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Pharmacology > Drugs acting autonomic nervous syetm > Flashcards

Drugs acting autonomic nervous syetm Flashcards

Chapt. 29-33

1
Q

**Sympathetic system
What does sns activity produce?

A

Catecholamines

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2
Q

What happens in the parasympathetic nervous system?

A

-Constrict pupils
-Stimulate saliva production
-Constricts bronchi
-Slows heart
-Stimulates stomach,pancreas, and intestines
-Stimulates urination

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3
Q

What happens in the sympathetic system?

A

-Dilates pupiles
-Inhibits saliva production
-Dilates bronchu
-Accelerates heart
-Stimulates epinephrine and norepinephrine release
-Stimulates glucose release
-Inhibits stomach, pancreas and intestines
-Inhibits urination

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4
Q

**sympathetic system
What is the main activators of the sympathetic nervous system and what are they stimulated by ?

A
  1. Adrenergic receptors
    2.Receptors are stimulated by norepinephrine/ epinephrine
    Alpha1 and 2
    Beta 1 and 2
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5
Q

**Alpha receptors sns
Describe alpha 1 recptors?

A

-Found in blood vessels, iris, bladder
-Cause vasoconstriction which increases bp
-Dilates pupiles
-Increase closure of internal sphincter(urethra) decreased urine output

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6
Q

**Alpha receptors sns
Describe alpha 2 receptors?

A

-Located on nerve membranes
-Control release of NE
-Decrease SNS activity and leads to decrease in sns activity which leads to decrease in blood pressure and heart rate

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7
Q

**Beta receptors sns
Descrieb beta 1 receptors?

A

-Mostly in heart
-Stimulation leads to increases myocardial activity and heart rate
-Beat1= 1 heart

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8
Q

**Beta receptors sns
Describe Beta 2 receptors?

A

-Lungs, uterine muscle, smooth muscles of blood vessels, liver- releases glucose
-Stimulation leads to dilating airways
-Beta 2=2 lungs

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9
Q

What do parasympathetic receptors do?
Stop here bookie

A

-Work in opposition to sns
-Cholinergic receptos –> neurotransmitter Ach
-Stimulation of PSNS results in
Gi tract- increased motility to promote digestion
CV-decreased heart rate and contractility
-Respiratory- constriction of the bronchi
-Pupillary constriction

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10
Q

What is adrenic apart of ?

A

Sympathetic nervous system

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11
Q

What are adrenic agonist also known as?

A

Sympathomimetic

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12
Q

Describe what sympathomimetic does?

A

**Adrenic agonists

-Drugs the stimulate/ mimic the actions of the SNS

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13
Q

**Adrenergic agnonists
What does the therapeutic site depend on?

A

-Site of action
-effects on adrenergic receptors

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14
Q

What are physiological adrenergic effects?

A

-Eyes: pupils dilate and los of accommodation

-Mouth: Decrease salivation, decrease secretions

-Respiratory: Bronchodilation, increase rr, increase depth of respirations

CV: Increase pulse, intrope effect, increase conduction , vasocinstriction, increase bp, and increase blood flow to muscles

GI: Decrease pancreatic secretions, decrease gastric secretions, decrease GI motility, Decrease perfusion and sphincter contraction

Gy: Decrease renal blood flow, decrease uterine activity, bladder relaxation, sphincter contraction and gential stimulation

Skin: VAsoconstriction (Pale), piloerection(goosebumps) and increase in swearing

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15
Q

**Adrenergic agonist
What are the general actions of adrenergic agonist?

A

-Usually indicated for shock or bronchospasm
General action of adrenergic agonists:
-Increased heart rate
-Bronchodilation
-Vasoconstriction**
-Glycogenolysis
-Reduce nasal congestion
-Dilation of pupils
-Sweating

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16
Q

What adverse effects of adrenergic agonists?

A

CNS: Headache, restlessness, excitement, insomnia, euphoria

Cardiovascular: Palpitations, tachycardia, arrhythmias, vasoconstriction, hypertension

Others: Loss of appetite, dry mouth, nausea, vomiting, urinary retention, potential for adverse effects to anesthesia

children and older adults are most likely to experience

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17
Q

What is the therapeutic actions of phenylephrine ( Neo-Synephrine)
Synthetic - produces vasoconstriction( Alpha 1 only )

A

**Alpha 1 adrenergic agonists

-Binds to alpha receptors

Alpha 1 receptor stimulation:
-Vasoconstriction of blood vessels –> vasopressor effect
-Nasal decongestant
-Contraction of GU sphincters
-Dilate pupils- due to constriction of eye muscles

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18
Q

What is the indications of phenylephrine (Neo-Synephrine)

A

**Alpha 1 adrenergic agonists

-Used to treat shock
-Used in cold and allergy products

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19
Q

What contras against of Alpha 1 adrenergic agonists?

