Section 3: Drugs that affect the nervous system

Question 1

Which nervous system consists of cranial and spinal nerves and all their branches (those nerves outside the CNS).

Answer 1

The Peripheral Nervous System (Pg. 297)

Question 2

Which nervous system controls functions that are under conscious, voluntary control such as skeletal muscles and sensory neurons of the skin?

Answer 2

Somatic Nervous System (Pg. 297)

Question 3

Which nervous system is comprised mostly of motor nerves, controls functions of involuntary smooth muscles, cardiac muscles, and glands?

Answer 3

The Autonomic Nervous System (Pg. 297)

Question 4

One of the four types of nerve fibers:

Convey impulses from the internal organs to the CNS

Answer 4

Visceral afferent (sensory) fibers. (Pg. 297)

Question 5

One of the four types of nerve fibers:

Convey impulses from the CNS to the internal organs, glands, and the smooth and cardiac (involuntary) muscles

Answer 5

Visceral efferent (motor) fibers. (Pg. 297)

Question 6

One of the four types of nerve fibers:

Convey impulses from the head, body wall, and extremities to the CNS

Answer 6

Somatic afferent (sensory) fibers (Pg. 297)

Question 7

One of the four types of nerve fibers:

Convey impulses from the CNS to the striated (voluntary) muscles

Answer 7

Somatic efferent (motor) fibers (Pg. 297)

Question 8

What is the neurotransmitter in the sympathetic and parasympathetic division for the preganglionic fiber?

Answer 8

Acetylcholine (Pg. 299)

Question 9

True or False:

All preganglionic neurons of the autonomic division and all postganglionic neurons of the sympathetic division are cholinergic

Answer 9

False.

All preganglionic neurons of the autonomic division and all postganglionic neurons of the parasympathetic division are cholinergic (Pg. 299)

Question 10

What are two types of cholinergic (parasympathetic) receptors? And what are the onset / duration of each?

Answer 10

Nicotinic receptors: fast onset / short duration

Muscarinic receptors: slow onset / long duration

(Pg. 299 NOTE)

Question 11

What are the two major receptor types for the adrenergic (sympathetic) nervous system?

Answer 11

Alpha-adrenergic receptors
Beta-adrenergic receptors

(Pg. 299)

Question 12

Any one of the postulated adrenergic components of receptor tissues that responds to norepinephrine and to various blocking agents

Answer 12

alpha-adrenergic receptor

Question 13

Any of the postulated adrenergic components of receptor tissues that respond to epinephrine and to various blocking agents

Answer 13

Beta-adrenergic receptor

Question 14

Norepinephrine has more affinity for alpha or beta receptors?

Answer 14

Alpha (Pg. 299)

Question 15

Epinephrine has more affinity for alpha or beta receptors?

Answer 15

Both! (Trick question) - nearly equal (Pg. 299-300)

Question 16

Autonomic drugs can be classified into four groups:

Remember: these drugs mimic or block the effects of sympathetic and parasympathetic

Answer 16

1. Cholinergic (parasympathomimetic) drugs
2. Cholinergic blocking (parasympatholytic) drugs
3. Adrenergic (sympathomimetic) drugs
4. Adrenergic blocking (sympatholytic) drugs

(Pg. 301)

Question 17

Drugs that affect nicotinic or cholinergic receptor sites on autonomic ganglia are:

Answer 17

Ganglionic-stimulating drugs and ganglionic-blocking drugs (Pg. 301)

Question 18

Cholinergic drugs have little therapeutic value. For the most part, they are not thought of as emergency drugs. Which drug may be used to manage extreme cases of poisoning resulting from atropine-type drugs?

Answer 18

Physostigmine (Antilirium)

Question 19

What is the best known cholinergic blocking drug used in emergency care?

Answer 19

atropine (Pg. 302)

Question 20

What are the three naturally occurring catecholamines in the body?

Answer 20

Epinephrine, norepinephrine, dopamine

Question 21

epinephrine (Adrenalin), norepinephrine (Levophed), dopamine (Intropin), and dobutamine (Dobutrex) are examples of what kind of drugs?

Answer 21

Direct-acting / synthetic catecholamines (Pg. 303)

Question 22

True or False:

Catecholamines depend on their ability to act directly with alpha and beta receptors

Answer 22

True (Pg. 303)

Question 23

Alpha 1 or Alpha 2?

