*Unit 4 - Pharmacology Affecting Peripheral Nerve Regulation (ANS) Flashcards
maintains homeostasis without any conscious thoughts or actions
autonomic nervous system
contracts cardiac muscle
autonomic nervous system
contracts smooth muscle
autonomic nervous system
secretions of glands
autonomic nervous system
the actions of _____________ assists the body to respond to emergencies and repair and replenish body tissues
autonomic nervous system
T/F: Many drugs affect autonomic functions
T
Subdivisions of the ANS (autonomic nervous system)
SNS (sympathetic nervous system) (fight or flight)
PNS (parasympathetic nervous system) (Rest & Digest or Breed & Feed)
adrenergic blocker - antiadrenergic
sympathetic
neurotransmitter of SNS
norepinephrine
recepors of SNS
alpha 1, alpha 2, beta 1, beta 2
cholinergic blocker - anticholinergic
parasympathetic
neurotransmitter of PNS
acetylcholine
receptors of PNS
nicotinic & muscarinic
SNS response of eye
dilates pupild
PNS response of eye
constricts pupils
SNS response of lungs
dilates bronchioles
PNS response of lungs
constricts bronchioles and increases secretions
SNS response of heart
increases heart rate
PNS response of heart
decreases heart rate
SNS response of blood vessels
constricts blood vessels
PNS response of blood vessels
dilated blood vessels
SNS response of gastrointestinal
relaxes smooth muscles of GI tract
PNS response of gastrointestinal
increases peristalsis
SNS response of bladder
relaxes bladder muscle
PNS response of bladder
constricts bladder
SNS response of uterus
relaxes uterine muscle
PNS response of salivary gland
increases salivation
T/F: sympathetic and parasympathetic nervous systems have opposite responses on body tissues and organs
T different tissues affected by different systems
Neurotrasmitters:
- tyrosine–dopamine–norepinephrine–epinephrine
norepinephrine
secreted by nerve fibers call adrenergic fibers
norepinephrine
synthesized from acetylcoenzyme A and Choline
Acetylcholine
secreted by nerve fibers called cholinergic fibers
Acetylcholine
How neurotransmitters work
- act on receptors in tissues and organs to cause a sympathetic or parasympathetic response
- either system may cause excitatory or inhibiting effects in an organ
- these effects are specific to SNS or PNS
T/F: just because you have stimulation of one system, you block the other system
F
T/F: most organs/tissues are predominantly controlled by either the SNS or PNS
T
cells of the lungs are predominantly covered with ______ receptors
beta 2
the heart is mostly covered with ______ receptors
beta 1
stimulated by stress: both physical and emotional
SNS
Which nervous system?
increased BP and cardiac output
SNS
Which nervous system?
Increased blood flow to the brain, heart, and skeletal muscles with decreased blood flow to the viscera, skin, and other body systems not needed in the fight or flight response
SNS
Which nervous system?
increased O2 used and production of CO2
SNS
Which nervous system?
increased breakdown of glycogen to produce energy
SNS
Which nervous system?
increased blood sugar
SNS
Which nervous system?
increased ability to think
SNS
Which nervous system?
increased muscle strength
SNS
Which nervous system?
increased rate of blood coagulation
SNS
Which nervous system?
increased rate and depth of respirations
SNS
Which nervous system?
pupils dilate - aids distant and dark vision
SNS
adrenergic neurotransmitters
norepinephrine, epinephrine dopamine
amount of norepinephrine and epinephrine present at the synapse effects amount of response
adrenergic neurotransmitters
has an intense short reaction
adrenergic neurotransmitters
reabsorbed or metabolized by monoamine oxidase (MAO) or catechol-O-methyltransferase (COMT)
adrenergic neurotransmitters
2 enzymes that breakdown adrenergic neurotransmitters
MAO (monoamine oxidase)
COMT (catechol-O-methyltransferase)
T/F: norepinephrine and epinephrine also act as hormones
T
Norepinephrine and epinephrine:
secreted into the blood stream by the ______
adrenal medulla
Norepinephrine and epinephrine:
amount present in blood at any time depends on the _____ being experienced and function of the _______
stress, adrenal medulla
Norepinephrine and epinephrine:
metabolized in the liver by __ and __
MAO or COMT
Adrenergic receptors:
blood vessels
Alpha 1 & Alpha 2
Adrenergic receptors:
heart
Beta 1
Adrenergic receptors:
coronary vessels
Beta 1
Adrenergic receptors:
lungs
Beta 2
Adrenergic receptors:
inhibits release of norepinephrine
Alpha 2
Adrenergic receptors:
bronchiole dilation
Beta 2
3 ways neurotransmitters are inactivated…which ones are the *main ways adrenergic neurotransmitters are inactivated?
