NS 112 - PHARM - ANS Flashcards
1
Q
Divisions of the PNS
A
Motor (efferent) and sensory (afferent)
2
Q
- What does the Somatic nervous system innervate
- what are its actions
A
- Skeletal muscles
- controls voluntary movements
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
4
Q
What are the two divisions of the ANS - autonomic nervous system
A
Sympathetic and parasympathetic
5
Q
What direction do efferent nerve impulses move
A
They “exit“ - move away the CNS toward smooth muscle and visceral organs and glands
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
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.
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.
9
Q
Which part of the ANS uses epinephrine or norepinephrine as a neurotransmitter
A
Sympathetic nervous system - SNS
10
Q
Which part of the ANS uses acetylcholine as a neurotransmitter
A
Parasympathetic nervous system - PSNS
11
Q
What action or ‘reaction’ is the SNS (Sympathetic nervous system) responsible for
A
Fight or flight
12
Q
What action or ‘reaction’ is the PSNS (parasympathetic nervous system) responsible for
A
Rest and digest
13
Q
What neurotransmitter does the PSNS use
A
Acetylcholine
14
Q
What neurotransmitter/s does the SNS use
A
Epinephrine and norepinephrine
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
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
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
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
19
Q
What are the primary neurotransmitters in the ANS
A
+ epinephrine (Epi)
+ norepinephrine (NE)
+ acetylcholine (ACh)
20
Q
What is the simple explanation of “adrenergic”
A
“Like adrenaline”
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!!!!
22
Q
What circulates continuously in the SNS at low levels as a hormone
A
Norepinephrine
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!!!
24
Q
What is the most prevalent neurotransmitter in the body
A
Acetyl choline
25
What transmits all PSNS signals to end organs
Acetylcholine
26
What hormone or NT is CRUCIAL for arousal, learning, memory, motor function
Acetylcholine
27
What receptors does acetylcholine bind to and where
+ Muscarinic receptors in muscles with muscarinic transmitters
+ Nicotinic receptors as excitatory neurotransmitters in skeletal muscle, controls muscle contractions in these areas
28
What receptors is acetylcholine attaching to to bring about parasympathetic response
Muscarinic
29
What receptor is acetylcholine attaching to to bring about excitatory response
Nicotinic
30
 Meds that cause effects in the body similar to those produced by ACh are called…
+ cholinergic agonists
+ cholinergic
+ Parasympathomimetics
+ cholinomimetic
(Interchangeable)
31
Meds that cause effects similar to those produced by the adrenergic Neurotransmitter norepinephrine see called…
+ Adrenergic
+ adrenergic agonists
+ alpha or beta adrenergic agonists
+ sympathomimetics
(Interchangeable)
32
What is the main function of an agonist drug molecule
Bind to SPECIFIC receptors and cause a process in the cell to become more ACTIVE
33
What is the main function of an antagonist drug molecule
To BLOCK something else from attaching and causing an effect
34
The Function of direct acting drugs
To DIRECTLY stimulate receptor
35
The function of indirect acting drugs
To STIMULATE Neurotransmitters to be released and attached to receptor sites to illicit parasympathetic response
36
 Controls heart rate in the sympathetic and parasympathetic systems (2 things, 1 each system)
+ Sympathomimetics
+ para sympathomimetics
37
Function of alpha-1 Adrenergic receptor
+ VASOCONSTRICTION
+ NorEpi – “potent vasoconstrictor”
+ Sympathetic response
38
Function of alpha-2 adrenergic receptor
+ to STOP vasoconstriction from occurring
+ STOP nor epi
+ give alpha-2 agonist to lower blood pressure
39
Two alpha adrenergic receptors
Alpha-1 & Alpha-2
40
Two beta adrenergic receptors
Beta-1 and beta-2
41
Function of beta-1 receptors
HEART - ⬆️ HR
42
 Function of beta-2 receptors
LUNGS - Bronchodilation
43
Why are alpha-2 agonist drugs so important? Why and when do you want to give an alpha-2 agonist drugs
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 
44
Class of drugs affecting adrenergic function
+ Alpha and beta adrenergic agonist drugs
+ Sympathomimetics – mimic SNS
45
Example of how an alpha adrenergic agonist drug is used
+ In the ER – given IV for rapid onset, short duration
+ Action – stimulate heart rate, dilate bronchi, constrict blood vessels
46
What happens when you cross an adrenergic drugs with an adrenergic antagonist drug
+ The adrenergic drug loses effectiveness
+ Increase risk of hypertension including from OTC an herbal therapies like caffeine
47
Prototype of a nonselective adrenergic Agonist
Epinephrine 
48
Prototype of alpha-2 adrenergic agonist drug
Clonidine – stops NorEpi, vessels dilate and blood pressure drops
