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pnm- pharm > week 4-Autonomic Nervous System > Flashcards

week 4-Autonomic Nervous System Flashcards

1
Q

SNS-sympathetic

A

Neurotransmitters are epinephrine, norepinephrine and dopamine

Receptors are alpha 1 and alpha 2, beta 1 and beta 2, and dopaminergic receptors

Fight of flight

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2
Q

PSNS-parasympathetic

A

Neurotransmitter is acetylcholine (Ach)

Receptors are centrally located nicotinic and peripherally located muscarinic

Rest and digest

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3
Q

sns + psns =

A

ans

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4
Q

adrenergics

A

large group of both exogenous (synthetic) and endogenous (naturally occurring) substances.

they also stim the SNS

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5
Q

catecholamines

A

substances that can produce a sympathic response

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6
Q

Adrenergic Agents: Definition

A

Drugs that stimulate the sympathetic nervous system (SNS)
Referred to as “fight or flight response”
Also known as:
 Adrenergic agonists
 Sympathomimetics

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7
Q

Catecholamines

A

Mimic the effects of the SNS neurotransmitters:
 norepinephrine (NE)
 epinephrine (EPI)
 dopamine

Direct-Acting: Designed to stimulate & act like a neurotransmitter (bind to receptor sites and creates a response)
 Non catecholamine adrenergic drugs
 ie. Phenylephrine, salbutamol

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8
Q

Adrenergic receptors (receptor sites for catecholamine norepi and epi)

A

are located throughout the body where adrenergic drugs bind and produce the desired effect.

Are receptors for the sympathetic neurotransmitters

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9
Q

Adrenergic receptors are divided into two

A

–alpha-adrenergic and beta adrenergic receptors

Subdivided into alpha 1 & 2 and beta 1 & 2

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10
Q

Alpha-adrenergic receptors:

A

respond to NE

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11
Q

Beta-adrenergic receptors:

A

respond to EPI***

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12
Q

Dopaminergic receptors:

A

respond to dopamine

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13
Q

Alpha 1 located on post synaptic effector cells

A

(on the muscle or organ that the nerve stimulates)

located on post synaptic effector cells

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14
Q

Alpha 2 located

A

on pre- and post-synaptic nerve terminal (sympatholytic effects)

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15
Q

Predominant Alpha-Adrenergic Agonist Responses

A

Vasoconstriction

CNS stimulation

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16
Q

Beta-Adrenergic Receptors are located

A

on postsynaptic effector cells

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17
Q

Beta1-adrenergic receptors —

A

located primarily in the heart resulting in cardiac stimulation

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18
Q

Beta2-adrenergic receptors —

A

located in smooth muscle of the bronchioles, arterioles, and visceral organs resulting in bronchial, GI and uterine smooth muscle relaxation (dilation)

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19
Q

Dopaminergic Receptors

A

An additional adrenergic receptor
Stimulated by dopamine

Causes dilation of the following blood vessels, resulting in increased blood flow
	Renal
	Mesenteric
	Coronary
	Cerebral
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20
Q

Indirect-acting sympathomimetic

A

Causes the release of catecholamine from the storage sites (vesicles) in the nerve endings
The catecholamine then binds to the receptors and causes a physiological response

ie. amphetamines

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21
Q

Mixed-acting sympathomimetic

A

Mixed-acting sympathomimetic

Directly stimulates the receptor by binding to it
and
Indirectly stimulates the receptor by causing the release of stored neurotransmitters from the vesicles in the nerve endings

ie. ephedrine

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22
Q

Responses to Stimulation

A

Location/ Receptor/ Response

Cardiovascular:
Blood vessels- alpha1 and beta2 / Constriction/dilation
Cardiac muscle/ beta1 / Increased contractility
AV Node beta1 / Increased / heart rate
SA Node beta1 / Increased / heart rate

Gastrointestinal:
Muscle/beta2 / Decreased motility
Sphincters/ alpha1 / Constriction

Genitourinary:
Bladder / alpha1 / Constrictionsphincter
Penis/ alpha1/ Ejaculation
Uterus / alpha1 and beta2 / Contraction/relaxation
Bronchial / beta2 / Dilation/relaxationmuscles

