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Neuro -test 2
neuro -test2
| Question | Answer |
|---|---|
| Parasympathetic Drugs | Cholinergic Agents (Direct-Acting) Anticholinesterase Agents (Indirect-Acting) Anticholinergic Agents |
| Sympathetic Drugs | Adrenergic Adrenergic Blockers Ganglionic Blockers |
| Cholinergic Agents | Also known as Cholinomimetics - mimics the action of acetylcholine - considered Direct-Acting agents |
| Cholinergic Agents Pharmacodynamics | pupilary constriction with increased accommodation, reduction of intraoccular pressure, increase muscle tone, increase peristaltic activity, increase bladder control, decrease heart rate, increase pancreatic & GI tract secretions |
| Cholinergic Agents Specific Agents / Prototype: | Tx. of Glaucoma pilocarpine Hcl (Pilocar) Tx. of Neurogenic Bladder / Post-Op Urinary Retention bethanechol chloride (Urecholine; Duvoid) Tx. For Post-Op N/V: metoclopramide Hcl (Reglan) |
| Cholinergic Agents Adverse Effects | Results in non-specific effects throughout the parasympathetic nervous system Hypothermia; increased sweating, salivation, lacrimation, increased urination; N/V/D; hypotension !!!!Cholinergic Crisis!!! can result in patients with hypersensitivity |
| Cholinergic Crisis | Non-specific and affect the whole parasympathetic nervous system Characterized by: Nausea, vomiting, increased salivation, diarrhea, sweating, miosis, hypotension polyuria Always have !!!Atropine!!! on hand to treat Cholinergic Crisis |
| Cholinergic Agents Nursing Implications | Monitor V.S., auscultate breath sounds, bowel sounds, visual acuity and accommodation Keep Atropine available as antidote Monitor and record changes in muscle strength Teach patient to take medication on an empty stomach (1 hr before or 2 hours a |
| Anticholinesterase Agents Pharmacodynamics | Inhibits enzyme destruction of acetylcholine, maintaining action of acetylcholine lowers intraoccular pressure, antispasmodic; skeletal muscle relaxation, increased muscle tone & gastric motility |
| Anticholinesterase Agents Pharmacotherapeutics: | Myasthenia Gravis, reversal of non-depolarizing muscle relaxants, treatment of glaucoma |
| Anticholinesterase Agents Specific Agents/Prototype: | physiostigmine (Antilerium) Additional Agents: ambenonium (Mytelase) edrophonium (Tensilon) pyridostigmine (Regonol) neostigmine (Prostigmin) |
| Anticholinesterase Agents Adverse Effects | Blurred vision; increased sweating; increased salivation; N/V/D Dyspenea; wheezing; bradycardia; hypotension Used to reverse the effect of non-depolarizing muscle relaxants (PACU) |
| Anticholinesterase Agents Nursing Implications / Teaching | Have respiratory support equipment available until patient is stable Monitor VS; B/P; Lung sounds Take seizure precautions Monitor & evaluate muscle strengh |
| Anticholinergic Agents | Competes with acetylcholine on muscarinic receptor sites increased heart rate and cardiac output, decreased salivation & drying of mucous membranes, relaxation of smooth muscles, decreased GI activity, antispasmodic |
| Anticholinergic Agents Pharmacotherapeutics | Cardiac Arrest & Bradycardia G I & Bowel disease Motion Sickness Parkinson’s Disease Pre-Op Medication |
| Anticholinergic Agents Specific Agents / Prototype: | atropine sulfate (Atropine) Additional Agents trihexyphenidyl Hcl (Artane) probanthine bromide (Pro-Banthine) glycopyrrolate (Robinul) scopolamine (Trans-Derm Scope) benztrophine mesylate (Cogentin) |
| Anticholinergic Agents Mnemonic: Common Adverse Effects | “ Red as a Beet” = vasodilation “ Fast as a Hare” = tachycardia “ Dry as a Bone” = decreased secretions,hyperthermia,urinary retention “ Mad as a Hatter” = nervousness, irritability “ Blind as a Bat” = blurred vision, photophob |
| Anticholinergic Agents Nursing Implications / Teaching | Monitor patient’s response to drug Administer 30 minutes before meals and/or at bedtime Monitor for S/S urinary retention Teach patient: Don’t double-up; good oral hygiene; reduce fluids prior to bedtime |
| Anticholinergic Agents Contraindications / Precautions | !!!!Glaucoma!!!! Unstable Heart conditions Acute hemorrhage Prostatic hypertrophy Chronic renal, hepatic, pulmonary or cardiac disease |
