Drugs affecting autonomic nervous system

Question 1

Autonomic nervous system 4 classes of drugs

Answer 1

1. turn on sympathetic nervous system (Adrenergic)
   - beta agonist
   - alpha agonist
2. turn off sympathetic nervous system (anti-adrenergic)
   - beta blocker
   - alpha blocker
3. turn on para-sympathetic nervous system (cholinergics)
   - muscarinics
   - “makes everything wetter”
4. Turn off para-sympathetic nervous system
   - musarinic blockers
   - “dries everything up”

Question 2

sympathetic nervous system =

Answer 2

fight or flight

Question 3

parasympathetic nervous system =

Answer 3

rest and digest

Question 4

an example of medication that affects the body as stimulating (turning on) the sympathetic nervous system

Answer 4

also can be called:

• sympathomimetic
• adrenergic
• alpha and beta adrenergic agonists
  ex: epinephrine

Question 5

examples of medications that affect body as blocking or opposing (ie. turn off) the sympathetic nervous system

Answer 5

also can be called:

• sympatholytic
• anti-adrenergic
• alpha and beta-adrenergic blocking drugs
  ex: clonidine, propanolol

Question 6

examples of medications that affect the body as stimulating the parasympathetic nervous system

Answer 6

can be called:

• parasympathetic
• cholinomimetic
• cholinergic
• ex: neostigmine

Question 7

examples of medications that affect the body as blocking or opposing the parasympathetic nervous system

Answer 7

can be called:

• parasympatholytic
• anticholinergic
• cholinergic blocking
• example: atropine

Question 8

Mechanism of action for Alpha 1 adrenergic drugs

Answer 8

vasoconstriction

Question 9

mechanism of action for Beta 1 adrenergic drugs

Answer 9

cardiac stimulation

Question 10

Mechanism of action for Beta 2 adrenergic drugs

Answer 10

vasodilation

Question 11

Indications for use of adrenergic drugs:

Answer 11

• emergency drugs used in treatment of cardiovascular, respiratory and allergic disorders
• cardiac stimulants and increase blood pressure
• bronchodilation and decrease nasal congestion
• vasconstriction of respiratory tract, skin and other tissues to relive edema
• relaxation of uterus and inhibition of contractions

Question 12

contraindications to use of adrenergic drugs

Answer 12

cardiac dysrythmias, angina, hypertension, hyperthyroidism and CV disease

Question 13

Epinephrine (Adrenalin):

Answer 13

Increases BP, vasodilation and increased blood flow to skeletal muscles, heart and brain. Relaxation of bronchial smooth muscle (ie. for asthma attack)

Question 14

Tx of anaphlylaxis

Answer 14

epinephrine is drug of choice

Question 15

Tx of cardiopulmonary resuscitation

Answer 15

vasopressin over epinephrine

Question 16

Tx of Hypotension and shock:

Answer 16

vasopressor drug therapy to maintain tissue perfusion

Question 17

Tx of nasal congestion

Answer 17

pseudoephedrine

Question 18

Assess for drug interactions: epinephrine and phenylephrine interact

Answer 18

with MAOI’s -> severe hypertension

Question 19

Anti-adrenergic drugs indications for use

Answer 19

• to decrease or block the effects of SNS stimulation. Suppress stimulation and retain physiological response to stress.

Question 20

Beta-adrenergic blocking drugs:

Prototype: Propranolol

Answer 20

• decrease cardiac motility, cardiac output, heart rate, bp

- other uses: migraine prophylaxis, stage fright, hyperthyroidism symptoms, esophageal varices

Question 21

Beta blockers used for

Answer 21

• hypertension
• anti-anginal
• prevention of MI or re-infarction

Question 22

Cardio selective agents (Beta 1 selective agents)

Answer 22

• preferred usage in clients with diabetes, PVD and asthma

- Note: leads to bradycardia, hold if HR is less than 60

Question 23

Labetalol and carvedilol block alpha 1, beta 1, and beta 2 to contribute to antihypertiensicve effects

Answer 23

may cause less bradycardia, but more postural hypotension

Question 24

what family of drugs has an adverse effect of interference of glycogenolysis

Answer 24

Non-selective beta blockers

non-selective beta blockers adverse effects: bronchoconstriction , peripheral vasoconstriction, interference with glycogenolysis

Question 25

Cholinergic drugs: | acetlycholine..

Answer 25

..stimulates salivary and gastric glands; gut to increase peristalsis; relaxation of sphincters to facilitate movement of feces and flatus

Question 26

Direct acting cholinergics

Answer 26

- decrease heart rate, vasodilation and unpredictable changes in blood pressure - increase tone and contractility of GI smooth muscle - increase tone and contractility of smooth muscle in urinary bladder and relaxation of sphincter

Question 27

Indirect acting cholinergics.. example of one used for treatment of Alzheimers disease

Answer 27

Donepezil

Question 28

Indications for use of cholinergic drugs:

Answer 28

-urinary retention due to bladder atony - Bethanechol (Duviod)

Question 29

Anti-cholinergic drugs: Atropine

Answer 29

-atropine is the antidote for a cholinergic crisis

Question 30

Mechanism of action anti-cholinergic drugs

Answer 30

- occupy receptor sites at PNS nerve endings, leaving few free to respond to acetlycholine - CNS- stimulation followed by depression - heart rate- increased - bronchodilation and decreased respiratory tract secretions - antispasomodic effects on GI

Question 31

Anti-cholinergic drugs. indications for use:

Answer 31

- parkinson's disease | - anticholinesterase toxicity, mushroom poisoning or organ phosphate pesticide poisoning

Question 32

atropine

Answer 32

antidote for cholinergic overdose

Question 33

Ipratropium (atrovent)

Answer 33

bronchodilator (inhaled)

Question 34

Titotropium bromide

Answer 34

treatment of COPD

Question 35

Centrally acting anticholinergics: | Benzotropine (cogentin):

Answer 35

treats acute dystonic reactions

Question 36

Urinary antispasmodics: | Oxybutynin (Ditropan and Ditropan XL)

Answer 36

- direct antispasmodics effects, increases bladder capacity and decreases voiding - used for neurological conditions like spinal bifida

Question 37

renal or biliary colic ______ given

Answer 37

atropine given with morphine to reduce pain of renal and biliary colic

Question 38

Extrapyradmidal reactions, anticholingergics prescribed only if

Answer 38

symptomatic

Question 39

Anti-cholinergic overdose symptom:

Answer 39

-hyperthermia, delirium, tachycardia, myclonic movements and choreoathetosis may be seen