DRUGS ACTING ON THE ANS Flashcards by michaela gail

Q

3 major divisions of the autonomic nervous system

A

sympathetic
parasympathetic
enteric nervous system (myenteric plexus, submucous plexus)

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Q

sympathetic:

spinal roots of origin

A

T1-T12
L1-L5

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Q

parasympathetic:

spinal roots of origin

A

CN 3, 7, 9, 10
sacrum

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Q

sympathetic:

location of ganglia

A

paravertebral chains of spinal column

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Q

parasympathetic:

location of ganglia

A

organs innervated, more distant from spinal cord

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Q

sympathetic:

preganglionic and postganglionic fibers

A

short, long

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Q

parasympathetic:

preganglionic and postganglionic fibers

A

long, short

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Q

primary transmitter at the sympathetic postganglionic neuron-effector cell synapses in most tissues

A

norepinephrine

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Q

exceptions of norepinephrine

A

eccrine sweat glands
vasodilator in the sympathetic fibers of skeletal muscles

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Q

primary transmitter in all autonomic ganglia and at the synapses between parasympathetic postganglionic neurons and their effector cells

A

acetylcholine

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Q

primary transmitter at the somatic skeletal muscle neurotransmitter junction

A

acetylcholine

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Q

direct activation of adrenoceptors
indirect activation by increasing concentration of available catecholamines in the synapse

A

sympathominetics

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Q

alpha-1 or alpha-2 adrenergic effect:

contraction of MOST vascular smooth muscle

A

alpha-1

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Q

alpha-1 or alpha-2 adrenergic effect:

stimulates glycogenolysis in the liver

A

alpha-1

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Q

alpha-1 or alpha-2 adrenergic effect:

stimulates aggregation of platelets

A

alpha-2

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Q

alpha-1 or alpha-2 adrenergic effect:

contraction of pupillary dilator muscle (mydriasis)

A

alpha-1

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Q

alpha-1 or alpha-2 adrenergic effect:

inhibits transmitter release in adrenergic and cholinergic nerve terminals

A

alpha-2

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Q

alpha-1 or alpha-2 adrenergic effect:

inhibits insulin release of pancreatic b cells

A

alpha-2

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Q

alpha-1 or alpha-2 adrenergic effect:

contraction of SOME vascular smooth muscle

A

alpha-2

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Q

alpha-1 or alpha-2 adrenergic effect:

contraction of pilomotor smooth muscle (erects hair)

A

alpha-1

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Q

alpha-1 or alpha-2 adrenergic effect:

inhibits lipolysis of fat cells

A

alpha-2

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Q

beta-1 or beta-2 adrenergic effect:

relaxes the airway, uterine, and vascular smooth muscle

A

beta-2

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Q

beta-1 or beta-2 adrenergic effect:

stimulates rate and force of heart

A

beta-1 and beta-2

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Q

beta-1 or beta-2 adrenergic effect:

stimulates glycogenolysis of liver

A

beta-2

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beta-1 or beta-2 adrenergic effect: causes tremors in the somatic motor neuron terminals

beta-2

beta-1 or beta-2 adrenergic effect: stimulates renin release from juxtaglomerular cells of kidney

beta-1

beta-1 or beta-2 adrenergic effect: stimulates insulin release from the pancreatic b cells

beta-2

6 classifications of sympathomimetics

- non-selective alpha agonist - alpha-1 selective - alpha-2 selective - non-selective beta agonist - beta-1 selective - beta-2 selective

- sympathomimetic (non-selective) - activates alpha and beta adrenergic receptors - for cardiac arrest, anaphylaxis, asthma, copd, hemostasis SE: HTN, tachycardia, ischemia, hyperglycemia

epinephrine

a1: vasoconstriction, increases BP b1: increased HR, conduction and contractility b2: bronchodilation

epinephrine

- sympathomimetic (non-selective) - activates alpha, beta, and D1 adrenergic receptors - for cardiogenic shock and heart failure SE: cardiovascular disturbance, arrythmias

dopamine

a1: vasoconstriction, increases BP b1: increased HR, conduction and contractility D1: vasodilation in splanchnic and renal vessels

dopamine

- sympathomimetic (alpha-2 selective) - activates a2 adrenergic receptors - decreases central sympathetic outflow - for HTN, cancer pain , opioid withdrawal SE: sedation, rebound HTN, dry mouth

clonidine

in using clonidine, what should you do to avoid rebound hypertension

taper / gradually decrease use prior to discontinuation

what is the treatment for rebound HTN after using clonidine?