| Sympathetic Nervous System | epinephrine, nor epinephrine, dopamine increased heart rate, respiratory rate, peripheral vasoconstriction, pupil dilation, increased fat and glycogen breakdown, suppression of GI system Prepares the body for stress or injury |
| Sympathetic Nervous SystemM ajor Receptor Sites | Alpha 1 Blood vessels - constriction Urinary bladder - constriction Increased secretion – salivary glands Decreased insulin production Alpha 2 Constriction of skeletal blood vessels |
| Sympathetic Nervous System Major Receptor Sites | Beta 1 Heart - increased rate, conduction Beta 2 Smooth Muscle – relaxation Dopaminergic Coronary arteries, Renal & Mesenteric blood vessels - dilation |
| Sympathetic Agents | Adrenergic Agents (Catecholamines) Adrenergic Blockers Ganglionic Blockers |
| Adrenergic Agents Pharmacodynamics: | Sympathomimetic –”Fight or Flight” hemostasis, pupil dilation, nasal decongestion, hypotension, cardiac failure, cardiogenic shock, asthma |
| Sympathetic Agents Prototype | epinephrine (Adrenalin) |
| Adrenergic Agents Major Category Direct-Acting | - increased cardiac rate, contractility - decreased bronchial secretions - decreased peristalsis & urination - respiratory stimulation & bronchodilation |
| Adrenergic Agents Major Category Indirect / Mixed-Acting | potent vasoconstriction - reflective bradycardia - rapid bronchodilation |
| Adrenergic Agents Pharmacotherapeutics: Shock | Shock dopamine (Intropin) epinepherine (Adrenalin) metaraminol (Aramine) norepinepherine (Levarterenol) dobutamine (Dobutrex) |
| Adrenergic Agents Pharmacotherapeutics Bronchospasm | Bronchospasm (Bronchodilators) albuterol (Proventil) epinepherine (Bronkaid) isoproterenerol (Medihalier -Iso) metaproterenol (Aramine) terbutaline sulfate (Brethine) |
| Adrenergic Agents Pharmacotherapeutics Nasal Decongestion | Nasal Decongestion ephedrine (Vicks Vantrol) naphazoline (Privine) pseudoephedrine (Afrin, Sudafed) Neo-Synepherine |
| Adrenergic Agents Common Adverse Effects | CV - hypertension, tachycardia dysrhythmias, orthostatic hypotension Renal -Urinary retention G.I. - Nausea/Vomiting/Diarrhea Respiratory - Bronchoconstriction Endocrine - Hypoglycemia |
| Adrenergic Blocking Agents Pharmacodynamics Pharmacotherapeutics / Agents | Blocks sympathetic action (Sympatholytic) Limited clinical usage decrease B/P – phentolamine (Regitine) decreased pulsations in migraines ergotamine (Ergostat) |
| Adrenergic Blocking Agents Beta (Adrenergic) Blockers Pharmacodynamics | Receptor Site: Beta 1 & 2 Pharmacodynamics decreased heart rate, contractility, cardiac output, conduction velocity, vasodilation, dysrhythmias, ventricular protection |
| Adrenergic Blocking Agents Beta Blockers Pharmacotherapeutics | Prototype: propranolol (Inderal) Pharmacotherapeutics Cardiac Dysrythmias, Cardiac protection following an MI, hypertension, angina, SVT, migraines, wide-angle glaucoma |
| Adrenergic Blocking Agents Beta Blockers | Additional Agents: metopropol (Lopressor) nadolol (Corgard) timolol maleate (Timoptic) atenolol (Tenormin) |
| Adrenergic Blocking Agents General Adverse Effects | CV – hypotension, A-V Block, CHF Resp - bronchoconstriction, bronchospasm GI – N/V/D; flatus, abd. cramping CNS – dizziness, disorientation, drowsiness Endocrine - hypoglycemia |
| Ganglionic Blockers Pharmacodynamics | prevents transmission of both sympathetic and parasympathetic nerve impulses, potent vasodilation, increases peripheral blood flow |
| Ganglionic Blockers Pharmacotherapeutics | Potent Antihypertensive; produce controlled hypotension during surgery (limited usage due to serious adverse effects), Short-Term therapy |
| Ganglionic Blockers Common Agents: Prototype | trimethaphan camsylate (Arfonad) Additional Agent: mecamylamine Hcl (Inversine) |
| Ganglionic Blockers Adverse Effects | severe hypotension, renal toxicity, hepatotoxicity, weakness, N/V/D, restlessness, tachycardia, angina, urinary re |
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d4w751
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