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Pharm 1 > sympathetic nervous system (adrenergic) > Flashcards

sympathetic nervous system (adrenergic) Flashcards

1
Q

the sympathetic nervous system (adrenergic) is stimulated by…

A

physical or emotional stress

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2
Q

physiological responses when the SNS is activated include

A
  • increased HR, arterial blood pressure, and cardiac output
  • increased blood glucose (breakdown of muscle glycogen prn)
  • increased mental activity/clear thinking
  • pupil dilation
  • increased rate of cellular metabolism
  • increased blood flow to brain, heart, and skeletal muscle
  • relaxation of smooth muscle of urinary bladder
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3
Q

what are the 3 primary adrenergic neurotransmitters

A
  • norepinephrine
  • epinephrine (adrenaline)
  • dopamine
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4
Q

norepinephrine, epinephrine, and dopamine are all…

A

endogenous “catecholamines”

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5
Q

define catecholamines

A
  • neurotransmitters when they are produced in the sympathetic nervous system and brain, and circulating hormones when synthesized in the adrenal medulla
  • can produce a sympathomimetic response
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6
Q

describe sympathomimetic

A

mimics the sympathetic system

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7
Q

where is norepinephrine synthesized?

A

adrenergic nerve endings (released when nerve endings are stimulated)

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8
Q

describe the action of norepinephrine

A
  • intense/brief/most → reuptake for reuse
  • does its job quickly in the sympathetic nervous system, then gets put away for later
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9
Q

what drugs prevent the reuptake of norepinephrine

A

cocaine and tricyclic antidepressants

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10
Q

what enzymes assist with reuptake and metabolism of norepinephrine and epinephrine

A
  • monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) metabolize remaining portion in tissue and bloodstream (via liver)
  • effects of epinephrine last longer
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11
Q

what is required in the diet to produce norepinephrine?

A
  • tyrosine
  • found in dairy, cheese, beef, soybeans, nuts, and eggs
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12
Q

where is epinephrine produced?

A

produced by both adrenal glands and a small number or neurons in the medulla oblongata where it acts as a neurotransmitter involved in regulating visceral functions (e.g. respiration)

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13
Q

describe how epinephrine is an important emergency medication

A
  • strengthens myocardial contraction and used in the treatment of anaphylaxis
  • in anaphylaxis (narrowing of the airway) it causes veins to constrict (pump more blood) and relaxes the respiratory muscles
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14
Q

where is dopamine found and how does it act?

A
  • found in brain, blood vessels of the kidneys, and other viscera
  • acts on the BP and HR
  • pleasure/rewards system and attention/problem solving in frontal lobe
  • affects are dose dependent
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15
Q

low dose dopamine is used to treat…

A
  • acute renal failure
  • increases renal blood flow
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16
Q

what is a higher dose of dopamine used for?

A

increase blood pressure

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17
Q

dopamine can be used to treat:

A
  • hypotension
  • shock
  • myocardial infarction
  • trauma
  • renal failure
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18
Q

where are Alpha1 receptors located

A

located primarily in smooth muscle in blood vessels, GI and GU tracts

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19
Q

what happens when Alpha1 receptors are stimulated

A
  • production of muscle contraction / vasoconstriction / mydriasis (dilated pupils)
  • gastrointestinal/bladder sphincter contraction (urinary retention)

-

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20
Q

what happens when Alpha1 receptors are inhibited

A
  • relax vascular smooth muscle / cause vasodilation
  • decrease BP and treat BPH
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21
Q

where are alpha2 receptors located

A

located in the brain and pancreatic B cells

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22
Q

what happens when alpha2 receptors are stimulated

A
  • inhibits norepinephrine → have antiadrenergic effect
  • inhibits insulin release
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23
Q

what happens when alpha2 receptors are inhibited?

A
  • stimulates norepinephrine - have adrenergic effect
  • stimulates insulin release
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24
Q

where are beta1 receptors located

A

primarily in cardiac cells

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25
Q

what happens when beta1 receptors are stimulated

A

increase HR and force of contraction

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26
Q

what happens when beta1 receptors are inhibited

A
  • decrease HR and force of contraction
  • “beta adrenergic blockers” (BP medication) work to lower BP and control heart rate by blocking these receptors
27
Q

beta adrenergic blockers are used in the treatment of…

A
  • HTN
  • dysrhythmias
  • HF
  • MI
  • narrow angle glaucoma
28
Q

where are beta2 receptors located

A

located primarily in smooth muscle of the lungs/skeletal/detrusor and uterine muscles

