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Pharmacology > Pharmacological therapy - Neurological system > Flashcards

Pharmacological therapy - Neurological system Flashcards

1
Q

Adrenergics

A
  • drugs in this class include naturally occuring substances such as norepinephrine, epinephrine, and dopamine
  • norepinephrine (NE) is the major neurotransmitter
  • Dopamine is a key neurotransmitter in the CNS
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2
Q

Predominant Adrenergic Agonist Responses

A
  • vasoconstriction
  • CNS and ANS stimulation
  • think fight or flight response: increase in BP, increase in responsivity of CNS
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3
Q

Receptors in the Sympathetic System

A
  • adrenergic receptors with two subtypes Beta and Alpha
  • Alpha 1 and Alpha 2
  • Beta 1 and Beta 2
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4
Q

Beta-Adrenergic Receptors

A
  • all are located on post-synaptic effector cells
  • beta1-adrenergic receptors - located primarily in the heart
  • beta2- adrenergic receptors - located in smooth muscle of the bronchioles, arterioles, and visceral organs
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5
Q

Treatment with receptor agonists:

A

alpha 1 - nasal congestion, hypotension, and mydriasis
alpha 2 - hypertension
beta 1 - cardiac arrest, heart failure, and shock. sometimes called cardiotonic or inotropic because they increase the force of contraction of the heart
- beta2 - asthma - relaxation of bronchial smooth muscle and premature labour contractions

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6
Q

Phenylephrine

A
  • affects the alpha 1 receptors
  • used during hypotension or for nasal congestion
  • has few cardiac side effects
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7
Q

Adrenergic Antagonists ( Blockers)

A
  • medications in this calls have great therapeutic application and are the most widely prescribed autonomic drugs. Mainly used for hypertension
  • Bind to adrenergic receptors, but inhibit or block stimulation of the sympathetic nervous system
  • alpha blockers and beta-blockers
  • have the opposite effect o adrenergic agents
  • also known as
    Adrenergic antagonists
    sympatholytics
    sympatholytics inhibit - or lyse - sympathetic neurotransmitters, such as norepinephrine and epinephrine
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8
Q

Alpha-blockers

A
  • cause both arterial and venous dilation, reducing peripheral vascular resistance and BP
  • used to treat hypertension
  • effect on receptors on prostate gland and bladder decreases resistance to urinary outflow, thus reducing urinary obstruction and relieving effects of BPH
  • used to control and prevent hypertension in patient with phenochromacytoma
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9
Q

Alpha blockers: side effects

A

palpitations, orthostatic hypotension, tachycardia, edema, dysrhythmias, chest pain. Dizziness, headache, drowsiness. anxiety, depression, vertigo, weakness, numbness, fatigue, nausea, vomiting, diarrhea. constipation, abdominal pain, incontinence, nosebleed, tinnitus, dry mouth, pharyngitis, rhinitis

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10
Q

Beta-Blockers

A
  • block stimulation of beta-receptors in the SNS
  • compete with norepinephrine and epinephrine
  • most common blood pressure medications
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11
Q

Beta 1 and 2 receptors

A
  • located primarily on the heart
  • beta-blockers selective for these receptors are called cardioselective beta-blockers
  • beta 2 receptors located primarily on smooth muscles of bronchiles and blood vessels
  • nonspecific beta-blockers block both beta1 and beta2 receptors
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12
Q

Beta-blocker examples

A 
Acebutolol
Carvedilol
Labetalol
Metoprolol
Notice the OLOL!
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13
Q

Beta-Blockers may cause

A
  • diarrhea
  • stomach cramps
  • nausea
  • vomiting
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14
Q

Beta-Blocking Agents: Patient Teaching

A
  • rebound hypertension or chest pain may occur if this medication is discontinued abruptly - dont do it
  • patients should notify their physician if they become ill and unable to take medication
  • ## Inform patients that they may notice a decrease in their tolerance for exercise, dizziness and fainting may occur with increased activity
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15
Q

Beta-Blocking Agents - Nursing Implications

A

patients should report the following to their physician

  • weight gain of more than 2 pounds within a week
  • edema of the feet or ankles
  • shortness of breath
  • excessive fatigue or weakness
  • syncope or dizziness
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16
Q

