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320 Pharmacology > Sympathetic ANS > Flashcards

Sympathetic ANS Flashcards

1
Q

Where are Nicotinic Receptors found?

A
  • found at the Neuromuscular Junction (NMJ)
  • stimulates effectors
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2
Q

Where are Muscarinic Receptors found?

A
  • Found at effectors all throughout the body
  • Can stimulate or inhibit a response
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3
Q

Where are alpha 1 receptors found?

A
  • arteries (Vascular smooth muscle)
  • eyes
  • nose (mucous membranes)
  • prostate and bladder
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4
Q

Where are beta 1 receptors found?

A
  • heart
  • kidney (Juxtaglomerular Cells)
  • eye
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5
Q

Where are beta 2 receptors found?

A
  • Lungs (Bronchioles)
  • Skeletal Muscle
  • Uterine Smooth Muscle
  • Liver
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6
Q

Sympathetic “E”, what does the E stand for?

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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7
Q

What else are adrenergic drugs called?

A
  • Adrenergic
  • Sympathetic
  • Sympathomimetic
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8
Q

What do adrenergic drugs do?

A

produce effects that mimic Norepinephrine (NE) or epinephrine at the target site

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9
Q

What are adrenergic drugs and where are they located?

A

generally agonists at α or β receptors

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10
Q

What are some types of Vasopressors?

A

epinephrine and adrenaline

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11
Q

What are Vasopressors used for?

A
  • INTRAVENOUS: Advanced Cardiac Life Support (ACLS)
    – IV Drip – Used for Shock, hypotension, bradycardia or asystole
  • SUBCUTANEOUS: Added to local anesthetics
    – Lidocaine w/epinephrine subcutaneously
  • INTRA-MUSCULAR: Anaphylaxis (The Epipen®!)
    – IM injection!
  • INHALED: Asthma (not recommended for routine use)
    – Inhaled
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12
Q

How does epinephrine work?

A

binds non-selectively to alpha and beta receptors

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13
Q

Where does adrenaline affect beta 1 activation?

A

heart

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14
Q

Where does adrenaline affect beta 2 activation?

A

lungs
- bronchodilation

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15
Q

Where does adrenaline affect alpha 1 activation?

A

Vascular Smooth Muscle
- Vasoconstriction (Increased BP)

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16
Q

What are the adverse effects of epinephrine?

A
  • Due to effects on the heart = risk of cardiac complications
    – tachycardia (chronotropic+)
    – Cardiac Dysrhythmia - EKG abnormalities, ischemia-MI
  • Due to effects on the vasculature - Hypertension
    – can lead to MI, stroke
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17
Q

What are some nursing interventions for epinephrine?

A
  • monitor IV site to ensure proper catheter placement (prevent extravasation)
  • Antidote for extravasation: Phentolamine
  • Monitor Heart rate, EKG, and Blood pressure (continuously if on IV drip)
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18
Q

What is a selective beta 1 blocker?

A

metoprolol
“lol”

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19
Q

List some non-selective beta 1 blockers.

A
  • propranolol
  • carvedilol
  • labetalol
    “lol”
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20
Q

List some alpha 1 blockers.

A
  • tamsulosin
  • prazosin
    “sin”
21
Q

How do beta 1 antagonists work?

A
  • Block Beta 1 receptors located on heart (also found in the kidneys)
    – will lower the heart rate -> lowers blood pressure
  • Eyes (eye-drops)= miosis, lower IOP!
22
Q

What is blood pressure?

A
  • Cardiac Output x Systemic Vascular Resistance
  • (Heart Rate * Blood Volume) x Artery Resistance
23
Q

What is orthostatic/postural hypotension?

A
  • defined as a fall in blood pressure brought on by moving from a supine or seated position to an upright position
  • the underlying cause is the relaxation of smooth muscle in veins
  • commonly seen with anti-hypertensive medications
24
Q

What are some concerns/signs of orthostatic/postural hypotension?

A
  • dizziness/lightheadedness, passing out/syncope
  • huge FALL RISK with geriatric patients!
25
Q

How do you manage orthostatic/postural hypotension?

A

Change positions SLOWLY (from sitting to standing). Hold on to something for support in case you get lightheaded. Stay seated until you know how the drug will affect you

26
Q

What are some adverse effects of metoprolol tartrate (beta 1 antagonist)?

A
  • Orthostatic Hypotension
  • Bradycardia leading to decreased cardiac output
    – don’t give if someone has bradycardia (<60)
  • Precipitation of heart failure (Exacerbation)
    – decrease in HR and fluid may back up into the lungs or periphery
  • Mask s/s of hypoglycemia (Diabetes)
    – When your blood glucose is too low, Fight or Flight kicks in!
    – Adrenaline= ↑HR, anxiety/jittery, sweaty!
    – Beta-Blockers mask the HR, anxiety
  • Cross BBB
    – may affect mood (depression, sleep, sexual desire, etc.)
  • Decrease blood pressure
    – Sexual dysfunction (erectile dysfunction, vaginal dryness)
    – Decreased libido (impotence)
27
Q

What do non-selective beta-blockers treat?

