Pharmacology Exam 3 Flashcards by Kayla Russo

Q

Consists of the brain and spinal cord

A

Central Nervous System

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Q

Made up of the autonomic and the somatic.

A

The Peripheral Nervous System

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Q

Also called visceral system; acts on smooth muscles and glands.

A

Autonomic nervous system

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Q

Functions to control and regulate the heart, respiratory system, gastrointestinal tract, bladder, eyes, and glands.

A

Automatic Nervous System

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Q

Voluntary system that innervates skeletal muscles

A

Somatic nervous system

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Q

Parasympathetic and Sympathetic are apart of what?

A

Autonomic nervous system

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Q

The sympathetic nervous system is also called what?

A

Adrenergic system

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Q

Sympathetic nervous system receptors

A

Alpha 1
Alpha 2
Beta 1
Beta 2

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Q

Parasympathetic Nervous System Receptor Cells

A

Muscarinic

Nicotinic

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Q

Sympathetic Stimulants are called

A

Sympathomimetics, adrenergics, adrenergic agonists

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Q

Sympathetic Depressants are called

A

Sympatholytics, adrenergic blockers, adrenergic antagonists

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Q

Parasympathetic stimulants are called

A

Direct acting: parasympathomimetic, cholinergic a, cholinergic agonists

Indirect acting: cholinesterase inhibitors

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Q

Parasympathetic Depressants are called

A

Parasympatholytics, anticholinergics, cholinergic antagonists, antispasmodics

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Q

Alpha receptors are located in

A

Blood vessels, eyes, bladder, and prostate

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Q

Alpha 1 Receptors do what when effected?

A

Increases cardiac contractility, vasoconstriction
Dilates pupils, decreases salivary gland secretion
Increases bladder and prostate contraction

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Q

Alpha 2 receptors do what when effected?

A

Inhibits norepinephrine release
Promotes vasodilation and decreased BP
Decreases GI motility and tone

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Q

Beta 1 Receptors do what when affected?

A

Increases cardiac contractility, HR.

* Increases renin secretion and increases BP

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Q

Beta 2 receptors do what when affected?

A

Decreases GI tone and motility
Bronchodilation
Increases blood flow in skeletal muscles
Relaxes smooth muscles of uterus
Activates liver glycogenolysis and increases blood glucose

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Q

Domaminergic receptors are located in

A

The renal, mesenteric, coronary, cerebral arteries

* When stimulated vasodilation occurs and increasesd blood flow

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Q

Neurotransmitter Inactivation by:

A

Reuptake of transmitter back into neuron
Enzymatic transformation or degradation
- MAO inside neuron
- COMT outside neuron
Diffusion away from the receptor

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Q

Drugs halt termination of neurotransmitter by inhibiting what?

A

Norepinephrine reuptake

* Norepinephrine degradation

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Q

Classification of adrenergic agonists

A

Direct acting
Indirect acting
Mixed acting

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Q

Direct acting adrenergic agonists

A

Epinephrine and norepinephrine

* Directly stimulates adrenergic receptor

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Q

Indirect-acting adrenergic agonists

A

Amphetamine

* Stimulates release of norepinephrine from terminal nerve endings

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Mixed-acting adrenergic agonists

* Ephedrine | * Stimulates adrenergic receptor sites and stimulates release of norepinephrine from terminal nerve endings

Catecholamines do what?

* produce a Sympathetic response * Endogenous: Epinephrine, norepinephrine, dopamine. * Synthetic: Isoproterenol, dobutamine

Noncatecholamines do what?

* Stimulate adrenergic receptors * Most have longer duration of action than endogenous and synthetic * Phenylephrine, metaproterenol, albuterol

Inotropic means:

Strengthen myocardial contraction ex: Epinephrine

Epinephrine is used for:

* Anaphylaxis * Anaphylactic shock * Bronchospasms * Status asthmaticus Cardiogenic shock * Cardiac arrest

Epinephrine Side effects

•Cardiac dysrhythmias, palpitations, tachycardia, hypertension, dizziness, headaches, sweating, insomnia, restlessness, tremors, hyperglycemia, renal vasoconstriction

Epinephrine drug interactions

Beta blockers •Decrease epinephrine action Digoxin •Causes cardiac dysrhythmias TCAs and MAOIs intensify and prolong effects Digoxin •Can cause dysrhythmias

Epinephrine is:

Nonselective

Epinephrine activates what receptors and what do they do?