A

Severe HTN, or tachycardia, Narrow angle glaucoma, gonna make worse

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20
Q

What are drug to drug interactions **Alpha 1 adrenergic agonists ?

A

Decrease effectiveness of HTN meds, beta-blockers

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21
Q

What are nursing considerations when taking Alpha 1 Adrenergic Agonists?

A
  • Don’t just stop abruptly, make sure to taper off
    -Monitor for IV extravasations, because it cause vasoctonstiricitions leading to necrosis
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22
Q

**Alpha 2 Adrenergic Agonists
What is a medicatiosn that is a Alpha 2 Adrenergic Agonists?

A

** clonidine (Catapres)
Oral and transdermal patches; epidural

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23
Q

What is therapeutic actions of ** clonidine (Catapres) ?

A

**Alpha 2 Adrenergic Agonists

-Alpha 2 receptor stimulation decreases sympathetic outflow from CNS
-Inhibits release of norepinephrine

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24
Q

What are indications of ** clonidine (Catapres)?

A

**Alpha 2 Adrenergic Agonists
HTN

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25
Q

What are adverse affects of ** clonidine (Catapres) ?

A

**Alpha 2 Adrenergic Agonists

-CNS effects –> sedation, drowsiness, HA
-Hypotension, bradycardia

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26
Q

What are cautions to have ** clonidine (Catapres) ?

A

**Alpha 2 Adrenergic Agonists

-PVD
-renal/hepatic dz

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27
Q

What are NSG considerations to have with ** clonidine (Catapres) ?

A

**Alpha 2 Adrenergic Agonists

Do not stop abruptly –> taper dose
If stopped abruptly it could cause rebound hypertension

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28
Q

**Beta 1 adrenergic agonists
Describe what happens during beta 1 stimulation

A

Cardiac/renal receptors
-Increased force contraction
-Increased heart
-Increase conduction through AV node, better contractility
-Increased renin secretions from kidneys, causing blood pressure to rise

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29
Q

**Beta 2 Adrenergic agnosit
Describe what happens during beta 2 Stimulation?

A

-Relaxation of smooth muscles in lungs =Bronchodilation
-Increase blood flow to heart, brain, skeletal muscle(Tissue needed for fight. flight)
-Relaxation of uterine muscle= Decrease in contractions
-Hepatic glycogenolysis–> increases Blood sugar but decreases pancreatic insulin secretion =Hyperglycemia

30
Q

What is a beta 2 adrenergic agonists medication?

A

Albuterol (Proventil

31
Q

What is the therapeutic action of albuterol(Proventil)?

A

**Beta 2 adrenergic agonists

Stimulates Beta 2 receptors  quickly dilates bronchi and increases rate and depth of respirations

32
Q

What are the indications albuterol(Proventil)?

A

**Beta 2 adrenergic agonists

Used during acute phase of asthmatic attacks

33
Q

What is the pharmacokinetics of albuterol(Proventil)?

A

**Beta 2 adrenergic agonists

Inhalants (some in oral, parenteral forms)
Inhaled –> rapidly absorbed; duration of action varies

34
Q

What is the Contras and cautious albuterol(Proventil)?

A

**Beta 2 adrenergic agonists

–Renal impairment, diabetes thyroid disease, vasomotor problems are all cautions
-allergy, pulmonary hypertension,

35
Q

Describe beta 1& 2 adrenergic agonists

A

-Most beta agonists, used as bronchodilator
for asthma, spams, copd
-Also sympathomimetic effect

36
Q

**Beta 1 & 2 adrenergic agonists
Describe what isoproterenol (isuprel) does?

A

Causes increased heart rate, positive inotropic effect, BP, treatment of shock, bronchospasm during surgery

37
Q

What medication is known as a Alpha and Beta Adrenergic Agonists?

