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Autonomic Nervous System drugs Flashcards

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1
Q

What is Autonomic Nervous System?

A
  • The autonomic nervous system (ANS) is a component of the peripheral nervous system. It is a network of neurons that regulates the activity of numerous organs, including the stomach, heart, and lungs.
  • Involuntary motor control of organs and body functions.
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2
Q

The two subsystems of ANS:

A
  • Sympathetic nervous system (SNS)
  • Parasympathetic nervous system (PNS)
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3
Q

What is Sympathetic Nervous System?

A
  • Adrenergic
  • SNS neurons generally prepare the body to respond to something in its environment. Physiological responses to an immediate response.
  • Fight or flight response
  • Stress response of the body
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4
Q

What are Adrenergic Drugs?

A
  • Adrenergic drugs stimulate the nerves in your body’s sympathetic nervous system (SNS). This system helps regulate your body’s reaction to stress or emergency.
  • They do this either by mimicking the action of the chemical messengers epinephrine and norepinephrine or by stimulating their release.
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5
Q

Origin of the Sympathetic Nervous system

A
  • Thoracolumbar division
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6
Q

Sympathetic Nervous System: Pre-ganglionic Neurotransmitter

A
  • Shorter pre-ganglionic neurotransmitter
  • Acetylcholine (ACh)
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7
Q

Sympathetic Nervous System: Post-ganglionic/Terminal Neurotransmitter

A
  • Long pre-ganglionic neurotransmitter
  • Norepinephrine
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8
Q

Sympathetic Nervous System: Receptor organ cells

A
  • Alpha [1 & 2]
  • Beta [1 & 2]
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9
Q

What are the physical effects of Sympathetic Nervous System?

A

a) Dilates pupil
b) Dilates bronchioles
c) Increase heart rate
d) Constricts blood vessels
e) Relaxes smooth muscles of the G.I
f) Relaxes uterine muscle

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10
Q

What is Norepinephrine (N.E)?

A
  • Substance that is primarily released from the ends of sympathetic nerve fibers, also known as noradrenaline.
  • Classified structurally as a catecholamine
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11
Q

What is adrenergic agonist?

A
  • Stimulate the SNS
  • Sympathomimetic
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12
Q

What is Sympathomimetic Drugs?

A
  • Agents which in general mimic responses due to stimulation of sympathetic nerves. These agents are able to directly activate adrenergic receptors or to indirectly activate them by increasing norepinephrine and epinephrine (mediators of the sympathoadrenal system) levels.
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13
Q

Adrenergic Antagonist

A
  • Inhibit the SNS
  • Parasympatholytic
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14
Q

What is Parasympatholytic Drugs?

A
  • Inhibit the activity of the sympathetic nervous system which is mediated by epinephrine and norepinephrine

.

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15
Q

What is the therapeutic uses of the receptor: Alpha 1

A
  • Hypotension
  • Nasal congestion
  • Dilation of pupils
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16
Q

What is the therapeutic uses of the receptor: Alpha 2

A
  • Hypertension
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17
Q

What is the therapeutic uses of the receptor: Beta 1

A
  • Heart failure
  • Cardiac Arrest
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18
Q

What is the therapeutic uses of the receptor: Beta 2

A
  • Asthma
  • Premature labors of contractions
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19
Q

What is Parasympathetic Nervous System?

A
  • Cholinergic
  • It functions to conserves the body’s natural activity, and relaxes the individual once an emergency has passed. The parasympathetic nervous system leads to decreased arousal.
  • Rest and Digest Response
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20
Q

What are Cholinergic Drugs?

A
  • Cholinergic drugs stimulate the parasympathetic nervous system by copying the action of acetylcholine (ACh), a neurotransmitter released from nerve endings that bind on the receptors of cell membranes of organs, tissues, and glands.
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21
Q

What is the main neurotransmitter that cholinergic drugs mimic in the body?

A
  • Cholinergic drugs mimic the function of the neurotransmitter acetylcholine, which is the most critical neurotransmitter of the parasympathetic nervous system.
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22
Q

Origin of the Parasympathetic Nervous System?

