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Pharm LP 4
| Question | Answer |
|---|---|
| What are the most commonly prescribed medications impacting the Autonomic Nervous? | Beta-blockers/Anti-cholinergics |
| The autonomic nervous system controls what responses? | Involuntary |
| The sympathetic division of the ANS is associated with the | Fight or flight response |
| The parasympathetic division of the ANS is associated with the | rest and digest response |
| Stimulation of the SNS causes what to happen to your heart rate? | Increase heart rate. |
| Preganglionic neurons release what onto nicotinic receptors on the postganglionic neuron | acetylcholine |
| Postganglionic neurons within the autonomic nervous systems are classified as either cholinergic or adrenergic. T/F | True |
| Cholinergic neurons release | acetylcholine |
| Adrenergic neurons release | norepinephrine |
| The cholinergic system includes two classes of postganglionic receptor: | nicotinic receptor and the muscarinic receptor |
| The adrenergic system also has two types of receptors: | alpha (α)-adrenergic receptor and beta (β)-adrenergic receptor |
| Acetylcholine (ACh) | Binds to both nicotinic receptors and muscarinic receptors in the PNS. |
| Adrenergic | Postganglionic neuron where neurotransmitters norepinephrine and epinephrine are released. Includes alpha (α) receptors and beta (β) receptors. |
| Adrenergic Agonist | Mimics the effects of the body’s natural SNS stimulation on alpha (α) and beta (β) receptors. Also called sympathomimetics. |
| Adrenergic Antagonist | Blocks the effects of the SNS receptors. |
| Anticholinergics | Inhibit acetylcholine (ACh), which allows the SNS to dominate. Also called parasympatholytics or muscarinic antagonists. Overall use is to relax smooth muscle. |
| Autonomic Nervous System | Controls cardiac and smooth muscle, as well as glandular tissue; associated with involuntary responses. |
| Catecholamines | Include norepinephrine, epinephrine, and dopamine. Stimulate the adrenergic receptors. |
| Central Nervous System (CNS) | Anatomical division of the nervous system located within the cranial and vertebral cavities, namely the brain and spinal cord. |
| Cholinergic | Postganglionic neuron where acetylcholine (ACh) is released that stimulates nicotinic receptors and muscarinic receptors. Also relating to drugs that inhibit, enhance, or mimic the action of ACh. |
| Chronotropic | Drugs may change the heart rate and rhythm by affecting the electrical conduction system of the heart and the nerves that influence it, such as by changing the rhythm (increasing) produced by the sinoatrial node. Positive chronotropes increase heart rate; negative chronotropes decrease heart rate. |
| Dromotropic | Stimulation causes increases speed of conduction between SA and AV node. |
| Fight-or-Flight Response: | The response when the SNS is stimulated, causing the main effects of increased heart rate, increased blood pressure, and bronchodilation. |
| Glycogenolysis | The breakdown of glycogen into glucose, causing elevated blood glucose. |
| Homeostasis (in ANS) | Balance between the SNS and PNS. At each target organ, dual innervation determines activity. For example, SNS stimulation causes the heart rate to increase, whereas PNS stimulation causes the heart rate to decrease. |
| Hyperglycemia | Elevated blood glucose. |
| Inotropic | Stimulation causes increased force of contraction |
| Involuntary Responses: | Responses that the brain controls without the need for conscious thought. |
| Motor Neurons | Consist of the somatic nervous system that stimulates voluntary movement of muscles and the autonomic nervous system that controls involuntary responses. |
| Muscarinic Agonists | Also called parasympathomimetics. Primarily cause smooth muscle contraction, resulting in decreased HR, bronchoconstriction, increased gastrointestinal/genitourinary tone, and pupil constriction. |
| Neurons | Cells that carry electrical impulses to the synapse of a target organ. |
| Nonselective Beta Blockers: | Medications that block both Beta-1 and Beta-2 receptors, thus affecting both the heart and lungs. |
| Parasympathetic Division (PNS) | Includes nerves outside the brain and spinal cord. Associated with the “rest and digest” response. Stimulation of PNS causes decreased heart rate, decreased blood pressure via vasodilation, bronchial constriction, and stimulates intestinal motility, salivation, and relaxation of the bladder. |
| Parasympatholytics | Inhibit acetylcholine (ACh), which allows the SNS to dominate. Also called anticholinergics or muscarinic antagonists. |
| Parasympathomimetics | Also called muscarinic agonists. Primarily cause smooth muscle contraction, resulting in decreased HR, bronchoconstriction, increased GI/GU tone, and pupil constriction. |