Cholinergic Agonists and Antagonists

A
  • drugs that stimulate the parasympathetic nervous system (PSNS) are cholinergic agonists
  • the PSNS is the opposing system to the SNS
  • Also known as parasympathomimetics
  • mimic the effects of the PSNS neurotransmitter: acetylcholine (Ach)
  • think rest and digest
17
Q

Acetylcholine main neurotransmitter of the PSNS

A
  • its all in the name
  • Acetylcholine (neurotransmitter)
  • stimulates or activates the next nerve cell as impulses move along a nerve from neuron to neuron or at the neural muscular junction simulating muscle stimulation
18
Q

Cholinergics- Indications and Uses

A
  • Direct-acting agents
    reduce intraocular pressure
    useful for glaucoma and intraocular surgery (acetylcholine, carbachol, pilocarpine)
    topical application due to poor absorption
19
Q

Cholinergics- Indications and Uses

A
  • Direct-acting agents
    reduce intraocular pressure
    useful for glaucoma and intraocular surgery (acetylcholine, carbachol, pilocarpine)
    topical application due to poor absorption
20
Q

example of direct-acting cholinergic: Bethanechol

A
  • increases tone and motility of bladder and GI trace
  • relaxes sphincters in bladder and GI tract, allowing them to empty or drain. Remember cholinergic effect.
  • helpful for post-surgical atony of the bladder and GI tract.
  • oral dose or SC injection
21
Q

Indirect Acting Agents - cholinergics

A

nonselective and allow the neurotransmitter to remain on cholinergic receptors for a long period of time

22
Q

toxic side effects typical cholinergic poising presentation (SLUDGE)

A 
Salivation 
Lacrimation 
Urinary incontinence
Diarrhea
GI cramps
Emesis
(too much of a good thing)
23
Q

Cholinergic Blocking Agents: Anticholinergics

A

drugs that inhibit or block the actions of acetylcholine in the parasympathetic nervous system
- decreased parasympathetic = increased sympathetic

24
Q

Mechanism of Action Anticholinergic

A
  • competitive agonist
  • compete with acetylcholine
  • block ACh at the muscarinic receptors in the PSNS
  • as a result, ACh is unable to bind to the receptor sites and cause a cholinergic effects
  • Once these drugs bind to receptors, they inhibit nerve transmission at these receptors
25
Q

Drug effects of anticholinergic agents

A
  • increase heart rate with those who have bradycardia (Cardiac rhythm abnormalities)
  • reduce muscle tremor and rigidity associated with Parkinsons (CNS)
  • decrease gastric acid secretion in peptic ulcer disease (GI disorders)
  • slow intestinal motility (GI disorders)
  • decrease respiratory secretions (pre-anesthesia)
26
Q

Indications for Anticholinergics

A
  • Asthma
  • dilates the bronchi
  • opthalmic
  • mydriasis
27
Q

Prototype Drug Anticholinergic: Atropine

A
  • most prominent actions are:
  • increased HR
  • bronchodilation
  • Decreased GI motility
  • Decreased secretion from glands
  • Mydriasis
28
Q

Nursing Implications

A
  • atropine is the antidote for cholinergics
  • it should be available for immediate use if needed
  • patients should notify their physician if they experience muscle weakness, abdominal cramps, diarrhea, or difficulty breathing
  • on the other hand, atropine overdose/toxicity produces the following symptoms of this mnemonic (hot as a hare, blind as a bat, dry as a bone, red as a beat, and mad as a hatter)
  • dysrhythmias, flushing, hot, dry skin and dry mouth, urinary retention, inhibition of sweating, blurred vision, dilated pupils, loss of balance, and notably in the elderly, extreme confusion, hallucinations, and agitation)
29
Q

Side effects

A

increased heart rate/dysrhythmias/ CNS excitiation, restlessness, irritability, disorientation, hallucinations, delirium, dilated pupils, decreased visual accommodations, increased intraocular pressure, decreased salivation, decreased gastric secretions, decreased motility, urinary retention, decreased sweating, decreased bronchial secretions

30
Q

Nursing Implications Anticholinergics

A

Anticholinergics taken by a geriatric patient may lead to higher risk for heatstroke due to effects on heat-regulating mechanisms

  • teach patient to limit physical exertion, and avoid high temperatures and strenuous exercise
  • emphasize the importance of adequate fluid and salt intake

Pharmacology (14 decks)

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