Alpha 1: increases BP Beta 1: increases HR Beta 2: prompts bronchodilation

Epinephrine contraindications and cautions

* Cardiac dysrhythmias * Hypertension * Hyoerthyroidism * Diabetes mellitus * Pregnancy

Epinephrine contraindications and cautions

* Cardiac dysrhythmias * Hypertension * Hyoerthyroidism * Diabetes mellitus * Pregnancy

Epinephrine contraindications and cautions

* Cardiac dysrhythmias * Hypertension * Hyoerthyroidism * Diabetes mellitus * Pregnancy

Epinephrine contraindications and cautions

* Cardiac dysrhythmias * Hypertension * Hyoerthyroidism * Diabetes mellitus * Pregnancy

Epinephrine contraindications and cautions

* Cardiac dysrhythmias * Hypertension * Hyoerthyroidism * Diabetes mellitus * Pregnancy

Epinephrine actions are:

* Inotropic * Vasoconstrictor * Bronchodilator

Albuterol is

Selective

Albuterol acts on what receptor and it does what?

Acts on beta 2 adrenergic receptors and promotes bronchodilation

Albuterol uses

* Treats bronchospasms * Treats asthma * Treats bronchitis * Treats COPD

Albuterol Cautions

•Severe cardiac disease Hypertension, hyperthyroidism, Diabetes mellitus, pregnancy, renal dysfunction

Albuterol Side effects/adverse reactions

* Tremors * Nervousness * Restlessness * Dizziness * Tachycardia * Palpitations * Cardiac dysrhythmias

Nursing Interventions for Adrenergic Agonists

* Monitor IV site frequently when administering norepinephrine or dopamine because extravasation of these drugs causes tissue damage and necrosis within 12 hours. * Moniyor ECG for dysrhythmias when adrenergic agonists are given IV * Explain the continuous use of nasal sprays or drops that contain an adrenergic agonists may result in rebound nasal congestion

IV Epinephrine extravasation antidote

Phentolamine mesylate

Blocks alpha receptors relaxing vascular smooth muscle and increasing blood flow to area

Phentolamine mesylate

* Selective alpha 2 adrenergic agonists * Used primarily to treat hypertension * Can cause orthostatic hypotension

Clondine (Central-acting alpha agonist)

* Alpha adrenergic agonists that acts with the CNS | * Alpha 2 activation leads to vasodilation and decreased BP

Methyldopa (Central Acting Alpha Agonist)

Methyldopa (Central Acting Alpha Agonist) Side effects

* Drowsiness * Headache * Nasal Congestion * Nightmares * Edema * Constipation * Ejaculation dysfunction

* Blocks effects of adrenergic neurotransmitters * Indirectly by inhibiting release of neurotransmitters epinephrine and norepinephrine * Directly by occupying receptors

Adrenergic Antagonists

Adrenergic Antagonists Types

Alpha-adrenergic antagonists | Beta-adrenergic antagonists

Effects of Adrenergic Antagonists at Receptors Alpha 1

* Vasodilation, dizziness * Orthostatic hypotension, reflex tachycardia * Pupil constriction * Suppresses ejaculation * Reduces contraction of smooth muscles in bladder neck and prostate

Effects of Adrenergic Antagonists at Receptors Beta 1

Reduces cardiac contractility and decrease pulse

Effects of Adrenergic Antagonists at Receptors Beta 2

* Bronchoconstriction * Contracts uterus * Inhibits glycogenolysis which leads to hypoglycemia

Drugs that inhibit a response at alpha-adrenergic receptor site

Alpha Adrenergic Antagonists

Alpha Adrenergic Antagonists Drugs

Selective- blocks alpha 1 Nonselective- block alpha 1 and alpha 2 Action: is to promote vasodilation Use: decrease symptoms of BPH, PVD

Alpha Adrenergic Antagonists Drugs

Selective- blocks alpha 1 Nonselective- block alpha 1 and alpha 2 Action: is to promote vasodilation Use: decrease symptoms of BPH, PVD

Beta Blocker Action (Beta Adrenergic Antagonists)

Decrease BP and pulse

Nonselective Beta Blockers

Blocks beta 1: decreases BP and pulse Blocks beta 2: bronchoconstriction; use with caution in patients w/ COPD or asthma Propranolol HCl: used for angina, cardiac dysrhythmias, hypertension, HF