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23
Q

Alpha Adrenergic Drug Effects

A

Stimulation of alpha-adrenergic receptors on smooth muscles results in:
 Vasoconstriction of blood vessels (used to increase BP)
 Relaxation of GI smooth muscles
 Contraction of the uterus and bladder
 Male ejaculation
 Decreased insulin release
 Contraction of the ciliary muscles of the eye
(dilated pupils)

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24
Q

Adrenergic drugs

A

drugs stay in the synaptic cleft where they induce a response

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25
Q

Direct Acting – (Adrenergic drugs)

A

bind directly to the receptor ie epinephrine
Used for glaucoma, shock due to trauma
Do not use in toes, finger or nose due to the vasoconstriction effects

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26
Q

Isoporternol—beta 1 & beta 2 sympathomimetics

A

Anti-asthmatic agent
Used to treat hypotension
Increases stroke volume & 02 consumption to the myocardium
Used for atropine, dopamine resistant bradycardia & or hypotension

27
Q

Alpha 1 agonists: decongestants

A

Phenylephrine
Pseudoephedrine
Tetrahydrozoline

28
Q

Alpha 2 agonists: antihypertensives, rehabilitation/ withdrawal

A 
Clonidine
Methyldopa (safe to use during pregnancy)
29
Q

Indications (BETA 2)

A

-Bronchodilators:
treatment of asthma and bronchitis
 Agents that stimulate beta2-adrenergic receptors of bronchial smooth muscles, causing relaxation
 Used for allergic reactions causing bronchoconstricton, viral or bacterial infections leading to bronchitis, pneumonia and wheeze
 ie.Salbutamol(Ventolin), Salmeterol (Advair)

-Reduction of intraocular pressure (IOP), mydriasis -pupil dilation and fluid regulation:

-Treatment of open-angle glaucoma
Cause mydriasis
ie. phenylephrine

-Temporary relief of conjunctival congestion by constricting the arteries which reduces the redness in the eye

-Decongestant
Alpha-adrenergic receptors
Examples:
– epinephrine		
– phenylephrine           
– tetrahydrozoline (Visine)

-Nasal decongestant
Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion

Vasoconstriction of nasal mucosa causes shrinkage of the mucosa, decreased secretion and reduced blood flow to the engorged sites

Abuse of nasal decongestants can cause rebound nasal congestion where the patient does not respond after chronic use
- epinephrine

30
Q

Tetrahydrozoline (Murine, visine)—

A

temporary relief of congestion, itchiness, minor irritation & redness
Can be used for diagnostic procedures to dilate the pupils

31
Q

Vasoactive Sympathomimetics (Pressors, Inotropes)

A

• Also called cardioselective sympathomimetics (Very potent vasoconstrictors)
 Used to support the heart during cardiac failure or shock (↑BP)
 Various alpha- and beta-receptors affected
 ie. epinephrine, norepinephrine, dopamine

32
Q

Pseudoephedrine (sudafed) & ephedrine

A

Stimulates both alpha & beta adrenergic receptors –large doses can elevate both blood pressure & heart rate
Acts as decongestant by stimulating alpha adrenergic receptors of vascular smooth muscles—constricting dilated arterioles within the nasal mucosa & reducing blood to the engorged area.

33
Q

Epinephrine

A 
Indications:
Anaphylaxis
Shock/severe hypotension
Part of infiltration anaesthesia
Status asthmaticus
Cardiac arrest
34
Q

Side Effects: Alpha-Adrenergic

A

CNS
 Headache, restlessness, excitement, insomnia, euphoria
Cardiovascular
 Palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension
Other
 Anorexia, dry mouth, nausea, vomiting, taste changes (rare)

35
Q

Alpha side effects

A

Headache, restlessness, excitement, CNS stimulation, euphoria, tachycardia, hypertension, palpitations, decreased appetite

36
Q

beta side effects

A

CNS stimulation, tremors, nervousness, dizziness, headaches, palpitations, tachycardia, hypertension, arrhythmias, GI distress

37
Q

Side Effects: Beta-Adrenergic

A

 CNS
Mild tremors, headache, nervousness, dizziness
 Cardiovascular
Increased heart rate, palpitations (dysrhythmias), fluctuations in BP
 Other
Sweating, nausea, vomiting, muscle cramps