| Peripheral Nervous System (PNS) | An anatomical division of the nervous system that is largely outside the cranial and vertebral cavities, namely all parts except the brain and spinal cord. |
| Postganglionic Neurons: | Differ for the SNS and PNS branches. Postganglionic neurons of the autonomic system are classified as either cholinergic, meaning that acetylcholine (ACh) is released, or adrenergic, meaning that norepinephrine is released. |
| Preganglionic Neurons | All preganglionic neurons (in the SNS and PNS) release acetylcholine (ACh). |
| Selective Beta Blocker | Medications that mostly inhibit B1 receptors. |
| Sensory Neurons | Sense the environment and conduct signals to the brain that become a conscious perception of that stimulus. |
| “SLUDGE | Mnemonic for the effects of anticholinergics: Salivation decreased, Lacrimation decreased, Urinary retention, Drowsiness/dizziness, GI upset, Eyes (blurred vision/dry eyes). |
| Somatic Nervous System | Causes contraction of skeletal muscles; associated with voluntary responses. |
| Sympathetic Division (SNS) | Associated with the “fight-or-flight response.” Stimulation causes the main effects of increased heart rate, increased blood pressure via the constriction of blood vessels, and bronchodilation. |
| Sympathomimetics | Mimic the effects of the body’s natural SNS stimulation of adrenergic receptors. Also called adrenergic agonists. |
| Synapse | The connection between the neuron and its target cell. |
| Other names for Parasympathetic | Parasympathomimetic, parasympathetic agonist, cholinergic, muscarinic, muscarinic agonist, nicotinic, nicotinic agonist |
| Other names for Sympathetic | Sympathomimetic, adrenergic, adrenergic agonist, alpha 1 agonist, alpha 2 agonist, beta 1 agonist, beta 2 agonist, catecholamines |
| Other names for Parasympatholytic | Parasympathetic blocker, anti cholinergic, muscarinic antagonist, muscarinic blocker, nicotinic antagonist, nicotinic blocker |
| Other names for Sympatholytic | Sympathetic blocker, adrenergic antagonist, adrenergic blocker, alpha 1 antagonists, alpha 2 antagonists, beta 1 antagonists, sympathetic antagonist |
| Pupils dilate (miosis) | parasympathetic |
| Stimulates Salivation | parasympathetic |
| Slows heart rate, contractility | parasympathetic |
| Constricts bronchioles | parasympathetic |
| Stimulates digestion | parasympathetic |
| Stimulates gallbladder function | parasympathetic |
| Contracts bladder | parasympathetic |
| Stimulates erection (male), vaginal lubrication (female) | parasympathetic |
| Stimulates ejaculation (male), orgasm (female) | sympathetic |
| Relaxes bladder | sympathetic |
| Secretes epinephrine and norepinephrine (peripheral vasoconstriction) | sympathetic |
| Stimulates release of glucose | sympathetic |
| Inhibits digestion | sympathetic |
| Dilates bronchioles | sympathetic |
| Accelerates heart rate and contractility | sympathetic |
| Inhibits salivation | sympathetic |
| Dilates pupils (mydriasis) | sympathetic |
| Parasympathetic uses | Limited use, often used as antidotes for anti cholinergic (like atropine) |
| Parasympathetic Blocker uses | Lowers GI and respiratory secretions (before/after/during surgery), treat Parkinson's, treat overactive bladder |
| Sympathetic uses | Increases contractility, increases heartrate, bronchodilation, promotes break down of stored fats |
| Sympathetic Blocker uses | Lowers heartrate, B/P, controls angina, treats heart dysthymias, all "olol" drugs (beta blockers) |
| Examples of Parasympathetics | Nicotine patch*, pilocarpine*, bethanechol, donepezil, neostigmine |
| Examples of Sympathomimetic | albuterol*, clonidine*, dobutamine*, epinephrine*, phenylephrine, pseudoephedrine, metaproterenol, norepinephrine*, dopamine* |
| Examples of Sympatholytic | atenolol, carvedilol, metoprolol*, prazosin, tamsulosin*, terazosin, propranolol* |
| Examples of Parasympatholytic | atropine*, oxybutynin, tiotropium, solifenacin, glycopyrrolate, benztropine, scopolamine |
| Clonidine chemical class | Alpha 2 agonist, centrally acting alpha adrenergic agonist |
| Clonidine usese | mild to moderate hypertension, ADHD |
| Clonidine Side effects | *heart failure* drowsiness, orthostatic hypotension, N/V, dry mouth, rash |
| Clonidine MOA | It works in the brain and changes nerve impulses to lower the BP, so it is an antihypertensive |
| Clonidine nursing considerations | Monitor B/P, pulse rate frequently. Rebound hypertension can occur if stopped abruptly. Take at same time each day. |
| Pilocarpine MOA | causes ciliary muscle to contract, allows for drainage of aqueous humor from anterior chamber of eye and reducing intraocular pressure related to glaucoma. |