A
  • Craniosacral division
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23
Q

Parasympathetic Nervous System: Pre-ganglionic Neurotransmitter

A
  • Longer pre-ganglionic neurotransmitter
  • Acetylcholine (ACh)
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24
Q

Parasympathetic Nervous System: Post-ganglionic/Terminal Neurotransmitter

A
  • Short post-ganglionic neurotransmitter
  • Acetylcholine (ACh)
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25
What are the two types of cholinergic receptors?
- Nicotinic [2] - Muscarinic [5]
26
What are Nicotinic receptors?
- Nicotinic receptors are found in the central, sympathetic, and parasympathetic nervous systems and, when stimulated, trigger the rapid depolarization of cells.
27
What are Muscarinic receptors?
- Muscarinic receptors are located in the smooth muscles and when stimulated, trigger contraction.
28
What is acetylcholinesterase?
- An enzyme that inactivates acetylcholine before reaching organ cells [breaks down / digest acetylcholine]
29
What are the physical effects of Parasympathetic Nervous System?
a) Constrict pupils b) Constrict bronchioles c) Increase secretions of salivary enzymes (Increases salivation) d) Decreases heart rate e) Dilates blood vessels f) Increases peristalsis
30
What are cholinergic agonist drugs?
- Stimulates the PNS - Parasympathomimetic
31
What is the main functions of our nervous system?
- Monitoring the external and internal environment of the body. (Afferent and Efferent neurons) - Process and integrate the environmental changes to determine the response. - Responded by using an actional response
32
What is afferent/sensory neurons?
- Detect the changes inside of the body - Impulses going Outside to Inside
33
Involuntary Control
- Dominated by Autonomic Nervous System
34
Voluntary Control
- Dominated by Somatic Nervous System
35
What is the three major function of ANS?
- Regulates heart rate - Regulation of secretory glands [working with endocrine system] - Regulation of smooth muscles
36
Alpha and beta adrenergic drugs will affect what system?
Sympathetic Nervous System
37
Anti-Cholinergic drugs will affect what system?
Parasympathetic drugs
38
What is the neuron that sends impulses to the CNS?
Afferent/Sensory Neuron
39
What are all these pre-ganglionic neurotransmitters?
Acetylcholine (ACh)
40
Where is epinephrine produced?
Adrenal Medulla
41
What is the biological process by which a neuron communicates with a target cell across a synapse?
Synaptic Transmission [from the neuron to effector organ]
42
What are the 5 processes involved in Synaptic transmission?
- Synthesis of the neurotransmitters [Synthesized by neurons] - Storage of neurotransmitter inside the vesicles - Releasing neurotransmitter because of action potential [when there is a stimulus the vesicle will fuse results discharging contents in the synaptic gap] - Action at the receptor [neurotransmitter bind into the receptor] - Termination of the transmission
43
What are the two terminals involved in Synaptic transmission?
Pre-synaptic terminal Post-synaptic terminal
44
Where is the origin of neurotransmitter in synaptic transmission?
Pre-synaptic nerve terminal
45
Which terminal receives neurotransmitter and this is where receptors are located?
Post-synaptic cell
46
What are the three termination ways in the synaptic transmission?
a) Disassociates from the receptor and reabsorbed back in the pre-synaptic nerve cells [REUPTAKE] b) Enzymatic degradation c) Diffusion away from the gap
47
What theory says that drugs act through receptors by binding through the receptors to initiate a response or prevent a response?
Receptor Theory [Lock and Key]
48
What are the drugs that blocks a response?
Antagonist
49
What are the drugs that fits the receptor sites?
Agonist
50
What do we call a drugs that degrades/blocks the effect of sympathetic nervous system?
Sympatholytic
51
What do we call a drugs that degrades/blocks the effect of parasympathetic nervous system?
Parasympatholytic
52
What is a Pharmacologic effect?
