Parasympathetic ANS Flashcards
Fill out the sympathetic / parasympathetic table.
(˶ᵔ ᵕ ᵔ˶)
What are the two divisions of the ANS and their catch phrases?
Sympathetic = “Fight or Flight“, “Stressed”
Parasympathetic = “Rest and Digest“, “Peace”
What are the three types of autonomic division control?
Generally: Opposition (two divisions compete)
Rare: Complementary (can work in synergy)
Rare: Sometimes only one division controls
What type of activities are involved in Sympathetic “E”?
- Involves E activities – exercise, excitement, emergency, and embarrassment
- Promotes adjustments during exercise – blood flow to organs is reduced, flow to muscles is increased
How would you illustrate the activity of Sympathetic “E”?
- Its activity is illustrated by a person who is threatened
~ Heart rate increases, and breathing is rapid and deep
~ The skin is cold and sweaty, and the pupils dilate
~ Mydriasis - “Wide Eyed with Fright”
What types of activities are involved in Parasympathetic “D”?
- Involves the D activities – digestion, defecation, and diuresis
- Concerned with keeping energy use low in the body
How would you illustrate the activity of Parasympathetic “D”?
- Its activity is illustrated in a person who relaxes after a meal
~ Blood pressure, heart rate, and respiratory rates are low
~ Gastrointestinal tract activity is high
~ The skin is warm, and the pupils are constricted
~ Miosis
What divisions are equal to parasympathetic and sympathetic? Give examples of neurotransmitters for each.
- Parasympathetic / Cholinergic Division
~ Acetylcholine (ACh) - Sympathetic / Adrenergic Division
~ Adrenaline (in the U.S. we call this Epinephrine)
Describe the two types of cholinergic receptors.
- Nicotinic Neuro Muscular Junction (NMJ)
~ These receptors are essential for SKELETAL MUSCLE control (skeletal, diaphragm) - Muscarinic (M1- M5)
~ These receptors are essential for SMOOTH MUSCLE control and work on various organs
~ Examples of smooth muscle include lung bronchioles, GI Tract, and Bladder
Describe muscarinic response during a cholinergic crisis.
SLUDGE (M) and the Killer B’s
- Salivation/Secretions (mouth, GI tract, lungs)
- Lacrimation (tear production)
- Urination (voiding)
- Defecation/Diarrhea
- GI Motility and Gastric Acid production, can lead to abdominal cramping
- ‘Emesis (vomiting)
- Miosis (pinpoint pupils)
- Bradycardia, Bronchospasm, Bronchorrhea, Blood pressure Drops
What can nicotinic receptors cause?
Nicotinic receptors will cause paralysis. Patients cannot use their diaphragm muscles to breathe (need breathing support).
What is an antidote for cholinergic crisis?
Atropine
What are the two divisions of parasympathetic / cholinergic drugs. List some examples of each.
- Direct Acting: Bethanechol, Pilocarpine
- Indirect Acting: Pyridostigmine
Describe the two types of cholinergic drugs.
- Direct Acting Agents
~ Work DIRECTLY at a RECEPTOR
~ Produce effects that mimic Acetylcholine (ACh)
~ Are typically agonists at Muscarinic receptors - Indirect Acting Agents
~ Do NOT work at RECEPTORs
~ Instead, they inhibit acetylcholinesterase, an enzyme that breaks down acetylcholine
What is bethanechol used to treat?
- Urinary retention
~ The goal is to reverse the retention and allow someone to void!
What do most cholinergic drugs target?
- GI Tract
- Bladder
- Eyes
- Heart (smaller percentage)
What is the mechanism of action of bethanechol?
Directly stimulate the parasympathetic division (muscarinic receptors) mainly located in the BLADDER
Describe the mechanism of action of bethanechol in terms of lock and key.
LOCK: Muscarinic Receptor
AGONISTS- stimulate a response
KEY: Natural-AcetylCHOLINE
DRUG: BethaneCHOL
BOTH DRUG AND KEY WILL BIND TO SAME RECEPTOR (MUSCARINIC) focused on the BLADDER
Describe some adverse effects of bethanechol?
- Increased salivation, gastric acid secretion, abdominal cramps and diarrhea
~ Exacerbation of asthma = contra-indication
~ In the Rest and Digest state- the (airways are narrow) lungs are constricted - RARE: hypotension and/or bradycardia
What are some nursing considerations for bethanechol? What is contraindicated?
- What is the intended use of the drug?
- (generally to get people to void after a procedure/surgery!)
- GOAL: Increase Urine Output! (>30 ml/hr!)
- I&O= Intake and Output
~ Intake = oral fluids, IV medications, IV fluids
~ Output = aka Urine Output!
Asthma CONTRA-INDICATED!
What is pilocarpine used to treat?