| Pilocarpine class | Muscarinic agonist Cholinergic |
| Pilocarpine uses | used to treat glaucoma |
| Pilocarpine side effects | N/V/D, sweating, watering of mouth, *blurred vision, tremors* |
| Pilocarpine nursing considerations | remove contact lenses before administration, use caution while driving at night. |
| Tamsulosin MOA | selectively blocks receptors in the prostate leading to relaxing of the smooth muscles in the bladder, neck, and prostate |
| Tamsulosin class | Selective Alpha 1 blocker--BPH agent |
| Tamsulosin uses | Benign prostatic hyperplasia |
| Tamsulosin nursing considerations | avoid using with other alpha blockers. Assess and monitor b/p, especially after first dose. CBC and liver function tests. |
| Tamsulosin side effects | dizziness, headache, hypotension, back pain, N/V, *angioedema* |
| Atropine MOA | dose related: small doses inhibit salivary and bronchial secretors and sweating. Moderate doses dilate pupil, inhibit accommodation and raise heart rate. Large doses lower motility of the GI and urinary tracts. Very large doses will inhibit gastric secretions. |
| Atropine class | Muscarinic Antagonist |
| Atropine uses | pre op to lessen secretions, increase heartrate to treat bradycardia, treat muscarinic symptoms of insecticide, poisonings and mushroom poisoning. |
| Atropine nursing considerations | monitor i&o ratios and VS, bowel sounds, avoid in older adults, avoid other beta blockers and antacids. |
| Atropine side effects | Drowsiness, sweating, flushing, dry mouth, constipation, *coma, tachycardia, overdose (urine retention, abnormal heartbeat, dizziness) |
| Nicotine patch class | Nicotinic Agonist- parasympathetic |
| Nicotine patch MOA | release nicotine in body through skin. binds to and activates nicotinic ACh receptors, mimicking the effect of the ACh at these receptors. |
| Nicotine patch uses | used as aid to stop smoking and relieve nicotine withdrawal symptoms. |
| Nicotine patch nursing considerations | assess for withdrawal symptoms, assess for nicotine toxicity |
| Nicotine patch side effects | headache, dizziness, flushing, *dysrhythmias, stevens-johnson syndrome, exfoliative dermatitis+ |
| Dobutamine MOA | stimulates Beta 1 receptors to increase heart rate and contractility |
| Dobutamine Class | Beta 1 agonist |
| Dobutamine uses | cardiogenic shock and severe heart failure |
| Dobutamine nursing considerations | dilute iv, monitor ECG, b/p, cardiac and urine output. |
| Dobutamine side effects | anxiety, headache, N/V, leg cramps *labored breathing, angina, palpations, and dizziness* |
| Metoprolol MOA | primarily blocks Beta 1 receptors in the heart, causing decreased heartrate and b/p. high doses can also block beta 2 receptors in the lungs causing bronchoconstriction |
| Metoprolol uses | high b/p, chest pain due to poor blood flow to the heart, early intervention for MI, abnormally fast heartrate. |
| Metoprolol class | Selective Beta 1 antagonist |
| Metoprolol nursing considerations | always check apical pule before giving, monitor b/p, pulse, asses for edema in feet, legs daily, monitor i&o, check weight daily. |
| Metoprolol black box warning | Abrupt withdrawal may cause MI, ventricular dysthymias |
| Metoprolol side effects | insomnia, dizziness, palpations, N/V/D, hiccups, *hypotension, bradycardia, worsening HF, bronchospasm, peripheral edema, chest pain* |
| Norepinephrine MOA | causes increased contractility and heartrate by acting on Beta receptors in heart. Alpha receptors cause vasocontraction in blood vessels which raises b/p and coronary blood flow improve and cardiac output decreases. |
| Norepinephrine class | catecholamines, adrenergic |
| Norepinephrine uses | acute hypotension, shock |
| Norepinephrine nursing considerations | assess i&o, b/p, pulse, assess for sulfite sensitivity--life threatening |
| Norepinephrine side effects | headache, dizziness, N/V, palpations, tachycardia, angina, hypertension, *cerebral hemorrhage, gangrene, anaphylaxis* |
| Norepinephrine Black Box Warning | Extravasation-injection site: tissue sloughing |
| Dopamine MOA | low doses it stimulates dopamine receptors and dilates the renal vasculature, Moderate doses stimulate Beta receptors for a positive inotropic effect. High doses stimulate Alpha receptors, constricting blood vessels and raising b/p |
| Dopamine class | Catecholamine, adrenergic |
| Dopamine side effects | headache, palpitations, N/V,D, hypotension, dyspnea, decreased blood flow to extremities *ectopic beats, wide QRS complex, necrosis, tissue sloughing with extravasation |
| Dopamine Black box warning | Extravasation- tissue sloughing |
| Dopamine nursing considerations | during infusion, frequently monitor b/p, cardiac output, and color/temp of limbs. Concurrent alpha or beta blockers can antagonize dopamine. |