A
  • Current or hx of MI (Heart attacks)
  • Hypertension, Angina (chest pain)
  • Dysrhythmias, Heart failure
  • Symptoms of Hyperthyroidism/Thyroid Storm/Thyrotoxicosis
  • Anxiety
28
Q

What do each of the non-selective beta-blockers do?

A

Timolol: Glaucoma Eye Drops (Tim has glaucoma)
Propranolol: Commonly used by Professionals
Carvedilol: Mainly used in Cardiac Conditions
Labetalol: Commonly used in Labor and Delivery (HTN management in pregnant patients)

29
Q

Where are each of the non-selective beta-blocker receptors located?

A
  • Block Beta 1 receptors located on the heart
  • May Block Beta 2 receptors in the lungs, skeletal muscle, liver
  • May Block alpha 1 receptors- relax vascular smooth muscle (arteries)
30
Q

What are the two types of Glaucoma?

A

Open and Narrow-Angle

31
Q

What is Glaucoma?

A
  • increased Intra-Ocular Pressure (IOP) aqueous humor in the eye
  • is a CHRONIC CONDITION, treat for life
32
Q

How do pupils affect Glaucoma?

A
  • IF pupil dilation occurs (mydriasis) this increases IOP
    – WORSENS GLAUCOMA
  • IF pupil constriction occurs (miosis) this decreases IOP
    – HELPS TREAT GLAUCOMA
33
Q

What does Timolol do?

A

Beta Blocker eye drops block adrenaline in the eye

34
Q

What are the adverse effects of non-selective β blockers in β1?

A
  • Bradycardia leading to decreased CO
  • Hypotension
  • Precipitation of heart failure (fluid retention)
  • Mask the S/S of hypoglycemia in diabetes
    – Tremor/palpitations
35
Q

What are the adverse effects of non-selective β blockers in β2?

A
  • Bronchoconstriction (bad for Asthma/COPD)
  • Prevent glycogenolysis in the liver (further complicates hypoglycemia)
36
Q

What is the contraindication of non-selective β blockers?

A

Asthma/COPD

37
Q

What is Tamsulosin used to treat?

A
  • MAIN USE #1: Benign prostatic hyperplasia (BPH)
  • MAIN USE # 2: Bladder Outlet Obstruction (kidney stones)
38
Q

What is Prazosin used to treat?

A
  • Main use Hypertension
    – Note: Guidelines no longer recommend these as 1st line
39
Q

What do α1 antagonists “blockers” do?

A
  • prevents activation of α1 receptors (antagonist)
  • there are subtype α1 receptors
40
Q

Where are α1 antagonists “blockers” located?

A
  • some are found in peripheral vascular smooth muscle (arteries)
  • some are found in Bladder/Urethra/Prostate
41
Q

What does it mean that α1 blockers are selective for or non-selective?

A

a drug that targets the bladder may also lower someone’s blood pressure

42
Q

What is reflex tachycardia commonly seen with?

A

Commonly seen with Anti-hypertensive drugs that DON’T WORK DIRECTLY ON THE HEART

43
Q

What causes reflex tachycardia?

A

dilation of arteries/veins (sudden drop in BP)

44
Q

Why is reflex tachycardia undesirable?

A
  • Tachycardia can put an unacceptable burden on the heart
  • If the vasodilator were given to reduce blood pressure, tachycardia would raise pressure and thereby negate the desired effect
45
Q

How can you treat reflex tachycardia?

A

To help prevent vasodilator-induced reflex tachycardia, patients can be pretreated with a beta-blocker (ex: propranolol), which blocks sympathetic stimulation of the heart

46
Q

What is a common adverse effect of α1 antagonists “blockers”?

A
  • First dose Orthostatic/postural hypotension
    – Almost always happens with the first dose
    » Medical textbooks call this, the “First Dose Phenomenon”
    – IMPORTANT COUNSELLING POINT
    » We don’t want our patients to fall!
    » Sometimes patients take it at night to reduce the risk
47
Q

What is a rare adverse effect of α1 antagonists “blockers”?

A

Reflex tachycardia (resulting from the sudden drop in blood pressure)

48
Q

What are some other adverse effects of α1 antagonists “blockers”?

A
  • Sexual dysfunction may occur in patients with all anti-hypertensive medications
    – This drug class is noted to cause retrograde or inhibited ejaculation
  • Rebound hypertension can occur if any anti-hypertensive is stopped suddenly (never stop a blood pressure medication suddenly)
    – Think of the Beta-Blocker Boxed Warning
49
Q

When should α1 antagonists “blockers” be given?

A

at bedtime to reduce risk for postural/orthostatic hypotension

320 Pharmacology (36 decks)

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