49
Prototype of beta-2 adrenergic agonist
Albuterol
50
Epinephrine is what classification of adrenergic agonist
Nonselective
51
Pharmacotherapeutics of Epinephrine
+ Allergic reactions
+ treatment of low blood pressure associated with septic shock
+ during eye surgery to maintain dilation
52
What are the pharmacodynamics of Epinephrine
+ 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
What is the classification of norepinephrine – Levophed
Adrenergic agonist with predominant alpha agonist affects
54
What are the pharmacotherapeutic‘s of Norepinephrine - Levophed
+ Severe hypotension
+ It is a strong vasoconstrictor
55
What are the pharmacodynamics of norepinephrine – Levophed
Predominantly alpha agonist affects:
+ POTENT peripheral arterial vasoconstriction
+ increaseS blood pressure
+ causes reduced renal flow
56
Why is Levophed (norepinephrine) to be used cautiously for Geri patients
Can cause/enhance Renal impairment
57
What would you teach your patience about adrenergic agonists
+ 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
Patient teaching – adverse effects of Norepi and other adrenergic drugs
+ 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
1. example of alpha-2 adrenergic agonist drug
2. Example of beta-2 adrenergic agonist drug
1. Clonidine
2. Albuterol
60
1. What organ do beta-1 blockers effect
2. what organs do beta-2 blockers effect
1. Heart
2. Lungs
61
What is the common name for beta adrenergic antagonists? What letters do they end in
+ Beta blockers
+ lol
62
What do beta blockers do, in an overall sense
Prevent stimulation of SNS by inhibiting catecholamines (nori and epi)
63
How are beta adrenergic antagonists grouped
Selective or non-selective
64
What is an example of a “nonselective beta blocker”
 Propanolol
65
1. Where are beta-1 receptor sites?
2. Where are beta-2 receptor sites?
1. Mainly in heart
2. Mainly in lungs, blood vessels, uterus
66
What drug is an example of a “selective” beta blocker (beta-1 adrenergic antagonist)
Metoprolol
67
Do “selective” beta blockers (adrenergic antagonist) effect beta-1 or beta-2 sites? What is their primary effect?
+ 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
What is the pharmacotherapeutic of a beta adrenergic antagonist drug
+ Angina
+ MI
+ hypertension
+ heart failure
+ dysrhythmias
69
What are beta blockers (adrenergic antagonists) responsible for in high doses
+ Even though they mainly effect BETA-1 sites, SELECTIVE beta blockers can still block BETA-2 sites in high doses causing BRONCHIAL CONSTRICTION! 
70
What is the action/MOA of beta blockers
+ Blocks beta receptors in heart
+ ⬇️ Heart rate
+ ⬇️ force of contraction
+ ⬇️ rate of A-V conduction
71
What are side effects of beta blockers (IMPORTANT)
+ Bradycardia
+ lethargy
+ G.I. disturbance
+ CHF
+ ⬇️⬇️⬇️ blood pressure
+ depression
72
What kind of drug is metoprolol
Selective beta adrenergic antagonist (beta-1, effects ❤️)
73
 What are the pharmacotherapeutics of Metropolol
+ Treatment of arrhythmias
+ hypertension
+ chronic angina
+ control heart failure
74
What are the pharmacodynamics of Metoprolol 
+ ⬇️ heart rate and contractibility
+ slows conduction
+ Decreases cardiac output
75
What kind of warning does metoprolol have: Contraindications and precautions, adverse effects
*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
Patient teaching for beta adrenergic antagonists (beta blockers)
+ 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
Beta blockers – what do you assess for?
+ Blood pressure
+ heart rate/apical pulse
+ respiration rate
+ blood glucose – can mask signs of hypoglycemia in diabetic patients
78
Side effects of adrenergic antagonists a.k.a. beta blockers
+ Hypotension
+ symptoms of CHF +bradycardia
+ drowsiness/depression
79
Two examples of adrenergic antagonists a.k.a. beta blockers
Propanolol and metoprolol 
80
What are 3 drugs from the lecture that affect cholinergic function
+ Bethanechol
+ nicotine
+ neostigmine
+ atropine
81
What drug is used for myasthenia gravis - cholinergic
Neostigmine
82
Do cholinergic agonists attach to receptors on the parasympathetic or the sympathetic nervous system
 parasympathetic
83
What type of drug is bethanechol as a cholinergic agonist
Direct acting muscarinic agonist
84
What type of drug is nicotine/clonidine as a cholinergic agonist
Direct-acting nicotinic agonist
85
What do direct acting nicotinic agonists do
They are muscle contractors
86
What type of drug is neostigmine as a cholinergic agonist
Indirect acting cholinergic agonist
87
What is an example of a direct acting muscarinic agonist drug
Bethanechol
88
What is an example of a direct acting nicotinic agonist drug
Nicotine/clonidine
89
What is an example of an indirect acting cholinergic agonist drug
Neostigmine
90
What is an example of a cholinergic antagonist drug
(IMPORTANT). What does this drug do?