When autonomic drugs are given, the goal is not to treat an autonomic disorder, it is to correct disorders of target organs through autonomic nerves.
53
Beta receptors most commonly helps in what organs in the body?
Heart and Kidney
54
What is direct-acting sympathomimetic?
Directly affects your receptor organs
55
What is indirect-acting sympathomimetic?
- Increase production of Norepinephrine - Kill enzymes that degrades the production of NE - Natural occurring NE will attached to the receptor sites
56
What is mixed-acting sympathomimetic?
- Directly affects your receptor organs - Increase production of Norepinephrine
57
What kind of medication is given in an emergency?
Catecholamines
58
What do you call a drug that only affects one type of receptor?
Selective [Drug]
59
What do we call a drug that affects every receptor?
Non-Selective [Drug] - Many side effects
60
What are the Alpha 1 receptor treatments?
- Hypotension - Nasal congestion - Dilation of pupils
61
What are the Alpha 2 receptor treatments?
- Hypertension
62
What are the Beta 1 receptor treatments?
- Heart failure - Cardiac arrest - Shock
63
What are the Beta 2 receptor treatments?
- Asthma - Premature labors of contractions
64
What receptors are affected by Epinephrine Medication?
A1, A2, B1, B2
65
What are the therapeutic uses of Epinephrine?
- Asthma - Cardiac arrest - Anaphylactic shock
66
What receptors are affected by pseudoephedrine and phenylephrine medications?
A1 and B2
67
What are the therapeutic uses of pseudoephedrine and phenylephrine?
Nasal decongestant
68
What receptors are affected by Isoproterenol?
B1 and B2
69
What are the therapeutic uses of Isoproterenol?
- Increase heart rate - Force of contraction and conduction - Shocks
70
What receptor is affected by Dobutamine?
B1
71
What are the therapeutic uses of Dobutamine?
- Increase heart rate - Force of contraction in heart failure - Shocks
72
What receptor is affected by Albuterol?
B2
73
What are the therapeutic uses of Albuterol?
- Asthma/COPD
74
Why catecholamines are only given through I.V [Parenteral route]?
Catechol rings can be dissolved by salivary enzymes/G.I enzymes.
75
What is the therapeutic class of epinephrine?
Vasopressor/ Vasoconstriction
76
What is the pharmacologic class of epinephrine?
Adrenergic Agonist
77
What are the indications for epinephrine?
Anaphylaxis Asthma Cardiac stimulation Indiction and maintenance of mydriasis during intraocular surgery.
78
Tissue necrosis [Lack of blood flow in the tissues results in the death of body tissues] is a side effect of what kind of agents?
Adrenergic Agonists [Check I.V sites frequently]
79
What are the side effects of adrenergic agonists?
- Effects on the sympathetic nervous system a)Tachycardia b) Palpitations c) tremors d) dizziness e) Increased blood pressure f) Urinary retention r/t high doses g) Nausea and vomiting - offer food
80
What is the antidote for adrenergic agonists side effects?
Phentolamine Mesylate (Regitine) - for extravasation of Norepinephrine and Dopamine
81
What are the assessment done for nursing process for patient taking Adrenergic Drugs?
- V.S - Drug History - Health History for contraindications - Capillary Blood Glucose
82
What are the possible diagnosis for patient taking Adrenergic drugs?
- Disturbed sleep pattern [Palpitation] - Deficient Knowledge
83
Why patient with glaucoma cannot take adrenergic drugs?
- Increases intraocular pressure
84
What monitoring will be done to a patient taking catecholamines?
- ECG - BP - U/O Urinary output - F/e
85
What are the drugs that blocks Alpha and Beta receptor blockers?
Adrenergic Blockers
86
What are the mechanism of Adrenergic Blockers?
- Direct blocking by occupying receptors - Indirect blocking by inhibiting release of neurotransmitters
87
What are the possible causes of alpha blockers?
- Relaxation of Smooth muscle - Vasodilation: Hypertension and PVD's - Reduces contractions of smooth muscle in bladder and prostate
88
What are the drugs that are included in alpha blockers?
Zosin Drugs - Terazosin - Doxazosin - Prazosin
89
What are the things to watch out for when taking alpha blockers?
- Dizziness - Orthostatic hypotension - Headache, nasal congestion