| Epinephrine class | Catecholamine, adrenergic |
| Epinephrine MOA | Alpha and beta adrenergic agonist receptors---decreases vasodilation and increases vascular permeability through its alpha adrenergic receptor action. Beta receptor action leads to bronchial smooth muscle relaxation and helps alleviate bronchospasm |
| Epinephrine uses | severe allergic reaction, acute bronchospasm, cardiac resuscitation |
| Dopamine uses | shock, improve perfusion to vital organs, increase cardiac output and correct hypotension |
| Epinephrine nursing considerations | caution in elderly, pre existing cardiovascular disease. Vasopressor, allergic reaction, paradoxical bronchospasm. Only lasts 15-20 minutes. |
| Epinephrine side effects | tremors, anxiety, palpations, tachycardia, N/V, dyspnea, *paradoxical bronchospasm* |
| Albuterol class | Beta 2 Agonist |
| Albuterol MOA | selective Beta 2 agonist primarily used to cause bronchodilation in the lungs. Receptors in the heart can also be stimulated, causing cardiovascular side effects. |
| Albuterol uses | asthma, COPD |
| Albuterol nursing considerations | monitor respiratory rate, oxygen saturation and lung sounds before and after administration. wait at least 2 minutes between inhalations |
| Albuterol side effects | restlessness, N/V, hypertension, anxiety *paradoxical bronchospasm* |
| Propranolol MOA | nonselective beta blocker because of its inhibition of both beta 1 and beta 2 receptors |
| Propranolol uses | treat high b/p, angina, various heart dysrhythmias, essential tremors, migraine prevention |
| Propranolol class | Beta 2 antagonist |
| Propranolol Side effects | dizziness, fatigue, hypotension, N/V/D, cough, sore throat, *worsening heart failure, stevens-johnson syndrome, bradycardia, heart failure, pulmonary edema. |
| Propranolol nursing considerations | use cautiously in patients with patients who have coexisting asthma or COPD, could mask symptoms of hypoglycemia in diabetes, caution in patients with hepatic/renal functions. check b/p and apical pulse before giving. |
| Propranolol black box warning | follow dose schedule. stopping abruptly can cause life threating arrhythmias. |
| True or False: The autonomic nervous system is unique because it has only one neuron that synapses in an autonomic ganglion. Hence it has only pregangolic neurons not postganglionic neurons. | Answer is FALSE. The autonomic nervous system has TWO neurons that synapse in an autonomic ganglion. Therefore, there is a pregangolic and postgangolic neuron. |
| The sympathetic nervous system postganglionic neuron releases what neurotransmitter? | Norepinephrine |
| The sympathetic nervous system preganglionic neuron releases what neurotransmitter? | Acetylcholine |
| In the sympathetic nervous system ganglia are found? Select all that apply: A. Thoracic B. Brain stem C. Sacral D. Lumbar | The answers are A and D. |
| In the parasympathetic nervous system the ganglia are found? Select all that apply: A. Cervical B. Brain stem C. Lumbar D. Sacral | The answers are B and D. |
| The postganglionic neuron releases what neurotransmitter in the parasympathetic nervous system? | Acetylcholine |
| Select all the signs and symptoms a patient can experience with the stimulation of the sympathetic nervous system: Select all that apply: A. Tachycardia B. Hypotension C. Hyperglycemia D. Dilated pupils E. Urinary incontinence F. Bronchodilation G. Cold and clammy H. Excessive salivation I. Sweating | The answers are A, C, D, F, and I. |
| Select all the signs and symptoms a patient can experience when the stimulation of the parasympathetic nervous system: Select all that apply: A. Bradycardia B. Dilated pupils C. Bronchoconstriction D. Constrict pupils E. Bladder contraction F. Dry mouth G. Slow digestion H. Hypertension | The answers are A, C, D, and E. |
| A patient is started on a norepinephrine drip. What side effects can this medication cause? Select all that apply: A. Tachycardia B. Hypoglycemia C. Hypertension D. Bronchoconstriction | The answers are A and C. This medication (also called Levophed) mimics the sympathetic nervous system (hence it is an adrenergic agonist also called sympathomimetic). It will increase the heart rate and blood pressure. |
| What are some side effects of adrenergic antagonist drugs (sympatholytic): select all that apply A. Tachycardia B. Bradycardia C. Bronchoconstriction D. Bronchodilation | The answers are: B and C |
| Select the drugs below that are considered sympathomimetic drugs: A. Albuterol B. Dopamine C. Epinephrine D. Propranolol | The answers are A, B, and C. All these drugs can mimic the sympathetic nervous system. |
Created by:
Steinemr