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