A

Dopamine(Intropin)

38
Q

What are therapeutic actions of dopamine(intropin)

A

*Alpha and Beta Adrenergic Agonists

-Stimulates alpha 1 and beta 1 receptor activity
-Stimulates heart and BP
-Increases blood flow to kidney

39
Q

What are indications of dopamine(intropin)?

A

*Alpha and Beta Adrenergic Agonists

Shock

40
Q

What are contras of dopamine(intropin)?

A

*Alpha and Beta Adrenergic Agonists

-Pheochromocytoma
-Tachy, arrhythmias or vfib
-Hypovolemia, not enough volume so it won’t really help

41
Q

What are cautions of dopamine(intropin)?

A

*Alpha and Beta Adrenergic Agonists

TCAs & MAOIs, HTN meds

42
Q

What are NSG considerations of dopamine(intropin)?

A

*Alpha and Beta Adrenergic Agonists

-Monitor for IV extravasation
-Not a treatment for Parkinsons!!

43
Q

What does epineephrine( Adrenaline) used as?

A

*Alpha and Beta Adrenergic Agonists

IV, SQ, ophthalmic (dilates) or inhaled-short acting
Used in OTC inhalation products

44
Q

*Alpha and Beta Adrenergic Agonists
What is therapeutic actions of epinephrine( Adrenaline)

A

-Stimulates alpha 1 and beta 1 & 2 receptors
-Increases force of contraction and heart rate
Bronchodilation

45
Q

*Alpha and Beta Adrenergic Agonists
What is indications of epinephrine( Adrenaline)?

A

-Cardiac arrest
-Drug of choice for bronchospasm, laryngeal edema, allergic reaction

46
Q

*Alpha and Beta Adrenergic Agonists
Describe why epinephrine(Adrenaline) Is a drug choice for anaphylaxis treatment?

A

-Antagonist to histamine
-IM injection (thigh), 90 degrees
-Beta blockers will minimize effect, may need higher dosing, double dosing
-Can add antihistamines/ raniditine (Zantac)

47
Q

*Nursing Considerations:
What should you assess with adrenergic agonists?

A

VS, Neuro status
Physical assessment
Past medical history
PVD, HTN, CV, pheochromocytoma, thyroid dz, diabetes
Labs
Current medication list (including OTC!)

48
Q

*Nursing Considerations:
What are nursing diagnoses with adrenergic agonists?

A

Inefficient tissue perfusion r/t CV effects
Risk for injury r/t CV or CNS effects
Discomfort r/t GI/GU effects

49
Q

*Nursing Considerations:
What are implementaion with adrenergic agonists?

A

Monitor pt closely
VS, ECG, urinary outpt, LBM
Wean meds over 2-4 days (esp. alpha agonists) to prevent rebound HTN, arrhythmias
Educate pt:
Overuse of nasal decongestants may cause rebound nasal congestion or ulcerations
Use of bronchodilators/inhalers
Avoid OTC or other medications because of possible interactions
Implement safety precautions (esp with alpha 2 r/t hypotension)

50
Q

*Nursing Considerations:
What are evaluations with adrenergic agonists?

A

Monitor pt response to medication  improvement in condition being treated

51
Q

Describe Adrenergic antagonists(blockers)

A

-Have the opposite effect of adrenergic agonists
-Bind to adrenergic receptors and block stimulation of SNS

Also known as:
-Adrenergic blockers
-Sympatholytics( Lice/ block the sns)
-a-blockers, b-blockers, or a-b–blockers

52
Q

What are effects of adrenergic blockade?

A

-Pupils do not dilate
-Increased Gi secretions
-Loss of bronchodilation
-Decrease venous return, related to vasodilation, lowered blood pressure
-Increased Gi activity
-Decreases glucose regulation
-Relaxed sphincters to increase Gi excretions
-Relaxed sphincters to increase urine flow
-Decreased sexual response

53
Q

What is the therapeutic action of labetalol(Normodyne)?

A

*Non-selective adrenergic antagonists

Block NE at alpha and beta receptor sites
Results in ↓ BP, ↓ HR, ↑ renal perfusion

54
Q

What are indications of labetalol(Normodyne)?

A

*Non-selective adrenergic antagonists

HTN without reflex tachycardia
When the bp is lowered body will compensate by increasing hr which is reflex tachycardia

55
Q

What are contras of labetalol(Normodyne)?

