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Medical Conditions 1 > Automomic Nervous system: overview and medications > Flashcards

Automomic Nervous system: overview and medications Flashcards

1
Q

What is the ANS affected by

A
  • brain
  • spinal cord
  • vasculature
  • hormones
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2
Q

What NT does the sympathetic NS use

A
  • Epinephrine
  • Norepinephrine
  • dopamine
  • adrenergic system/Ach
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3
Q

What NT does the parasympathetic NS use

A
  • acetylcholine
  • cholinergic system
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4
Q

Describe the difference between the sympathetic and parasympathetic pre and post ganglionic cell

A

Sympathetic:
- pre ganglionic is short/close to the spinal cord and releases ACh
- post ganglionic is long and releases Ach, NE, dopamine, EP

Parasympathetic:
- pre-ganglionic is long and releases ACh
- post-ganglionic is short and releases ACh

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5
Q

ANS: sympathetic nervous system overview

A
  • neurons in spinal cord connection to sympatetic chain ganglion outside the spine
  • provide input to organs, arterioles, skin
  • adrenergic system or thoracolumbar
  • epi, norepi, and dopamine
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6
Q

effects of the sympathetic NS

A
  • increase HR and BP
  • increase in heart contractility
  • bronchodilation
  • vasodilation to skeletal muscle
  • kidney secrete renin
  • sweating
  • decrease GI activity
  • bladder relaxes and sphincter contracts
  • pupils dilate
  • gluconeogensis/glycogenolysis
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7
Q

What is the basic function for the parasympathetic NS, where do the nerves mainly come from and what NT does it use

A
  • neurons in brain stem or saccral spinal cord connect to cranial nerves or pelvic
  • provide imputs to organs like the heart, lungs, and bladder
  • cholinergic system also called craniosacral
  • uses Acetylcholine (Ach)
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8
Q

What are the main effects of parasympathetic NS stimulation

A
  • Decrease in HR and BP
  • decreased cardiac contractility
  • bronchoconstriction (this also maintains moisture)
  • increase in GI activity
  • bladder constricts and sphincters relax
  • pupils constrict
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9
Q

What in the body does not have any direct parasympathetic input to

A
  • arterioles
  • kidney
  • radial muscles of iris
  • sweat glands
  • liver
  • fat cells
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10
Q

Autonomic NS receptors system: used in both sympathetic and parasympathetic

A
  • Ach is used to transmit information from the brainstem or spinal cord to the autonomic ganglia
  • nicotinic receptors
  • these neurons then connect to peripheral structures
  • used in both
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11
Q

Sympathetic nervous system receptors
- where are they located generally
- types
- what do they do

A
  • the second set of neurons release norepinenphrine (after chain ganglion)
  • attaches to alpha or beta receptors
  • difference receptors on different organs
  • can increase or decrease sympathetic input to peripheral cells
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12
Q

Alpha receptors in the sympathetic NS

A

primarily in peripheral arterioles of smooth muscle

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13
Q

Beta 1 receptors in the sympathetic NS

A
  • primarily in the heart
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14
Q

Beta 2 receptors in the sympathetic NS

A

primarily in the lungs

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15
Q

The second set of neurons in the parasympathetic nervous system receptors

A
  • release Ach
  • Ach attaches to muscarinic receptors in peripheral cells
  • increase parasympathetic effect
  • muscarinic is just in parasympathetic
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16
Q

ANS medications: agonist - general for both sympathetic and parasympathetic

A
  • adrenergics: stimulate sympathetic NS meaning they are agonist
  • cholinergics stimulate the parasymapthetic
  • mimetics = mimics which can mean an agonist also
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17
Q

ANS medications: antagonist - general for both sympathetic and parasympathetic

A
  • beta blockers = inhibit sympathetic NS
  • alpha blockers = inhibit sympathetic NS
  • anticholinergics = inhibit parasympathetic NS
  • lytics = breaks/blocks action
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18
Q

Drug mechanism on NT in the ANS

A
  • action potential
  • synthesis, storage, release
  • postsynaptic receptor
  • metabolism, reuptake, degradation
  • continued NT release
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19
Q

Receptors and pharmacology are…

A
  • receptor-specific drugs can target specific organs
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20
Q

What do cholinergic drugs typically affect

A
  • parasympathetic system
  • muscular system
  • brain
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21
Q

Cholinergics stimulants

A

increase action of neurons that use Ach

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22
Q

what are the types of cholinergics stimulants and what do they do

A
  1. direct: bind to receptor for Ach
  2. block action of acetylcholinesterase so Ach can be used longer
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23
Q

Direct cholinergic stimulants
- how does it work
- what does it do

A
  • receptor specificity for muscarinic receptors (so it just affects Parasympathetic)
  • increases parasympathetic activity
24
Q