phentolamine

- sympathomimetic (alpha-2 selective) - activates a2 adrenergic receptors - decreases central sympathetic outflow - used for preeclampsia, GHTN SE: sedation, hemolytic anemia

methyldopa

- sympathomimetic (beta-2 selective) - activates beta 2 receptors in bronchial smooth muscle causing bronchodilation - used for acute asthma attack, tocolytic for preterm labor SE: tachycardia, tremors, nervousness, restlessness, arrhythmias, loss of responsiveness

albuterol / salbutamol

drug choice for anaphylaxis

epinephrine

drug of choice for asthma attacks

albuterol / salbutamol

albuterol / salbutamol may precipitate ___ in patients with concurrent COPD and heart disease

arrhythmias

true or false: sympathomimetics are C/I in patients with cardiac dysrhythmias, narrow angle glaucoma, and cardiogenic shock

true

what should you monitor when administering sympathomimetics?

- VS and UO - SE: tachycardia, palpitations, tremors, dizziness, HPN

continuous nasal spray can cause ___

nasal congestion rebound

alpha blockers non-selective - irreversible

phenoxybenzamine

alpha blockers non-selective - reversible

phentolamine

alpha blockers alpha-1 selective

prazosin

alpha blockers alpha-2 selective

yohimbine

beta blockers non-selective

propranolol

beta blockers beta-1 selective

atenolol

beta blockers beta-2 selective

butoxamine

- adrenergic antagonist (alpha non-selective) - irreversibly blocks alpha adrenergic receptors

phenoxybenzamine

used for pheochromocytoma (pre-surgical) SE: orthostatic hypotension, reflex tachycardia, GI irritation, myocardial ischemia

phenoxybenzamine

forms covalent bond with alpha receptors = effects lasts for several days

phenoxybenzamine

- adrenergic antagonist (alpha non-selective) - reversibly blocks alpha adrenergic receptors SE: orthostatic hypotension, reflex tachycardia, GI irritation

phentolamine, tolazoline

- used for pheochromocytoma (pre-surgical) - antidote to a1 antagonist overdose, rebound HTN

phentolamine, tolazoline

- adrenergic antagonist (alpha-1 selective) - selectively blocks a1 adrenergic receptors - used for benign prostatic hyperplasia, HTN SE: 1st dose orthostatic hypotension, reflex tachycardia

prazosin

- adrenergic antagonist (beta non-selective) - block b1 and b2 receptors - block sympathetic effects on heart and BP - reduce renin release

propranolol

- used for angina prophylaxis, HTN, arrhythmias, migraine, performance anxiety, hyperthyroidism SE: bronchospasm, AV block, heart failure, CNS sedation, erectile dysfunction

propranolol

- may mask symptoms of hypoglycemia in diabetics - carvedilol and labetalol has combines alpha and beta blockade (may be used for pheochromocytoma)

propranolol

- adrenergic antagonist (beta 1 selective) - selectively block b1 receptors - blocks sympathetic effects on heart and BP - used for angina, HTN, heart failure SE: bronchospasm, AV block, heart failure, CNS sedation, erectile dysfunction

atenolol

when administering adrenoceptor blockers, you should monitor?