A

*Non-selective adrenergic antagonists

Bradycardia, heart block( Heart isn’t conducting as it normally would), asthma, heart failure

56
Q

What are cautions of labetalol(Normodyne)?

A

*Non-selective adrenergic antagonists

Diabetes, bronchospasm, pregnancy
-Beta2 receptors are block so it could make bronchospasm worse
-Can block signs and symptoms of hypo and hyper glycemia so diabetics should check blood sugar more frequently!

57
Q

*Alpha 1 Selective Adrenergic Antagonists
Therapeutic actions of tamsulosin (Flomax)?

A

Blocks alpha 1 receptors
BPH – produces smooth muscle relaxation prostate and bladder  improved urine flow

58
Q

Indications of tamsulosin (Flomax)?

A

*Alpha 1 Selective Adrenergic Antagonists

BPH (tamsulosin)
Some used for HTN

59
Q

What are adverse effects of tamsulosin (Flomax)?

A

*Alpha 1 Selective Adrenergic Antagonists

r/t SNS blockage
CNS effects  orthostatic hypotension, dizziness
Vasodilation  Tachycardia/ flushing
“first dose syncope”  30 -90 min after dose; start low, wean up, give at night

60
Q

What are Contras/cautions of tamsulosin (Flomax)?

A

*Alpha 1 Selective Adrenergic Antagonists

-Allergy and pregnancy
-Heart, renal and hepatic failure

61
Q

What are drug to drug interactions of tamsulosin (Flomax)?

A

*Alpha 1 Selective Adrenergic Antagonists

Monitor effect with other pressure lower meds

62
Q

Describe Non-Selective Beta-Adrenergic Antagonists

A

-Used to treat wide variety of cardiovascular problems
-Block both beta 1 and beta 2 receptors in SNS
Especially effective in:
Heart – reduces heart rate, contractility, excitability, BP
Kidneys – juxta-glomerular  decreases renin(causes decrease in blood pressure
Creates a problem when receptors blocked in lungs!!

63
Q

Describe beta blockers action?

A
  • Beta 1-Cardio-selective meds have more effect of B! receptors, less effects on glucose metabolism, less effects on lungs
    -Beta 2- Drugs that block B2 receptors can cause bronchoconstriction
64
Q

*Beta 1 Selective Adrenergic Antagonists
What is therapeutic actions of metoprolol (Lopressor, Toprol XL)?

A

-Cardio-selective  Block cardiac beta 1 receptors
Does not usually block beta 2 receptors in lungs

65
Q

What are indications of metoprolol (Lopressor, Toprol XL)?

A

*Beta 1 Selective Adrenergic Antagonists

Lowers heart rate, contractility, cardiac workload
Post MI
Ophthalmic – reduces IOP (timolol)

66
Q

What are adverse of metoprolol (Lopressor, Toprol XL)?

A

*Beta 1 Selective Adrenergic Antagonists

-CNS –> fatigue, dizziness
-CV –>bradycardia, hypotension
-GI –> N/V/D
Induce CHF —> SOB, edema, wt gain

67
Q

What are contras of metoprolol (Lopressor, Toprol XL)?

A

*Beta 1 Selective Adrenergic Antagonists

Bradycardia, heart block, hypotension, could be worse cause sns is blocked

68
Q

What are cautions of metoprolol (Lopressor, Toprol XL)?

A

*Beta 1 Selective Adrenergic Antagonists

Diabetes, thyroid dz, pregnancy, renal/hepatic

69
Q

Nursing Considerations:
What do assess with adrenergic antagonists?

A

-VS, Neuro status
-Physical assessment
-Past medical history
-Asthma, COPD, diabetes, CV
-Labs
-Renal, liver, blood glucose
-Current medication list

70
Q

Nursing Considerations:
What are nursing diagnosis with adrenergic antagonists?

A

Ineffective airway clearance r/t bronchodilation effects
Risk for falls r/t CV effects
Acute pain r/t CNS & GI effects

71
Q

Nursing Considerations:
What are Implementations with adrenergic antagonists?

A

Monitor blood glucose
Monitor VS, ECG closely
Monitor for s/s of worsening HF
Implement safety precautions (fall risk!)
Do not stop abruptly  taper over 2 weeks
Provide adequate hydration

72
Q

Nursing Considerations:
What are Implementations with adrenergic antagonists?

A

Monitor pt response to medication  improvement in condition being treated

Pharmacology (39 decks)

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