90
What is orthostatic hypotension?
Something to do with the position [Supine to standing]
91
What are the possible causes of beta blockers?
- Decrease heart rate - Decreases blood pressure - Useful for treating mild to moderate hypertension, angina pectoris, and myocardial infarction
92
What are the drugs that are included in beta blockers?
Olol Drugs - Atenolol - Propanolol - Pindolol - Timolol - Metoprolol
93
What receptors are affected with phentolamine and phenoxybenzamine?
A1 and A2
94
Therapeutic use of phentolamine and phenoxybenzamine?
For Hypertension
95
What receptors are affected with prazosin and terazosin?
A1
96
Therapeutic use of prazosin and terazosin?
For hypertension
97
What receptors are affected with Tamsulosin and alfuzosin?
A1
98
Therapeutic use of tamsulosin and alfuzosin?
BPH - urinary relief Benign prostatic hyperplasia
99
What receptors are affected with Propanolol (1st gen)
B1 and B2
100
Therapeutic use of Propanolol (1st gen)?
- Hypertension - Angina - Migraine
101
What receptors are affected with timolol (1st gen)?
B1 and B2
102
Therapeutic use of timolol (1st gen)?
- Glaucoma - Decrease intraocular pressure
103
What receptors are affected with atenolol and metoprolol?
B1
104
What is the therapeutic use of atenolol and metoprolol?
Hypertension (2nd gen-cardioselective)
105
What receptors are affected with carvedilol and labetalol?
B1 and B2
106
What is the therapeutic use of carvedilol and labetalol?
Hypertension-with vasodilation
107
What receptor is affected with pindolol?
B1 and B2
108
What are the therapeutic use of pindolol?
Decrease CO HR for patients with heart block
109
Why adrenergic antagonist cannot be given with patient with respiratory health concerns?
- Bronchoconstriction
110
What is the therapeutic class of Prazosin?
Anti-hypertensive
111
What is the pharmacologic class of Prazosin?
Alpha Blocker
112
What are the indications of Prazosin?
Mild to moderate hypertension
113
How many receptors are there in Muscarinic receptors?
5 receptors that stimulate smooth muscle and slows heart rate
114
What is the function of M1?
GenitoUrinary
115
What are the function of M3?
For lungs and glands (may increase calcium-anticoagulant)
116
What are the function of M2?
For heart - May increase potassium - Decrease heart rate
117
How many receptors are there in Nicotinic?
2 Receptors Nm Nn
118
Nicotinic affects what muscle?
Affects skeletal muscles
119
What is the function of Nm?
Muscle contraction
120
What is the function of Nn?
Transmission of cholinergic signals
121
Acetylcholine are made of what?
Choline and Acetyl CoA
122
What happen to choline after action at the receptor site?
re-uptake or reabsorbed back to pre-synaptic nerve cell terminal
123
What happen to acetate after action at the receptor site?
Waste product and diffuse away
124
What are the cholinergic agonists?
- mimic the parasympathetic neurotransmitter acetycholine
125
What is direct acting parasympathomimetic? cholinergic drugs
Directly affects the receptor sites even without acetylcholine. Drug will act as a substitute in the receptor.
126
What is indirect acting parasympathomimetic? cholinesterase drugs
- Drugs will not directly attached to the receptor sites instead it will attached to acetylcholinesterase that will not degrade acetylcholine and will stay to the receptor sites. - affects acetylcholinesterase
127
Direct acting parasympathomimetic drugs mostly affects what receptor?
Muscarinic receptor
128
What are the direct acting drugs?
- Acetylcholine - Carbachol - Pilocarpine - Betanechol
129
What are the therapeutic use of Acetylcholine?
Non-specific cholinergic effect Decreases CO, HR, BP Increase GI Activity
130
What are the therapeutic uses of Carbachol?
Not as susceptible to AChE Use locally to constrict pupil Decrease IOP
131
What are therapeutic uses of Pilocarpine?
Constricts pupil Decrease IOP for acute glaucoma
132
What are therapeutic uses of Bethanechol?
Increase muscle tone in bladder and GIT
133
What is the therapeutic class of bethanechol?
Urinary stimulants
134
What is the pharmacologic class of bethanechol?