- re-uptake
- enzymes MAO and COMT breakdown neurotransmitters
- diffusion of the neurotransmitter away from the receptor site
neurotransmitter is floating around between one cell and another
re-uptake
prolong action of norepinephrine by:
- inhibiting re-uptake of norepinephrine
- inhibiting the enzyme breakdown of norepinephrine
3 ways of stimulation of adrenergic receptors
- direct acting
- indirect acting
- mixed acting
we are giving a med in the same shape (acts and functions) as the neurotransmitter itself
direct acting
we are allowing the body’s natural amount of neurotransmitter to stay there..trying to increase the “norepinephrine” that’s already there and available to the receptors
indirect acting
combination of both direct and indirect acting
mixed acting
only stimulate one kind of receptor
selective
affects all the different adrenergic receptors (use for something like shock)
nonselective
T/F: there are NEVER any contraindications if you can save someone’s life using epinephrine
TRUE!
Nursing Considerations for Epinephrine:
T/F if you’re using this as an IV, you HAVE to have the patient on a cardiac monitor
T
Nursing Considerations for Epinephrine:
T/F: you always have to be working on treating the underlying cause for the reason you’re having to use epinephrine
T
Is Albuterol Selective or Nonselective?
Selective
We are blocking the effects of the adrenergic system when we give these kinds of medications
adrenergic antagonists
rare adverse affect that creates a significant drop on BP
- when a patient takes this med for the 1st time, it has an extraordinary reaction. It decrease their BP significantly because those receptors have not had this kind of stimulation before = significant BP decrease, bradycardia, dizziness, significant HR increase
1st dose effect (ex. of drug = Prazosin)
All meds that end in “olol” it is a _____
beta-blocker
How I love the Beta-blockers, falol-lol-lol-lol-lol-lol
T/F: If adrenergic agonists tend to cause bronchodilation, then an adrenergic antagonist would potentially cause bronchiol-constriction
T
T’F: propranolol should be weened slowly (slowly get off medication, not just suddenly stop taking it)
T
Which nervous system?
Dilation of blood vessels in the skin
PNS
Which nervous system?
decreased HR - bradycardia
PNS
Which nervous system?
increased secretion of digestive enzymes
PNS
Which nervous system?
increased motility of the GI system
PNS
Which nervous system?
Constriction of smooth muscles of the bronchi
PNS
Which nervous system?
Increased Secretions (lungs, stomach, intestines, skin)
PNS
Which nervous system?
pupil constriction and accommodation of near vision
PNS
Which nervous system?
contraction of smooth muscle in the urinary bladder
PNS
Which nervous system?
contraction of skeletal msucles
PNS
Which nervous system?