29
Q

what happens when beta2 receptors are stimulated

A

relaxation of smooth muscles of the lungs = bronchodilation

30
Q

what happens when beta2 receptors are inhibited

A

bronchoconstriction

31
Q

what receptor is the site of action for respiratory and asthma medications

A

beta2 receptors

32
Q

name the adrenergic drug classifications

A
  • adrenergic
  • sympathomimetic / adrenergic agonist
  • sympatholytic / adrenergic antagonist
  • adrenergic blocker
  • alpha 1 and 2 receptor (selective vs nonselective)
  • beta 1 and 2 receptor (selective vs nonselective)
33
Q

what drugs mimic the effect of norepinephrine

A
  • sympathomimetics
  • adrenergic agonists
34
Q

what drugs block the effects of norepinephrine

A
  • sympatholytics
  • adrenergic blockers AKA adrenergic antagonists
35
Q

sympathomimetic treatment based on receptor site activation

Alpha1

A

Tx of nasal congestion, hypotension, cause dilation of pupils (for glaucoma)

36
Q

sympathomimetic treatment based on receptor site activation

alpha2

A

Tx of hypertension (inhibits norepinephrine, decreases BP)

37
Q

sympathomimetic treatment based on receptor site activation

Beta1

A

tx of cardiac arrest, HF, shock

38
Q

sympathomimetic treatment based on receptor site activation

beta2

A

tx of asthma and premature labor contractions

39
Q

explain the difference between selective and nonselective medications

A

selective medications

  • act on a specific receptor site
  • induces the normally occurring action of the receptor site
  • less side effects

nonselective medications

  • act on more than one type of receptor site
  • more broad range of effects
  • more side effects
40
Q

Describe phenylephrine

A
  • stimulates A1 to constrict
  • increases BP
  • common in allergy, decongestant preparations bc it constricts nasal vessels to decrease congestion
41
Q

what should you monitor when giving low dose dopamine

A

urine output (bc its a renal dose)

42
Q

what should you monitor when giving a high dose of dopamine

A

monitor BP (bc its a cardiac dose)

43
Q

what receptors does norepinephrine stimulate

A

A1, A2, and B1

44
Q

what should you be concerned about when a pt is hypertensive and is given an epi pen

A

epi pens are nonselective and can cause BP issues when used with hypertension

45
Q

what is epinephrine used for

A
  • allergic reaction/anaphylaxis
  • ACLS medication
46
Q

describe midodrine

A
  • alpha adrenergic agonist
  • for treatment of orthostatic hypotension
47
Q

describe albuterol

A
  • selective B2 adrenergic agonist
  • bronchodilation
48
Q

describe isoproterenol

A

-nonselective B1 and B2 adrenergic agonist

  • increased HR (B1) and bronchodilation (B2)
  • not safe for pts with tachycardia or hypertension
49
Q

name some side effects of sympathomimetics

A
  • tachycardia, dysrhythmias, chest pain
  • HTN
  • CNS excitement, nervousness, restlessness
  • dry mouth
  • N/V
  • HA
  • dysuria
50
Q

what are some nursing concerns related to the sympathomimetic side effect…

tachycardia, dysrhythmias, CP

A
  • VS
  • telemetry
  • nitrates (med that treats CP - potent vasodilators)
51
Q

what are some nursing concerns related to the sympathomimetic side effect…

HTN

A
  • VS
  • low sodium diet
  • renal function
  • fluid intake
52
Q

what are some nursing concerns related to the sympathomimetic side effect…

CNS excitement, nervousness, restlessness

A

relaxation techniques

53
Q

what are some nursing concerns related to the sympathomimetic side effect…

dry mouth

A
  • fluid provision
  • oral hygiene
  • ice chips
54
Q

what are some nursing concerns related to the sympathomimetic side effect…

nausea and vomiting

A
  • ginger ale
  • antiemetic
  • fluid volume status (careful of dehydration)
55
Q

what are some nursing concerns related to the sympathomimetic side effect…

headache

A
  • lighting
  • quiet environment
  • pain meds
56
Q

what are some nursing concerns related to the sympathomimetic side effect…

dysuria

A
  • I&O
  • urine assessment
  • increase fluids to flush (if not on fluid restriction)
57
Q

what are some contraindications/cautions r/t sympathomimetics

A
  • pheochromocytoma
  • tachy-arrhythmias
  • CV disease/PVD
  • thyroid disease
  • hypovolemia
  • renal or hepatic impairment
  • drug interactions
58
Q

describe pheochromocytoma

A

a rare neoplasm that secrets catecholamines and is usually found in the adrenal medulla

59
Q

what are the signs/symptoms and treatment of pheochromocytoma

A
  • Sx: HTN, headache, heart palpitations, sweating
  • Tx: medication and often times surgery
60
Q

describe tachy-arrhythmias

A

fast, irregular heart rhythms

61
Q

how can thyroid disease contraindicate sympathomimetics

A
  • hyperthyroid
  • the thyroid hormone increases target cell responsiveness to catecholamines
62
Q

how can hypovolemia contraindicate sympthaomimetics

A

vasoconstrict a vascular system with no blood volume

63
Q

what types of drugs do sympathomimetics interact with

A
  • TCAs: impairs reuptake of norepinephrine
  • MAOIs: inhibits liver metabolism or norepi/epi
  • herbals
  • OTCs

Pharm 1 (29 decks)

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