Cholinergic agonists
135
What are the indication for bethanechol drug?
- Acute post-operative and post-partum nonobstructive urine retention - Neurogenic atony of urinary bladder with urine retention
136
What are the indirect acting reversible drugs?
- Edrophonium - Physostigmine - Neostigmine - Pyridostigmine - Donepezil - Rivastigmine - Galantamine
137
What is the therapeutic use of Edrophonium?
Diagnosis of MG [Myasthenia gravis (MG)] - generalized weakness
138
What is the therapeutic use of Physostigmine?
Overdose of atropine[sulfate an emergency drugs]
139
What is the therapeutic use of Neostigmine?
Symptoms of MG Reverse effects of anesthesia
140
What is the therapeutic use of Pyridostigmine?
Symptoms of MG Reverse effects of anesthesia
141
What is the therapeutic use of Donepezil?
Alzheimer's disease to improve cognitive function
142
What is the therapeutic use of Rivastigmine?
Alzheimer's disease to improve cognitive function
143
What is the therapeutic use of Galantamine?
Alzheimer's disease [progressive dementia] to improve cognitive function
144
What kind of cholinergic agonist drug that is not used for medicinal purposes?
Indirect acting irreversible - Paralysis
145
What is an indirect acting irreversible cholinergic agonist drug?
Famous for military use as nerve gasses that can cause paralysis [world war 2]
146
Echothiopate drug is used for?
Treatment of open glaucoma
147
What is the mnemonic for adverse reactions of Cholinergic agonists?
D.U.M.B.B.E.L.S
148
D.U.M.B.B.E.L.S stands for
D- diarrhea U- urination M- Miosis and muscle weakness B- bronchorrhea B- bradycardia E- emesis L- lacrimation S- salivation/ sweating
149
What is the cause of cholinergic crisis?
Overdose of cholinergic agonists drugs
150
Myasthenic crisis
low level of acetylcholine
151
Neostigmine (Tensilon test)
Increased weakness Use to differentiate Myasthenic crisis and cholinergic crisis
152
Anti-cholinergic drugs
produces sympathetic effects
153
What are the anti-muscarinic agents?
- Atropine - Cyclopentolate - Tropicamide [emergency drugs] - Scopolamine - Ipratropium - Oxybutynin - Benztropine
154
What is the therapeutic use of Atropine?
Mydriasis Psychoplegia prior to an eye surgery or Exam Blocks M3- Reduces G.I motility Blocks M2- SA and AV node, tachycardia in high doses
155
What is the therapeutic use of Cyclopentolate?
Same as atropine but with less duration of action
156
What is the therapeutic use of Tropicamide?
Same as atropine but with less duration of action
157
What is the therapeutic use of Scopolamine?
Motion sickness Post op nausea vomiting as patches
158
What is the therapeutic use of Ipratropium?
COPD Rhinorrhea as inhalation to bronchodilation Decrease secretion
159
What is the therapeutic use of Oxybutynin?
Bladder function
160
What is the therapeutic use of Benztropine?
Parkinson's like disorders
161
What is the therapeutic class of Atropine?
Anti-arrhythmic
162
What is the pharmacological class of atropine?
Anti-cholinergic belladonna alkaloids
163
What is the mnemonic for adverse reactions of anti-cholinergic agonists drugs?
A.B.C.D.S
164
A.B.C.D.S stands for?
A- agitation B- blurred vision C- constipation, confusion D- dry mouth S- stasis of urine and sweating
165
What is nicotine?
- Not used in clinical practice - Stimulate and blocks cholinergic function Increase production of neurotransmitter [cause: bronchoconstriction] -CNS stimulation: Causes addiction
166
What are the two subdivision of neuro-muscular blockers?
Non-depolarizing agent Depolarizing agent
167
What agents that binds to ACh receptors but do not induce ion channel opening?
Non-depolarizing agent [Curium-Coronium]
168
Facilitates ECT
Succinylcholine
169
What are the adverse effect of anti-cholinergic drugs?
- Prolong apnea - Hyperkalemia [fluids and electrolytes] - Malignant hyperthermia
170
Sympathomimetic and Parasympatholytic
Synergic
171
Sympatholytic and Parasympathomimetic
Synergic
172
Sympathomimetic and Parasympathomimetic
Antagonistic
173
Sympatholytic and Parasympatholytic
Antagonistic

PHARMACOLOGY (6 decks)

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