No effect on blood coagulation, blood sugar, mental activity or muscle strength
PNS
Ex. of Cholinergic Neurotransmitter
Acetylcholine
excitatory effects at nerve synapses and nerve-muscle junctions
Acetylcholine (Cholinergic Neurotransmitter)
inhibitory effects at some peripheral sites
Acetylcholine (Cholinergic Neurotransmitter)
after action is split into acetate and choline by the enzyme acetylcholinesterase
Acetylcholine (Cholinergic Neurotransmitter)
Cholinergic receptors
nicotinic and muscarinic
Nicotinic:
- located in the _____________
- stimulation produces ________
- located in the motor nerves and skeletal muscles
- stimulation produces muscle contraction
Muscarinic:
- location in most ______
- stimulation can produce either an ______ or _______
- location in most internal organs
- stimulation can produce either an excitatory or inhibiting response
blocking the rest/digest system
parasympatheolytic (anticholinergic)
urinary retention due to detrusor muscle relaxation and increased tone of the internal sphincter
parasympatheolytic (anticholinergic)
dilates pupils and paralyzes the ciliary muscle causing decreased accommodation
parasympatheolytic (anticholinergic)
decrease salivation, perspiration, bronchila secretions
parasympatheolytic (anticholinergic)
dilates the bronchi
parasympatheolytic (anticholinergic)
decreased tremors
parasympatheolytic (anticholinergic)
decreased muscle rigidity
parasympatheolytic (anticholinergic)
drowsiness, disorientation, and hallucinations can be experienced with large doses
parasympatheolytic (anticholinergic)
Cholinergic Agonists:
bethanechol (urecholine)
direct
Cholinergic Agonsits:
Pyridostiigmine (Mestinon)
Indirect
helping or stimulation cholinergic/rest&digest system
agonist
How do you treat cholinergic crisis?
with Atropine, may need mechanical ventilation
can cause respiratory muscle paralysis
cholinergic crisis
excessive parasympathetic stimulation
cholinergic crisis
muscarinic antagonist
atropine
comes from “the deadly night shade plant”
nicotine antagonists (3)
- mecamylamin
- succinylcholine
- turbocurarine
What drug:
- decrease allergic reaction
- treat anaphylaxis, branchospasm, cardiac arrest
epinephrine
What drug:
- treat bronchospasm, asthma, bronchitis, COPD
Albuterol
What drug:
- treats nasal decongestion, treats hypotension
phenylephrine
What drug:
- controls HTN, treats BPH, Refractory CHF
Prazosin
What drug:
- controls HTN, cardiac dysrhythmias, angina, MI
Propranolol
What drug:
- decrease urinary retention by prompting bladder contraction
- increase peristalsis and gastrointestinal secretions
bethanechol
What drug:
- treat myasthenia gravis
- decrease skeletal muscle weakness and fatigue, used in the military to prevent potential nerve gas effects
pyridostigmine
What drug:
- used preoperatively to dry secretions, increase heart rate, and to dilate pupils
- used to treat hypermotility of the GI tract (slows peristalsis)
Atropine sulphate
The nurse monitors a client on a newly prescribed antihypertensive drug. The nurse recognizes the symptom of hypotension to be indicative of which reaction?
A. an idiosyncratic drug reaction
B. a side effect of the drug
C. an allergic response to the drug
D. a therapeutic drug effect
B. a side effect of the drug
Can you drive after taking an anticholinergic?
NO! You would think it would cause similar symptoms of flight of fight, but it crosses the BBB which makes an affect on sleepiness
Q: The main neurotransmitter of the parasympathetic nervous system is: A. dopamine. B. norepinephrine. C. serotonin. D. acetylcholine.
D. acetylcholine.
Q: A client reports using an herb that is known to block muscarinic receptors. The nurse would expect which of the following effects: A. Urinary incontinence B. Watery eyes C. Hypotension D. Constipation
D. Constipation
Q: The nurse would expect to use which medication for a patient diagnosed as being in cholinergic crisis? A. Atropine B. Pyridostigmine C. Bethanechol D. Epinephrine
A. Atropine
Q: Which type of medication would be inappropriate for a patient with hypertension?
A. Propranolol, a nonselective beta antagonist
B. Bethanechol, a direct cholinergic agonist
C. Prazosin, a selective alpha-1 antagonist
D. Phenylephrine, an alpha agonist
D. Phenylephrine, an alpha agonist
Q: Sympathomimetic drugs have similar physiologic effects as: A. Anticholinergics. B. Muscarinic agonists. C. Parasympathomimetics D. Adrenergic antagonists.
A. Anticholinergics.
Q: Which of the following is NOT a way that pharmacology can prevent the decrease of neurotransmitters?
