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Adrenergic/cholinergic Flashcards

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1
Q

Review of Autonomic Nervous System

  • Branch of the peripheral nervous system
  • Fuctions independently without conscious effort
  • Oversees HR,BP, respirations, body temperature, and digestion.
  • Aids in maintaining homeostasis.
  • contains two branches:
    • Sympathetic nervous system
    • Parasympathetic nervous system.
A
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2
Q

Sympatheic Nervous System

  • AKA The fight or flight
  • When activated stimulates essential organs to respond to stress.
  • Signs of SNS simulation:
  • Dilated pupils
  • ◦Increased respirations, HR and BP
  • ◦Flushing
  • ◦Decreased peristalsis
  • ◦Increased blood glucose levels
A
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3
Q

SNS NEUROTRANSMITTERS

A
  • Neurotransmitters include
    • Norepinephrine
    • Epinephrine
    • Dopamine
  • These N.Ts are also known as catecholamines
  • These N.Ts bind to receptors throughout the body
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4
Q

SNS RECEPTORS CONT..

A
  • Alpha 1 receptors: located on post synaptic effector cells
    • The tissue,muscle, or organ that the nerve stimulates
  • Alpha 2 receptors: located on pre-synaptic nerve terminals
    • Controls release of N.T
  • Stimulation of alpha receptors causes VASOCONTRICTION AND CNS STIMULATION
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5
Q

SNS RECEPTORS CONT…

A
  • Beta 1 receptors: heart and kidneys
    • Simulation results in increased HR and force of contraction.
    • Positive inotropic effect: increase in HR
    • positive dromotropic effect: increase in impulse conduction through the AV node
    • In kidney causes increase in renin secretion.
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6
Q

SNS RECEPTORS CONT…

A
  • Beta 2 receptors: smotth muscle fibers of the bronchioles, arterioles and visceral organs.
    • stimulation causes bronchodilation, relaxation of smooth muscl in the G.I and GU system and increased glycogenolysis.
  • Dopaminergic Receptors
    • when stimulated by dopamine these receptors cause the vessels of the renal,mesenteric,coronary and cerebral arteries to dilate.
    • Results in increased blood flow
    • Dopamine is the only substance that stimulates these receptors.
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7
Q

OVERVIEW OF ADRENERGIC DRUGS

(SYMPATHOMIMETICS)

A
  • Drugs that mimic the effects of the sympathetic NS are known as SYMPATHOMIMETICS
  • Direct acting SYMPATHOMIMETICS bind directly to the receptor site and cause a reaction
    • EX.Epinephrine
  • Indirect acting SYMPATHOMIMETICS cause the release of N.T from storage sites which then bind to receptors causing a response
    • EX.Amphetamine
  • Mixed acting SYMPATHOMIMETICS do both
    • EX.Ephedrine
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8
Q

INDICATIONS FOR ADRENERGIC DRUGS

A
  • Respiratory: asthma and bronchitis
    • Stimulate beta 2 receptors causeing bronchodilation
    • Ex.Albuterol,epinephrine,ephedrine,salmeterol
  • Topical nasal decongestants
    • Stimulate alpha 1 receptors causing vasoconstriction
    • Ex. phenylephrine
  • Opthalmic: Glaucoma and eye examination
    • Stimulate alpha 1 receptors causing vasoconstriction and reduction in intraocular pressure.
    • Ex.Epinephrine, phenylephrine, tetahydrozline
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9
Q

INDICATIONS CONT…

A
  • Cardiovascular:
    • bind to both alpha and beta receptors causing vasoconstriction
    • used to support the cardiovascular system during cardiac failure.
    • also known as “pressors”
    • EX. Dobutamine, dopamine, epinephrine, fenoldopam, noreipinephrine
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10
Q

CONTRAINDICATION..