Atropine
+ Blocks function of cholinergic response!!!
91
What do indirect acting cholinergic agonists do
STIMULATE Neuro transmitter acetylcholine
92
What type of receptor does acetylcholine always attached to
It ALWAYS attaches to cholinergic receptors
93
What happens when acetocholine is released
+ Travels across synapses
+ binds to cholinergic receptors on target organs
+ + brings about parasympathetic effects
94
What is a cholinergic receptor
A receptor that is stimulated by acetylcholine (ACh)
95
Name two cholinergic receptors
+ Muscarinic (M 1-5)
+ Nicotinic
- Nicotinic–N: Neuron
- nicotinic–M: Muscle
96
What happens when a nicotinic-N receptor is stimulated
Epinephrine is released
97
What happens with a nicotinic – M receptor is stimulated
skeletal muscles contract
98
What part of the ANS do cholinergic drugs impact
PSNS - parasympathetic nervous system
99
What do drugs classified as cholinergic agonists do
Stimulate cholinergic receptors
100
What do drugs classified as cholinergic antagonists do (aka anticholinergics)
Block cholinergic receptors and prevent ACh from attaching to receptor
101
What drug is an example of a cholinergic antagonist
Atropine
102
Does atropine, a cholinergic antagonist, cause SNS effects
NO!!! Atropine/cholinergic antagonists only bring body back to baseline!!
103
What enzyme inhibits cholinergic response
Cholinesterase
104
How do drugs effect the PSNS (basic explanation, not signs/symptoms)
+ By stimulating cholinergic receptors
+ by blocking cholinergic receptors so ACh cannot attach to the receptor
105
What do cholinergic antagonistic drugs do
 + Block the effects of acetylcholine ACh
+ Most are antagonists directly at the nicotinic or muscarinic receptors
106
What do cholinergic agonist drugs do
Mimic the action of acetylcholine ACh
107
Drugs that stimulate parasympathetic receptors are called… (interchangeable)
+ Parasympathetic agonists
+ para sympathomimetics
+ cholinergic agonist
+ cholinergics stimulant
+ cholinomimetic
108
1. 3 drugs that affect cholinergic function?
2. Which of the 3 is considered to be an anticholinergic/cholinergic antagonist? 
+ Neostigmine
+ bethanechol
+ atropine
ATROPINE is a cholinergic antagonist
109
What are the pharmacotherapeutic‘s for Bethanechol
Treatment of urinary retention
110
What are the pharmacodynamics for bethanechol
+ Increased muscle tone in the bladder
+ Promotes bladder emptying due to increase muscle tone
111
What would you teach your patient about bethanechol
+ Take on an empty stomach, one hour AC or two hours PC
+ Adverse effects:
- orthostatic hypotension
- cholinergic crisis
112
What is cholinergic crisis? A basic explanation
Too much cholinergic stimulation
113
What is the antidote for a cholinergic crisis
Atropine
114
What are signs and symptoms of a cholinergic crisis
+ Drooling
+ RR drops severely
+ severe respiratory secretions that you cannot clear
+ lethargy
+ hypotension
+ vomiting and diarrhea
115
In a cholinergic crisis, what does atropine do
Brings the organ system functions “back to baseline”
116
1. What are common side effects of atropine
2. What are adverse effects from too much atropine
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
True or false
Atropine overdose causes cholinergic crisis
FALSE
118
What happens when ACh leaks into the whole body in a cholinergic crisis?
It causes severe muscle contractions. But the body can’t stay in that state so then it goes limp and weak
119
What do you have to be careful of in the throat when giving atropine
A mucous plug could build up and block the airways
120
What receptors does atropine target
Muscarinic cholinergic receptors
121
What are the pharmacotherapeutics for atropine
+ Antidote to overdose of cholinergic drugs
+ decrease secretions
122
What are the pharmacodynamics for atropine
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
What are you assessing the patient for with they are taking cholinergic agonist and antagonist drugs
+ 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
Patient teaching about atropine
+ Avoid high temperatures
+ drink water frequently
+ rinse mouth frequently
+ void before taking medication
+ see ophthalmologist regularly
+ notify HCP if fever or weakness becomes severe