A. Preventing the reuptake of neurotransmitters
B. Preventing the dissemination of neurotransmitters
C. Preventing the action of enzymes
B. Preventing the dissemination of neurotransmitters
Q: Albuterol, a selective beta-2 agonist, is used for the treatment of: A. Hyperglycemia B. Hypertension C. Asthma D. Glaucoma
C. Asthma
Q: A patient is being discharged to home with a prescription of Ditropan XL, a muscarinic antagonist. Which of the following is NOT an important teaching point?
A. Avoid fiber to prevent diarrhea
B. Report inability to urinate to your doctor
C. Chew gum to decrease dry mouth
D. Use eye drops for dry eyes
A. Avoid fiber to prevent diarrhea
Q: What effects would stimulation of the sympathetic nervous system have on the heart, blood vessels, and lungs?
A. Bradycardia, hypotension, and bronchoconstriction
B. Bradycardia, hypertension, and bronchoconstriction
C. Tachycardia, hypertension, and bronchodilation
D. Tachycardia, hypotension, and bronchodilation
C. Tachycardia, hypertension, and bronchodilation
Q: A patient with COPD would need to be cautious about taking which type of medication? A. A non-selective beta-blocker B. A selective beta-2 agonist C. An anti-cholinergic D. A non-selective adrenergic agonist
A. A non-selective beta-blocker
potential interactions of epinephrine
Beta blockers, alpha-adrenergic blockers
prazosin classification
alpha1-adrenergic antagonist
epinephrine classification
nonselective adrenergic agonist
albuterol classification
beta2-adrenergic agonist
phenylephrine classification
alpha adrenergic agonist
propranolol classification
nonselective beta adrenergic blocker
can you give bethanechol IM or IV
NO!
pyridostigmine classification
indirect acting acetylcholinesterase inhibitor
T/F: Nonsteroidal anti-infalmmatory drugs may be given for fevers in young children
T
Q: A patient is being discharged to home with a new prescription for hydrocodone/acetoaminophen 5/325 mg po q4-6h prn. Which of the following statements by your pt leads you to believe that she has understood the teaching you have done about the relief of pain.
A. “after I take the medication, I will use distraction to lessen the pain until I start getting relief”
B. I will take the med only after the pain is severe”
C. If I think that I may have pain during the day, I will take a dose in the morning with breakfast”
D. After I take the med, I should get total relief in 5 minutes.”
A. “after I take the medication, I will use distraction to lessen the pain until I start getting relief”
Q: Which of the following is NOT a contraindication for the use of cholinergic agonist drugs? A. asthma B. diabetes mellitus C. bradycardia D. bowel obstruction
B. diabetes mellitus
Q: Atropine and atropine-like drugs are anticholinergics. Atropine is usually prescribed as one of the preoperative drugs. What is the primary use for atropine as a preoperative drug? A. decrease urination B. decrease GI motility C. decrease salivation D. decrease HR
C. decrease salivation (so they don’t aspirate)
Q: a nurse is discharging a pt who is taking an anticholinergics med. Which of the following should the nurse include is the discharge teaching regarding the pt’s anticholinergic med?
A. Decrease fluid and fiber intake to avoid diarrhea
B. instruct the pt to use sunglasses in bright light
C. alert the pt that drowsiness may occur and to avoid driving a car
D. suggest hard candy, chewing gum, & oral hygiene for dry mouth
B. instruct the pt to use sunglasses in bright light
C. alert the pt that drowsiness may occur and to avoid driving a car
D. suggest hard candy, chewing gum, & oral hygiene for dry mouth
Q: How does the student nurse explain the action of an agonist to a pt?
A. it produces a desired therapeutic effect
B. it blocks a cellular response
C. it produces a response similar to regular cellular function
D. it produces an idiosyncratic response
C. it produces a response similar to regular cellular function
Q: The nurse was very busy and administered a new, unfamiliar med without looking it up first. Later the nurse looked up the med. How would the nurse manager evaluate this behavior?
A. an error could have occurred because the nurse was unfamiliar with the med
B. this was acceptable as long as the nurse looked up the action and side effects of the drug at some point
C. it was an error
A. an error could have occurred because the nurse was unfamiliar with the med