A
  • known drug allergy
  • severe hypertension
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11
Q

COMMON SIDE EFFECTS OF ADRENERGIC DRUGS

A

ALPHA ADRENERGIC:

  1. Headache
  2. restlessness
  3. excitement
  4. insomnia
  5. euphoria
  6. chest pain
  7. hypertension
  8. tachycardia
  9. palpitations
  10. dyshrthmias
  11. dry mouth
  12. anorexia
  13. N & V
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12
Q

COMMON SIDE EFFECTS OF ADRENERGIC DRUGS

A

BETA ADRENERGIC:

  1. Mild tremours
  2. headache
  3. nervousness
  4. dizziness
  5. increased HR
  6. palpitations
  7. fluctuation of BP
  8. sweating
  9. N & V
  10. muscle cramps
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13
Q

NURSING ASSESSMENT WHEN ADMINISTERING ADRENERGIC DRUGS:

A
  • History of asthma,TIAs or CVAs, hyper of hypotension, cardiac irregularities
  • Renal and hepatic function
  • Baseline vital signs
  • Cardiac and respiratory system assessment
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14
Q

NURSING CONSIDERATIONS WHEN ADMINISTERING ADRENERGIC DRUGS

A
  • Dopamine is drug of choice for treating shock because it does not cause constriciton of the renal vasculature.
  • Drugs administered IV require the use of an infusion pump and frequent assessment of IV site
  • Medications given via an inhaler or nebulizer require education on proper use, storage and care of equipment.
  • When using ophthalmic medications make sure solution is clear and administer drops and ointments into conjunctival sac, not directly onto the eye itself.
  • Stress importance of taking medications exactly as prescribed to prevent exacerbation of adverse effects. avoid rebound effects and minimize drug interactions.
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15
Q

NURSING CONSDIERATIONS CONT..

A
  • Instruct patients to report complaints of chest pain, palpitations, blurred vision, HA, seizures or hallucinations.
  • Instruct patients with chronic lung disease to avoid anything that makes their conditions worse.
    • allergens, smoke, others with respiratory illness.
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16
Q

OVERVIEW OF ADRENERGIC BLOCKING DRUGS

(SYMPATHOLYTICS)

A
  • Drugs that inhibit the sympathetic nervous system are known as sympatholytic.
  • Alpha blockers interrupt the stimulation of the SNS by binding with receptors sites and:
    • Preventing norepinephrine from binding to its receptor sites.
    • making receptor sites less responsive to norepinephrine.
  • Blocking alpha receptors causes:
    • Vasodilation
    • reduced BP
    • papillary constriction
    • reduced smooth muscle tone in organs like the bladder and prostate.
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17
Q

INDICATIONS FOR ALPHA ADRENERGIC BLOCKERS

A
  • Hypertension
    • causes both arterial and venous vasodilation which reduces peripheral vascular resistance
    • Ex. DOXAZOSIN,PRAZOSIN,TERAZOSIN
  • BPH
    • Causes smooth muscle relaxation in the bladder
    • EX. TAMSULOSIN,TERAZOSIN,DOXAZOSIN
  • Treatment of Raynauds disease, acroycyanosis and frostbite
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18
Q

INDICATIONS FOR ALPHA ADRENERGIC BLOCKERS CONT..

Study These Flashcards
A
  • Prevent skin necrosis following extravasation of vasopressors
    • EX. Phentolamine
  • Contraindicated in patients with known allergies and peripheral vascular disease.
19
Q

SIDE EFFECTS OF ALPHA ADRENERGIC BLOCKERS

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A
  • palpitations
  • orthostatic hypotension
  • tachycardia
  • edema
  • dysrhythmias
  • chest pains
  • dizziness
  • HA
  • Nosebleed
  • tinnitus
  • drowsiness
  • anxiets
  • depression
  • vertigo
  • fatigue
  • N & V
  • diarrhea
  • constipation
  • incontinence
  • dry mouth
20
Q

BETA ADRENERGIC BLOCKERS

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A
  • Complete with norepinephrine and epinephrine at receptor sites
  • can be selective meaning they bind with only one type of receptor or non-selective meaning they can bind to some extent with all adrenergic receptors
  • Beta 1 blockers block beta receptors on the surface of the heart causing decreased heart rate and contractility.
  • Beta 2 blockers block beta receptors in the lungs causing bronchocontriction.
21
Q