- ORAL: Systemic doses are for Xerostomia
~ Xerostomia can be caused by radiation or Sjögrens Syndrome - Eye drops: for Glaucoma
~ In glaucoma, one of our major concerns is pressure in the eye= Intra-Ocular Pressure (IOP)
~ Higher pressure= worsens glaucoma (puts pressure on ocular nerve=blind)
~ Lower pressure= treats glaucoma
What is pyrydostigmine used to treat?
- Can be used for Alzheimer’s Disease
- Reverse Anticholinergic Effects
- Myasthenia Gravis
- Reverse effects of Neuromuscular Blocking Agents
- Pre-treatment for exposure to nerve gas (military)
What are adverse effects of pyridostigmine?
- Minor SLUDGE (M)
- drop in BP and/or HR
- Cholinergic Crisis!
What are some intended and unintended outcomes of pyridostigmine?
- What are our intended outcomes?
~ Myasthenia Gravis- recovery of muscle strength
~ Alzheimer’s Disease- maintain cognition
~ Reversal of NMB- Improve breathing status/respiratory function - What are unintended outcomes?
~ Watch excessive activation (think SLUDGE)
~ Watch out for Cholinergic Crisis- concern is respiratory blockade
Give examples of organophosphates / carbamates that can cause poisoning. What is the mechanism of action?
- Organophosphates/Carbamates
~ Insecticides (malathion)
~ Nerve Gas (V agents like VX, Sarin) - MOA: acetylcholinesterase inhibitors, potentially irreversible
~ Can cause: Cholinergic Crisis
What are the types of anti-cholinergic drugs?
- Atropine *SPECIAL
- Oxybutynin, Solifenacin, Tolterodine
What is atropine used to treat?
- ANTIDOTE to Poisoning by Cholinergic Drugs/Agents
~ Antidote to “Cholinergic Crisis” - Reduce salivation and secretions (mucus)
~ Anti-SLUDGE and the Killer B’s
~ Used in the OR (to reduce secretions)
~ Palliative Care, “Death Rattle” - Symptomatic Bradycardia
~ Heart is in constant battle between Sympathetic and Parasympathetic
~ This medication blocks the Vagus Nerve’s influence on the heart
Why do hospitals stockpile atropine?
1) ACLS (reverse bradycardia)
2) Antidote (treat Cholinergic Crisis)
What is the mechanism of action of atropine?
- Antagonists at various muscarinic receptors in the parasympathetic division of the body
- Particularly the Heart! This allows the sympathetic division to take control
What are the adverse effects of atropine?
- Can’t See
- Can’t Pee
- Can’t Spit
- Can’t Shit
- Can’t Schvitz
What are contraindications of atropine?
- Glaucoma
- Benign Prostatic Hyperplasia / Urinary retention / hesitancy
Describe “Can’t See” of atropine adverse effects.
- Mydriasis (dilated pupils; allow light in at night)
- Blurred vision, dry eyes, increased IOP (bad for glaucoma!)
- Protect the eyes with sunglasses
Describe “Can’t Pee” of atropine adverse effects.
- Urinary retention / hesitation
- Report a distended bladder!
- Do not give in patients with enlarged prostate (BPH)
Describe “Can’t Spit” of atropine adverse effects.
- Xerostomia (dry mouth)
- Sugar Free Gum/Candy (avoid sugar, if possible, to reduce risk of cavities)
- Avoid Alcohol based mouthwash (use artificial saliva)
Describe “Can’t Shit” of atropine adverse effects.
- Constipation
- Increase Fiber, Fluid intake! Exercise!
Describe “Can’t Schvitz / Sweat” of atropine adverse effects.
- Hypohydrosis
- Patients may overheat and develop hyperthermia!
- Be careful in hot heat/outdoors
- Can experience Heat Related Illness (Heat stroke/exhaustion)
Confusion! (Benadryl like state!)
What are some nursing considerations for atropine? What are some lifespan considerations?
- Nursing considerations:
~ Goal/Intent of Usage?
~ Atropine- Many uses! - Lifespan considerations:
~ Geriatric patients are very susceptible to developing adverse effects of anticholinergics!
What are oxybutynin, solifenacin, and tolterodine used to treat?
- All three are for Overactive Bladder (OAB)
- Urinary Incontinence (the loss of bladder control)
List some patient symptoms that may need to be treated with oxybutynin, solifenacin, and tolterodine.
- Urinary urgency (constantly feel like they need to pee)
- Urinary frequency (constantly peeing, often in small amounts)
- Urinary incontinence (some people refer to this as constant dribbling)
- Constantly waking in the night to pee (nocturia)
What are some contraindications of oxybutynin, solifenacin, and tolterodine?
- Contraindicated in Glaucoma and BPH
- Avoid in urinary retention / hesitation!
What are some nursing considerations for oxybutynin, solifenacin, and tolterodine? What are some lifespan considerations?
- Nursing considerations:
~ Overactive Bladder (OAB)- patients should have decrease in urinary urgency/frequency, nocturia - Lifespan considerations:
~ Geriatric patients are very susceptible to developing adverse effects of anticholinergics!