Located on presynaptic and postsynaptic nerve endings.

Presynaptic receptors inhibit the further release of norepinephrine. Postsynaptic receptors produce vasoconstriction to increase resistance in blood vessels and thus increase blood prsssure

Answer 23

Alpha 2 (Pg. 303)

Question 24

Alpha 1 or Alpha 2?

Located on the effector organs

Chief role is to stimulate contraction of smooth muscle. In the vasculature, this results in an increase of blood pressure.

Answer 24

Alpha 1 (Pg. 303)

Question 25

Memory aid to differentiate the physiological effects of beta receptors:

Answer 25

1 heart (beta1) and two lungs (beta2) (Pg. 303 NOTE)

Question 26

Beta receptors do what?

Answer 26

Stimulate the heart, dilate bronchioles, dilate blood vessels in the skeletal muscle, brain, and heart; and aid in glycogenolysis (Pg. 303)

Question 27

Alpha activities in human beings:

Answer 27

- Vasoconstriction of arterioles, resulting in a rise in blood pressure and peripheral shunting of blood to the heart and brain - Pupil dilation - Relaxation of the gut (Pg. 303)

Question 28

Beta activities in human beings:

Answer 28

- Cardiac acceleration and increases contractility - Vasodilation of arterioles supplying the skeletal muscle - Bronchial relaxation - Uterine relaxation (Pg. 303)

Question 29

Adrenergic blocking agents (alpha- and beta-blocking drugs)

Answer 29

Block the vasoconstricting effect of catecholamines. Used in certain cases of hypertension. (Pg. 303)

Question 30

Why should all drugs with alpha effects be administered through a secure IV line?

Answer 30

Because of the possibility of extravasation (leakage of fluid) and tissue necrosis (Pg. 303 NOTE)

Question 31

Examples of selective beta1-blocking agents

Answer 31

metoprolol (Lopressor, Toprol-XL) and atenolol (Tenormin) (Pg. 303) Antihypertensive and antidysrhythmics

Question 32

Examples of nonselective beta-blocking agents

Answer 32

antianginal antihypertensives: nadolol (Congard) and propranolol (Inderal) antihypertensive: labetalol (Normodyne, Trandate). (Pg. 303)

Question 33

Examples of Opiod analgesics:

Answer 33

morphine, codeine (methylmorphine), hydromorphone (Dilaudid), meperidine (Demerol), fentanyl, methadone, oxycodone, hydrocodone, propoxyphene (Pg. 305)

Question 34

Body's own supply of "opiates". Produced by the pituitary gland and the hypothalamus during strenuous exercise, excitement, pain, and orgasm. Act as "natural pain relievers".

Answer 34

Endorphins (Pg. 305 NOTE)

Question 35

Examples of Opiod antagonists:

Answer 35

Naloxone (Narcan), naltrexone (Trexan), nalmefene (Revex) (Pg. 305)

Question 36

What makes the difference between Narcotic analgesics and Nonnarcotic analgesics?

Answer 36

When nonnarcotic analgesics are used, the nerve endings in damaged tissues are stimulated less often. This differs from the mechanism of narcotic analgesics that act at the level of the CNS. (Pg. 305)

Question 37

What does NSAID stand for? And what are some examples?

Answer 37

nonsteroidal antiinflammatory drug ketorolac (Toradol), tramadol (Ultram), ibuprofen (Advil), naproxen (Aleve), and acetaminophen (Tylenol) (Pg. 305)

Question 38

What is the name of drug that depresses the CNS? What are the three major types?

Answer 38

Anesthetics General anesthesia: achieved by IV or inhalation- most common for surgery Regional anesthesia: Injection near a nerve trunk (spinal block) Local anesthesia: topically or injection to produce a loss of sensation (Lidocaine) (Pg. 305)

Question 39

A small dose of an agent administered to calm a patient is called a _____; a larger dose of the same agent sufficient to induce sleep is called a _____.

Answer 39

Sedative, hypnotic (Pg. 306)

Question 40

Antianxiety and sedative-hypnotic agents and alcohol, depress what system that is known to determine the level of awareness to the environment?

