Parasympathetic ANS Flashcards

1
Q

Fill out the sympathetic / parasympathetic table.

A

(˶ᵔ ᵕ ᵔ˶)

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2
Q

What are the two divisions of the ANS and their catch phrases?

A

Sympathetic = “Fight or Flight“, “Stressed”
Parasympathetic = “Rest and Digest“, “Peace”

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3
Q

What are the three types of autonomic division control?

A

Generally: Opposition (two divisions compete)
Rare: Complementary (can work in synergy)
Rare: Sometimes only one division controls

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4
Q

What type of activities are involved in Sympathetic “E”?

A
  • Involves E activities – exercise, excitement, emergency, and embarrassment
  • Promotes adjustments during exercise – blood flow to organs is reduced, flow to muscles is increased
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5
Q

How would you illustrate the activity of Sympathetic “E”?

A
  • 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”
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6
Q

What types of activities are involved in Parasympathetic “D”?

A
  • Involves the D activities – digestion, defecation, and diuresis
  • Concerned with keeping energy use low in the body
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7
Q

How would you illustrate the activity of Parasympathetic “D”?

A
  • 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
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8
Q

What divisions are equal to parasympathetic and sympathetic? Give examples of neurotransmitters for each.

A
  • Parasympathetic / Cholinergic Division
    ~ Acetylcholine (ACh)
  • Sympathetic / Adrenergic Division
    ~ Adrenaline (in the U.S. we call this Epinephrine)
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9
Q

Describe the two types of cholinergic receptors.

A
  • 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
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10
Q

Describe muscarinic response during a cholinergic crisis.

A

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
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11
Q

What can nicotinic receptors cause?

A

Nicotinic receptors will cause paralysis. Patients cannot use their diaphragm muscles to breathe (need breathing support).

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12
Q

What is an antidote for cholinergic crisis?

A

Atropine

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13
Q

What are the two divisions of parasympathetic / cholinergic drugs. List some examples of each.

A
  • Direct Acting: Bethanechol, Pilocarpine
  • Indirect Acting: Pyridostigmine
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14
Q

Describe the two types of cholinergic drugs.

A
  • 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
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15
Q

What is bethanechol used to treat?

A
  • Urinary retention
    ~ The goal is to reverse the retention and allow someone to void!
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16
Q

What do most cholinergic drugs target?

A
  • GI Tract
  • Bladder
  • Eyes
  • Heart (smaller percentage)
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17
Q

What is the mechanism of action of bethanechol?

A

Directly stimulate the parasympathetic division (muscarinic receptors) mainly located in the BLADDER

18
Q

Describe the mechanism of action of bethanechol in terms of lock and key.

A

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

19
Q

Describe some adverse effects of bethanechol?

A
  • 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
20
Q

What are some nursing considerations for bethanechol? What is contraindicated?

A
  • 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!

21
Q

What is pilocarpine used to treat?

A
  • 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
22
Q

What is pyrydostigmine used to treat?

A
  • 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)
23
Q

What are adverse effects of pyridostigmine?

A
  • Minor SLUDGE (M)
  • drop in BP and/or HR
  • Cholinergic Crisis!
24
Q

What are some intended and unintended outcomes of pyridostigmine?

A
  • 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
25
Q

Give examples of organophosphates / carbamates that can cause poisoning. What is the mechanism of action?

A
  • Organophosphates/Carbamates
    ~ Insecticides (malathion)
    ~ Nerve Gas (V agents like VX, Sarin)
  • MOA: acetylcholinesterase inhibitors, potentially irreversible
    ~ Can cause: Cholinergic Crisis
26
Q

What are the types of anti-cholinergic drugs?

A
  • Atropine *SPECIAL
  • Oxybutynin, Solifenacin, Tolterodine
27
Q

What is atropine used to treat?

A
  • 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
28
Q

Why do hospitals stockpile atropine?

A

1) ACLS (reverse bradycardia)
2) Antidote (treat Cholinergic Crisis)

29
Q

What is the mechanism of action of atropine?

A
  • Antagonists at various muscarinic receptors in the parasympathetic division of the body
  • Particularly the Heart! This allows the sympathetic division to take control
30
Q

What are the adverse effects of atropine?

A
  • Can’t See
  • Can’t Pee
  • Can’t Spit
  • Can’t Shit
  • Can’t Schvitz
31
Q

What are contraindications of atropine?

A
  • Glaucoma
  • Benign Prostatic Hyperplasia / Urinary retention / hesitancy
32
Q

Describe “Can’t See” of atropine adverse effects.

A
  • Mydriasis (dilated pupils; allow light in at night)
  • Blurred vision, dry eyes, increased IOP (bad for glaucoma!)
  • Protect the eyes with sunglasses
33
Q

Describe “Can’t Pee” of atropine adverse effects.

A
  • Urinary retention / hesitation
  • Report a distended bladder!
  • Do not give in patients with enlarged prostate (BPH)
34
Q

Describe “Can’t Spit” of atropine adverse effects.

A
  • Xerostomia (dry mouth)
  • Sugar Free Gum/Candy (avoid sugar, if possible, to reduce risk of cavities)
  • Avoid Alcohol based mouthwash (use artificial saliva)
35
Q

Describe “Can’t Shit” of atropine adverse effects.

A
  • Constipation
  • Increase Fiber, Fluid intake! Exercise!
36
Q

Describe “Can’t Schvitz / Sweat” of atropine adverse effects.

A
  • 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!)

37
Q

What are some nursing considerations for atropine? What are some lifespan considerations?

A
  • Nursing considerations:
    ~ Goal/Intent of Usage?
    ~ Atropine- Many uses!
  • Lifespan considerations:
    ~ Geriatric patients are very susceptible to developing adverse effects of anticholinergics!
38
Q

What are oxybutynin, solifenacin, and tolterodine used to treat?

A
  • All three are for Overactive Bladder (OAB)
  • Urinary Incontinence (the loss of bladder control)
39
Q

List some patient symptoms that may need to be treated with oxybutynin, solifenacin, and tolterodine.

A
  • 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)
40
Q

What are some contraindications of oxybutynin, solifenacin, and tolterodine?

A
  • Contraindicated in Glaucoma and BPH
  • Avoid in urinary retention / hesitation!
41
Q

What are some nursing considerations for oxybutynin, solifenacin, and tolterodine? What are some lifespan considerations?

A
  • 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!