38
Q

Do not administer similar drugs together

A

can cause severe hypertension, tachycardia, chest pain, palpitations with arrhythmias

39
Q

Need to wait at least 4hrs between medications

40
Q

Always administer IV drug through a pump,

A

never by gravity

41
Q

Asthma – (nursing considerations)

A

bronchodilator & steroid—first bronchodilator to open bronchioles and steroids would be more effective. Wait 5mins between meds
Inhalation isoproterenol can cause pink sputum due to medication—do not confuse with blood

42
Q

Epinephrine (Adrenalin)

nursing considerations

A

should not be used in toes or fingers due to the potent vasoconstriction effects

43
Q

Albuterol (Ventolin)

A

is indicated for the management of acute asthma symptoms

44
Q

Overuse of nasal decongestants may cause

A

rebound nasal congestion or ulcerations

45
Q

Administering two adrenergic agents together

may precipitate

A

severe cardiovascular effects such

as tachycardia or hypertension crisis

46
Q

ANS=

47
Q

SPECFICI TARGERT RECEPTORS FOR CATECHOLAMINES EPI AND NOREPI ARE CALLED

A

ADRERGIC RECEPTORS.

48
Q

TWO MAIN GROUPS OF ADRENERGIC RECEPTORS

A

A-DRENERGIC AND B-

49
Q

A1-ADRENERGIC RECEPTORS ARE LOCATED ON

A

POSTSYNAPTIC EFFECTOR CELLS

50
Q

A2-ADRENERGIC RECEPTORS ARE LOCATED ON

A

PRESYNAPTIC NERVE TERMINALS

THEY CONTROL THE RELEASE OF NEUROTRANSIMITTERS

51
Q

B1 ADRENERGIC RECEPTORS

A

IN THE HEART (B1, 1 HEART)

52
Q

B2 ADRENERGIC RECPETIORS

A

IN THE LUNGS (2 LUNGS)

AND SMOOTH MUSCLE!!

53
Q

THE PREDOMINATE A-ADRENERGIC AGONIST EFFECT IS

A

VASOCONSTRICTION AND CENTRAL NERVOUS SYSTEM STIMULATION

54
Q

THE PREDOMINATE B-ADRENERGIC AGNOIST RESPONSE RESULTS IN

A

BRONCHIAL, GI, AND UTERINE SMOOTH MUSCLE RELAXATION

ALSO HEART STIMULATION

55
Q

DOPAMINERGIC RECEPTOR

A

WHEN STIMULATED BY DOPAMINE, VASODIALTION

56
Q

ADRENERGICS

A

MIMIC THE EFFECTS OF NOREPI, EPI, AND DOPAMINE

57
Q

CATECHOLAMINE DRUGS USED THERAPEUTICALLY PRODUCE THE SAME RESULT AS THE

A

ENDOGENOUS (NATURAL) EFFECTS.

58
Q

B1-ADRENERGIC RECEPTORS HAVE THREE EFFECTS WHEN STIMUALTED

A
  1. INCREASED FORCE OF CONTRACTION
  2. INCREASE IN HEART RATE
  3. NERVE CONDUCTION
59
Q

B2- ADRENERGIC RECEPTORS PRODUCES

A

RELAXATION OF THE BRONCHI
AND GLYCOGENOYSIS
AND INCREASE RENIN SECRETION.

60
Q

B2 IS MOST COMMON FOR

A

ASTHMA AND BRONCHITIS

61
Q

PRESSOR DRUGS

A

USED TO SUPPORT THE CARDIOVASCULAR SYSTEM DURING SHOCK OR HEART FAILURE.

62
Q

MIDODRIN USE

A

REQUIRES CAREFUL BP MONITORING

63
Q
  1. Stimulation of beta adrenergic receptors in the heart results in (3 THINGS)
A
  1. INTROPIC______(increased force of contraction), 2.CHRONOTROPIC AGENTS_________(increased heart rate)
  2. *DROMOTROPIC AGENTS_____(increased conduction through the AV node)
64
Q
  1. Alpha blockers cause both
A
  1. ARTERY and
  2. VEINS dilation which reduces
  3. BLOOD RESISTANCE and
  4. DECREASE BP

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