examples of direct cholinergic stimulants

A
  • bethanechol: treats urinary retention or ileus (take mostly after surgery due to bowel stop working and backs up the colon)
  • nicotine pathes or gum
25
Indirect cholinergic stimulants
- increase availability of Ach by reducing the AchE - non-specific effects: increase availability throughout the body not at a particular part - can increase Ach activity at nicotinic receptors (which are found in sympathetic NS also) - some drugs have specificity at certain doses - uses: increase Ach availble at neuromuscular junction, brain, treat glaucoma, urinary retention
26
What are the side effects of cholinergic stimulants?
- increase in parasympathetic function... - GI distress: nausea, vomiting, diarrhea, abdominal cramping - bronchoconstriction and increased salivation (keeps moisture) - bradycardia - pupils constricted, impacts vision
27
Rehab considerations for cholinergic stimulants
- bronchoconstriction: pace activities (dyspnea) - urinary frequency with abdominal contractions - impaired vision in low light - fall risk
28
Rehab considerations with nicotine
- increase in blood pressure - non-prescription (smoking/vaping) - decrease oxygen-carrying capacity - increase risk of angina
29
cholineterase inhibitor poisoning
- caused by too much Ach - Diarrhea - Urination - Miosis: pupil constriction - Bradycardia - Bronchospasm - Excitation of ms - Lacrimation - Sweating - Salivation
30
Anticholinergic drugs: antagonsits
- inhibit parasympathetic NS - can block action of nicotinic or muscarinic receptors - some can specifically target different subtypes (M1-M5) - anticholinergics for nicotinic receptors which will affect both sympathetic and parasympathetic - can target autonomic ganglia or neuromuscular junction
31
Uses of anticholinergic drugs
- Gi system: reduces gastric secretion, motility, GI smooth muscle tone - used for peptic ulcers, irritable bowl syndrome - cardiovascular: reduces bradycardia and some heart arrhythmias - bladder: reduces contraction of bladder/reduces tone of bladder muscles - eye: reduces pupillary constriction: dilates the eye
32
What can anticholinergics be used for in the brain or brain stem
- parkinsons disease: improves motor symptoms - motion sickness - targets problems in brain or brainstem
33
Anticholinergic at neuromusclar junction
- Succinylcholine - causes temporary paralysis in a larger dose - can be used during surgery or to input a ventilator to avoid them coughing it up -
34
PT considerations for anticholinergics at neuromuscular junction
- nausea - emesis: throwing up - myalgia: tight muscles - hyperkalemia
35
Side effects of anticholinergic drugs
- dry mouth - blurred vision - tachycardia - urinary retention - constipation - confusion - dizziness - nervousness - drowsiness
36
Rehab considerations for anticholinergics
- increased HR - light sensitivity - sedation/decrease cognition - decreased sweating/hyperthermia
37
Adreneric drugs generally affect what
- sympathetic NS - brain - spinal cord
38
Adrenergic receptors types and where they are located
- Alpha 1: peripheral arterioles of smooth muscles - alpha 2: brainstem, spinal cord - Beta 1: primarily in the heart - beta 2: primarily in lungs (bronchial smooth muscle)
39
Uses of sympathomimetics
- anaphylaxis - epinephrine; fast acting; causes bronchodilation, vasoconstriction - increases alertness: ADHD, narcolepsy, amphetamines (adderall) - eyes: increase dilation to reduce itching, or pressure (glaucoma) - overactive bladder - incontinence in children and adults
40
Cardiovascular uses of sympathomimetics
increase blood flow - heart failure: B1 agonist - increase contractility (positive ionotrope) decrease blood flow or increase blood pressure - hemorrhage or spinal shock/hypotensive emergency: alpha 1 agonist - causes vasoconstriction
41
Respiratory uses of sympathomimetics
- reduce nasal congestion: alpha agonist to promote vasoconstriction so you are not as stuffy - reduce bronchoconstriction: beta agonist - ei: asthma, COPD, short acting for attacks and long acting for prevention often taken by inhaler
42
Adverse effects of sympathomimetics
- too much stimulation can cause too much of it - vasoconstriction, heart attack (due to increase HR), heart arrhythmia, tachycardia - nervousness, anorexia, insomnia - pulmonary edema or hemorrhage - hypertension - hyperglycemia (increase in cortisol and gluconeogeneis)
43
side affects of alpha 1 sympathomimetics
- hypertension - headache - bradycardia (to try to lower blood pressure) - it is called reflex bradycardia/cardiac baroreceptor reflex
44
Side effects of beta agonists (sympathomimetics) - beta 1 and beta 2
- beta 1: chest pain (less time for heart to get O2 blood), arrhythmias, shortness of breath - Beta 2: nervousness, restlessness, trembling (associated with bronchodilation)
45
Mixed sympathomimetics side effects (occur in any of them)
- nervousness - restlessness - anxiety - hypertension - arrhythmias - cardiac arrest
46
Adrenergics/sympathomimetics: rehab considerations
- may allow a pt to participate in therapy - be cautious with exercise - precautions: restlessness, increase BP or hR, angina
47
Sympatholytics:
- adrenergic antagonists - adrenergic blockers
48
purpose of sympatholytic drugs
- block action of sympathetic NS - most drugs target a specific receptor - ex: 1. alpha anatgonist/alpha blocker 2. beta anatgonist/beta blockers
49
Alpha blockers
- most are selective to alpha 1 receptors - designed to reduce vasoconstriction (bring back to normal vasotone through vasodilation) - uses: 1. treat HTN 2. some used for benign prostatic hypertrophy - end in osin
50
Side effects from alpha blockers
1. reflex tachycardia: BP drops a lot so body compensates by increasing HR - baroreceptor reflex - decrease effect (baroreceptor reflex) with alpha selective blocker 2. orthostatic hypotension
51
Beta blockers
- used for effect on beta 1 receptors on the heart - beta 1 selective/cardioselective - some beta blockers are beta-nonselective (work on both beta 1 and 2) - beta 2 selective drugs are not clinically useful - not many times you want to cause bronchoconstriction
52
adverse effects of beta blockers
- blunted exercise response: prevents/decreases HR causing tired and dyspnea - orthostatic hypotension, dizziness - heart failure - depression - lethargy
53
uses of beta blockers
- manage hypertension: reduces heart rate and contractility - can be used to manage angina, reduce the workload of heart - most beta blockers end in -lol
54
Rehab relevance to beta blockers
- orthostatic hypotension: frequent BP checks and aquatics with warm pool can cause systemic vasodilation which decreases BP - bronchoconstriction - depressed HR/blunted HR response to exercise
55
Side effects of non-selective beta blockers
- bronchoconstriction - special concern with existing lung disorders

Medical Conditions 1 (16 decks)

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