
+ Adverse effects:
- orthostatic hypotension
- cholinergic crisis

112
Q

What is cholinergic crisis? A basic explanation

A

Too much cholinergic stimulation

113
Q

What is the antidote for a cholinergic crisis

A

Atropine

114
Q

What are signs and symptoms of a cholinergic crisis

A

+ Drooling
+ RR drops severely
+ severe respiratory secretions that you cannot clear
+ lethargy
+ hypotension
+ vomiting and diarrhea

115
Q

In a cholinergic crisis, what does atropine do

A

Brings the organ system functions “back to baseline”

116
Q
  1. What are common side effects of atropine
  2. What are adverse effects from too much atropine
A
  1. Dry mouth + constipation + urinary retention + blurred vision + tachycardia + lack of sweating

2.
* Dry as a bone - dry mouth
* Hot as a hare - Increased temp, decreased sweating
* Mad as a Hatter - confusion, delirium
* Blind as a bat - blurred vision
* Red as a beet - flush face, tachycardia

117
Q

True or false

Atropine overdose causes cholinergic crisis

A

FALSE

118
Q

What happens when ACh leaks into the whole body in a cholinergic crisis?

A

It causes severe muscle contractions. But the body can’t stay in that state so then it goes limp and weak

119
Q

What do you have to be careful of in the throat when giving atropine

A

A mucous plug could build up and block the airways

120
Q

What receptors does atropine target

A

Muscarinic cholinergic receptors

121
Q

What are the pharmacotherapeutics for atropine

A

+ Antidote to overdose of cholinergic drugs
+ decrease secretions

122
Q

What are the pharmacodynamics for atropine

A

Strong inhibitor of cholinergic receptors:
+ Increase heart rate
+ decreased secretions/salivary/bronchial/sweat glands
+ Mydriasis/enlarged pupils
+ Contraction of the bladder/G.I. smooth muscle
+ decrease G.I. motility
+ decrease gastric secretions + drowsiness
+ interfere with EKG

123
Q

What are you assessing the patient for with they are taking cholinergic agonist and antagonist drugs

A

+ OTC medications and herbal supplements
+ Bradycardia at low doses
+ tachycardia high doses
+ geriatric CNS - nervousness, weakness, confusion, excitement
+ increased temp: geriatric and kids are prone to hyperpyrexia due to suppression of perspiration and heat loss

124
Q

Patient teaching about atropine

A

+ Avoid high temperatures
+ drink water frequently
+ rinse mouth frequently
+ void before taking medication
+ see ophthalmologist regularly
+ notify HCP if fever or weakness becomes severe

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