NON-SELECTIVE ADRENERGIC BLOCKING DRUGS:

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A
  • Some adrenergic blocking medications work on both alpha and beta receptor sites.
  • This results in:
    • Vasodilation causing a decrease in blood pressure (blocking of alpha receptors)
    • Decrease in HR and contractility (blocking of beta 1 receptors)
    • Bronchocontriction (blocking of beta 2 receptors)
22
Q

INDICATIONS FOR BETA ADRENERGIC BLOCKERS

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A
  • Angina:
    • decrease myocardial oxygen demand
  • Cardio protection following MI:
    • prevent catecholamines from binding with receptor sites increasing myocardial oxygen demand
  • Treatment of dysrhythmias
    • Slows conduction through SA and AV nodes which decrease HR
  • Hypertension:
    • Decrease HR and force of contraction
  • EX of beta blockers:atenolol, carvedilol, labatelol, metoprolol
23
Q

CONTRAINDICATIONS FOR BETA ADRENERGIC BLOCKERS

Study These Flashcards
A
  • Known drug allergies
  • uncompensated heart failure
  • cardiogenic shock
  • heart block or bradycardia
  • pregnancy
  • chronic or sever pulmonary disease
  • raynauds disease
24
Q

PARASYMPATHETIC NERVOUS SYSTEM

Study These Flashcards
A
  • AKA: rest and digest system
  • concerned with maintaining homeostasis and conserving energy
  • N.T:acetycholine
  • receptors for acetycholine are known as cholinergic receptors
25
**PNS RECEPTORS**
* PNS receptors * **Nicotinic**: located in the ganglia of both the PNS and the SNS * **Muscarinic:** located postsynaptically in the effactor organs supplied by the PNS * smooth muscle,cardiac muscle, glands * Drugs that mimic the effects of the sympathetic nervous system are **PARASYMPATHOMIMETICS**
26
**CHOLINERGIC RECEPTOR BINDING**
* Direct acting agonist bind directly to receptors and activate them * Indirect acting agonist stimulate postsynaptic nerve cell release of acetylcholine at the receptor sites allowing it to bind and stimulate the receptor. * inhibits the action of actetylcholinesterase which breaks down acetylcholine * can form a reversible or irreversible bond with actetylcholinesterase
27
**ACTIONS OF CHOLINERGIC DRUGS**
* Increased gastric acid secretion and GI motility * increased urinary frequency * pupil constriction with decreases in intraocular pressure * increased salvation and sweating * **reduced** HR * vasodilation * constriction of bronchi
28
**INDICATIONS FOR CHOLINERGIC DRUGS**
* Direct acting cholinergic drugs: * glaucoma:topical application only (eye drops) * atony of the GI tract and urinary retention * **BETHANECHOL** * excessive dry mouth * Neuromuscular blockade in general anesthesia * **SUCCINYCHOLINE** * indirect acting cholinergic drugs * diagnosis and treatment of myasthenia gravis * reversal of neuromuscular blockade caused by neuromuscular blocking drugs or anticholinergic poisoning * **PHYSOSTIGIMINE**
29
**INDIRECT ACTING CHOLINERGIC DRUGS CONT..**
* Alzheimers: increase amount of acetylcholine in the brain * **DONEPEZIL**
30
**CONTRAINDICATIONS FOR CHOLINERGIC DRUGS**
* allergy * GI/GU tract obstruction * Bradycardia * defects in cardiac impulse conduction * Hyperthyroidism * epilepsy * hypotension * COPD * Parkinson's disease
31
**COMMON SIDE EFFECTS OF CHOLINERGIC DRUGS**
* Bradycardia * hypotension * conduction abnormalities * headache * dizziness * convulsions * abdominal cramps * increased secretions\N & V * increased bronchiole secretions * bronchospasms * sweating * loss of ocular accomodation
32
**CHOLINERGIC CRISIS**
* Results from overdose of cholinergic medication * early signs: * abdominal cramping * salvation * flushing of the skin * N & V * if not treated promptly can lead to circulatory collapse and cardiac arrest * **antidote is ATROPINE**
33