VS, BP, and HR

when administering adrenoceptor blockers, report any complaint of ___

stuffy nose

when administering adrenoceptor blockers: for clients with DM, have ___ available and follow adjustment of insulin dose as ordered

glucagon

true or false: when administering adrenoceptor blockers, quickly rise from supine to sitting / standing position

false - slowly rise

- not very useful for systemic therapy because their effects are not sufficiently selective - parasympathetic and sympathetic ganglia and somatic junctions all may be blocked

cholinergic drugs

location of M1 cholinoreceptor

nerve endings

location of M2 cholinoreceptor

heart, some nerve endings

location of M3 cholinoreceptor

effector cells, smooth muscle glands, endothelium

location of Nn cholinoreceptor

ANS ganglia

location of Nm cholinoreceptor

neuromuscular end plate

- cholinergic (direct-acting) - similar to carbachol - active muscarinic receptors - act on M receptor only

betanechol

- used for bladder and bowel atony (post-surgery or spinal cord injury) - SE: cyclospasm, diarrhea, urinary urgency, vasodilation, reflex tachycardia, sweating

betanechol

- cholinomimetic (direct-acting) - activates M3 receptors in ciliary muscle and salivary glands - used for glaucoma, sjogren syndrome - SE: miosis, blurring of vision

pilocarpine

autoimmune disorder characterized by triad of: - xerostomia (dry mouth) - xerophthalmia (dry eyes) - rheumatoid arthritis

sjogren syndrome

- cholinomimetic (direct-acting) - activates nicotinic ACH receptors (Nn and Nm) - used for smoking cessation - SE: generalized ganglionic stimulation

nicotine

nicotine overdose leads to?

convulsion, paralysis, coma

- CNS stimulation - eye: miosis, spasm of accommodation - lungs: bronchoconstriction - GIT/GUT: excessive smooth muscle actiivity - increased secretory activity - vasodilation

muscarinic toxicity

- ganglionic stimulation - blockade of neuromuscular end plate depolarization - fasciculation and paralysis - CNS toxicity: stimulation (convulsions) followed by CNS depression

nicotinic toxicity

- bind to cholinesterase and undergo prompt hydrolysis - alcohol portion is released - acidic portion is retained and release slowly

indirect-acting cholinomimetics

- prevents the binding and hydrolysis of endogenous acetylcholine - amplify acetylcholine effects wherever ACH is released

indirect-acting cholinomimetics

- cholinomimetic (indirect-acting) - inhibits acetylcholinesterase, amplifies endogenously released acetylcholine - used for myasthenia gravis, differentiation of cholinergic crisis and myasthenic crisis - SE: miosis, salivation, NV, diarrhea, bradycardia

edrophonium

true or false: edrophonium is known to be very short acting upon IV administration

true

how is myasthenia gravis diagnosed?

tensilon test

- cholinomimetic (indirect-acting) - inhibits acetylcholinesterase, amplifies endogenously released acetylcholine - used for myasthenia gravis, reversal of nondepolarizing neuromuscular blockade, glaucoma - SE: miosis, salivation, NV, diarrhea, bradycardia

neostigmine

muscarinic effects caused by neostigmine are blocked by ___

atropine

autoimmune destruction of nictonic ACH receptors characterized by: - fluctuating muscle weakness - ocular symptoms - bulbar symptoms - proximal muscle weakness

myasthenia gravis

acute worsening of symptoms due to infection, stress or undermedication

myasthenic crisis

excessive activation of cholinoreceptors (skeletal muscle weakness and parasympathetic signs) due to overmedication

cholinergic crisis

how does edrophonium differentiate myasthenic crisis from cholinergic crisis?

myasthenic - IMPROVES muscle strength cholinergic - WEAKENSS muscle strength

- prototype non-selective muscarinic blocker - found in atropa belladona - tertiary amine that readily crosses membrane barriers

atropine

- cholinergic antagonist - competitively blocks all muscarinic receptors - used for mydriatic, cycloplegic, antidote for organophosphate poisoning, bradycardia, hypersalivation - SE: tachycardia, mydriasis, cycloplegia, skin flushing, delirium, hallucination

atropine

drug of choice for organophosphate poisoning

atropine

these can cause what? malathion and parathion (insecticide) sarin, tabun, soman: nerve gases

organophosphate poisoning

signs and symptoms of organophosphate poisoning DUMBBELSS

diarrhea urination miosis bronchospasm bradycardia excitation lacrimation sweating salivation

- atropine fever - atropine flush - decreased secretion - tachycardia - arrhythmias - constipation - blurred vision - CNS toxicity

atropine toxicity

- use cautiously in infants, may cause hyperthermia - C/I: acute angle-closure glaucoma, benign prostatic hyperplasia

muscarinic blockers