Answer 40

reticular activating system (Pg. 306)

Question 41

What two drugs are used to treat anxiety and induce sleep?

Answer 41

benzodiazepines (most often used today) and barbiturates. (Pg. 307)

Question 42

What are benzodiazepines four actions? And why is it considered to be a schedule IV drug?

Answer 42

Anxiety reducing, sedative-hypnotic, muscle relaxing, and anticonvulsant Schedule IV because of its potential for abuse (Pg. 307)

Question 43

Examples of benzodiazepines:

Answer 43

alprazolam (Xanax), flurazapam (Dalmane), midazolam (Versed), lorazepam (Ativan) (Pg. 307)

Question 44

Barbiturates are divided into four classes according to their duration of action:

Answer 44

Ultrashort acting (seconds), short acting (10-15 mins), intermediate acting (45-60 mins), and long acting (more than 60 mins) Dependent on their lipid solubility and protein-binding properties (Pg. 307)

Question 45

Which of the four classes of barbiturates is used to treat epilepsy and other chronic neurological disorders?

Answer 45

Long-acting barbiturates (Pg. 307)

Question 46

Anorexiants and amphetamines are an example of:

Answer 46

CNS stimulants (Pg. 308)

Question 47

What CNS stimulant stimulates the cerebral cortex and reticular activating system?

Answer 47

Amphetamines - increases alertness and responsiveness to environmental surroundings. (Pg. 308)

Question 48

A potentially irreversible neurological disorder characterized by involuntary repetitious movements of the muscles of the face, limbs, and trunk

Answer 48

Tardive dyskinesia - excessive blinking, lip smacking etc. (Pg. 309) This is often times caused by the use of certain antipsychotics, developing supersensitivity of dopamine receptors.

Question 49

A condition characterized by local or diffuse changes in muscle tone, resulting in painful muscle spasms, unusually fixed postures, and strange movement patterns

Answer 49

Dystonia (Pg. 309)

Question 50

Type of depression that is considered normal. Results from a person's response to a loss or disappointment having "the blues".

Answer 50

Exogenous depression (Pg. 309 NOTE)

Question 51

Type of depression that lasts 6 months or longer. Characterized by the absence of external causes; maybe the result of genetic or biochemical alterations. Antidepressants often are needed to treat.

Answer 51

Endogenous depression (Pg. 309 NOTE)

Question 52

What are two movement disorders resulting from an imbalance of dopamine and acetylcholine?

Answer 52

Parkinson's disease and Huntington's disease (Pg. 310)

Question 53

What is the current drug of choice in the treatment of movement disorders associated with dopamine-acetylcholine imbalance?

Answer 53

Levodopa (L-dopa) (Pg. 311)

Question 54

What drug is the preferred treatment for mania?

Answer 54

Lithium (an antimanic drug) (Pg. 309)

Question 55

What do monoamine oxidase A and monoamine oxidase B metabolize?

Answer 55

MAO A- metabolizes norepinephrine and serotonin MAO B- metabolizes dopamine (Pg. 311)

Question 56

Skeletal muscle relaxants can be classified as?

Answer 56

Central-acting muscle relaxants Direct-acting muscle relaxants Neuromuscular blockers (Pg. 311)

Question 57

Which muscle relaxant is used to treat muscle spasms, that are thought to work by producing CNS depression in the brain and spinal cord?

Answer 57

Central-Acting Muscle Relaxant - diazepam (Pg. 311)

Question 58

Which muscle relaxant directly affect skeletal muscles to produce muscle relaxation, resulting in a decrease in muscle contraction?

Answer 58

Direct-Acting Muscle Relaxant - Dantrolene (Dantrium). (Pg. 311)

Question 59

Which kind of muscle relaxant drug produces complete muscle relaxation and paralysis? It is accomplished by binding to the nicotinic receptor for acetylcholine at the neuromuscular junction.

Answer 59

Neuromuscular blockers - pancuronium, vecuronium, succinylcholine. (Pg. 311)

Question 60

What are the two types of neuromuscular blocking drugs? And provide an example of each.

Answer 60

Depolarizing agent - succinylcholine - rapid onset, brief duration. Used commonly for ET intubation Nondepolarizing agent - pancuronium - long onset, long duration (Pg. 311 NOTE)