**ASSESSMENT WHEN ADMINISTERING CHOLINERGIC DRUGS**
* Baseline vital signs * past medical history * GI or GU problems * Heart block * COPD * complete head to toe physical assessment * assessment and documentation of neurologic status with drugs used to treat alzheimers disease.
34
**NURSING CONSIDERATION WHEN ADMINISTERING CHOLINERGIC MEDICATIONS**
* Do not administer **BETHANECHOL** if mechanical obstruction is suspected * use non pharmacologic measure to promote peristalsis whenever possible * for Myasthenia Gravis patients oral medications should be given 1/2 prior to meals. * Myasthenia Gravis patient should have **ATROPINE** readily available to treat cholinergic crisis.
35
**NURSING CONSIDERATIONS CONT..**
* remind patients and caregivers that cholinergic medications will not cure alzheimers disease * take with food to prevent GI upset * take medication exactly as prescribed * do not stop abruptly * most have side effects that are low dose limiting * it may take up to 6 weeks for a therapeutic response to be seen in patients with alzheimers disease * encourage patient to wear alert bracelet
36
**CHOLINERGIC BLOCKING DRUGS**
* AKA: **anticholinergics** * drugs that inhibit the parasympathetic nervous system are known as **PARASYMPATHOLYTICS** * cholinergic blocking drugs block the action of acetylcholine at the muscarnic receptors in the parasympathetic NS * Most are competitive agonist: they bind with receptors which prevents acetycholine from binding to the receptor sites.
37
**ACTIONS OF CHOLINERGIC BLOCKING DRUGS**
* dilation of pupils * decrease in GI motility and secretions * decrease salvation * increased HR * decreased bladder contractions * decreased sweating * decreased respiratory secretions * bronchial dilation
38
**INDICATIONS FOR THE USE OF CHOLINERGIC BLOCKING DRUGS**
* Parkinsons disease * decreases muscle rigidity and tremors * Treatment of AV block and sever bradycardia * **ATROPINE** * decrease secretions preoperatively * **GLYCOPYRROLATE** * COPD and asthma due to bronchodilation * IBS and GI hyper secretion * decreases GI motility * **DICYCLOMINE**
39
**INDICATIONS CONT..**
* Neurogenic bladder and incontinence (overactive bladder) * relax smooth muscle of the bladder and increase sphincter tone * **OXYBUTYNIN (*DITROPAN),* TOLTERODINE *(DETROL)*** * Motion sickness * **SCOPOLAMINE**
40
**CONTRAINDICATIONS FOR THE USE OF CHOLINERGIC BLOCKING DRUGS**
* Allergies * Angle-closure glaucoma * Acute asthma or other respiratory distress * myasthenia gravis * acute cardiovascular instability * GI/GU obstruction
41
**ADVERSE EFFECTS OF CHOLINERGIC BLOCKING DRUGS**
* increased Hr * dysrthrymias * CNS ecitation * restlessness * irritability * Dilated pupil * increased intraocular pressure * dry mouth * urinary retention * decreased sweating * decreased bronchial secretions * **the dosage of these medications are very important, there is a small difference between the therapeutic and toxic dosages.**
42
**NURSING ASSESSMENT WHEN ADMINISTERING CHOLINERGIC BLOCKING DRUGS**
* assess for history of: * allergies * glaucoma * GERD * poor GI motility * obstruction of the GI/GU system * Severe ulcerative colitis
43
**NURSING CONSIDERATIONS WHEN ADMINISTERING CHOLINERGIC BLOCKING DRUGS**
* take medication at the same time each day * encourage adaquate fluid intake * frequent mouth care * sugar free gum or hard candy may help relive dry mouth * if mixing medication in a syringe check for compadability * if administered transdermally make sure the prior patch is removed prior to placing new patch-rotate site patch placement. * instruct patient to avoid strenuous ecercise and extreme heat * insturuct patient to wear dark glasses, sensitivity to light is increased with this medication * encourage measures to prevent constipation.

Pharmacology (3 decks)

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