Selective Beta Blockers

* Metoprolol | * Atenolol

* Blocks Beta 1 Only * Decreases BP and HR * Fewer Side Effects

Selective Beta Blockers

Selective Beta Blockers Side Effects/Adverse Reactions

* Bradycardia * Hypotension * Dysrhythmias * Headaches * Dizziness * Fainting * Fatigue * Drowsieness * Depression * Nausea * Vomiting * Diarrhea * HF * Tell patient to monitor their HR and BP * Can mask signs and symptoms of hypoglycemia so monitor closely of they are a diabetic

Beta Adrenergic Drug Interactions

* Decreased side effects w/ NSAIDs * Increased effects w/ Atropine & other anticholinergics * Increasef risk of hypoglycemia w/ insulin, sulfonylureas

•Block release of norepinephrine. •User to decrease BP •Example Reserpine: Reduces the serotonin and catecholamine transmitters. Depletion of these neurotransmitters may lead to severe mental depression *Ask about st. John's wort

Adrenergic Neuron Antagonists

Adrenergic Neuron Antagonists Assessment

* Obtain a Health History. | * Determine what drugs the patient currently takes.

Adrenergic Neuron Antagonists Nursing Diagnosis

* CO * Decreased related to hypotension and bradycardia * Fatigue related to medication adverse effects

Adrenergic Neuron Antagonists Planning

BP lowered

Adrenergic Neuron Antagonists Nursing Interventions

* Monitor vitals and report significant changes especially low BP. * Assist patient with ambulation due to orthostatic hypotension (FALLS!!!!) * Therapeutic effects might not occur for 2-3 weeks after initiation of therapy

Cholinergic receptors

Muscarinic receptors | Nicotinic receptors

Affects smooth muscles, slow heart rate

Muscarinic receptors

Affects skeletal muscles

Nicotinic receptors

Types of cholinergic agonists

Direct acting: acts on receptors to activate tissue response Indirect acting: Inhibits action of enzyme cholinesterase

Effects of Cholinergic Agonists Cardiovascular

Decrease HR, BP, vasodilation, slow conduction of AV node

Effects of Cholinergic Agonists Cardiovascular

Decrease HR, BP, vasodilation, slow conduction of AV node

Effects of Cholinergic Agonists GI

Increase tone, motility, peristalsis, and relax spincter muscles, stimulate urination

Direct-acting cholinergic agonists

Primarily selective to muscarinic receptors

Muscarinic receptors are located:

In smooth muscles.

Direct-Acting Cholinergic Agonists Medications

* Metoclopramide * Pilocarpine * Bethanechol chloride

Metoclopramide is used for:

* Increasing gastric emptying | * Treats gastroparesis, nausea, GERD

Pilocarpine is used for:

Constricting pupils

Bathanechol chloride is used for:

Increasing urination by contracting the bladder

Bethanechol Side effects/adverse reactions

* Blurred vision, miosis * Hypotension bradycardia, sweating * Increased salivation and gastric acid, nausea, vomiting, diarrhea, abdominal cramps * Bronchocomstriction * Cardiac dysrhythmias

Bethanechol Contraindications

* Bradycardia * Hypotension * COPD * Peptic ulcer * Parkinsonism * Hyperthyroidism

Bethanechol Nursing Assessment

* Assess baseline vital signs for future comparisons * Assess urine output (should be >1500 mL/day) * Obtain patient history of health problems such as peptic ulcer, urinary obstruction, or asthma

Bethanechol Nurse Planning

Patient will void more frequently

Bethanechol Nursing Interventions

* Monitor BP and HR * Teach patient to rise slowing to avoid dizziness and orthostatic hypotension * Auscultate breath sounds for rales, crackling from fluid congestion in the lungs. * Monitor the patient for possible cholinergic crisis (overdose), including symptoms of muscular weakness and increases salivation

Indirect-Acting Cholinergic Agonists Functions

* Inhibit cholinesterase enzyme | * Allow ACh to activate muscarinic and nicotinic cholinergic receptors

Indirect Acting Cholinergic Agonists Effects

* Skeletal muscle contraction * Increased tone * Greater GI motility * Bradycardia * Miosis * Bronchial constriction * Promote urination

Indirect acting Cholinergic Agonists Contraindications

Intestinal and urinary obstruction

Reversible Cholinesterase Inhibitors Uses

* Produce pupil constriction in glaucoma | * Increases muscle strength in myasthenia gravis

Reversible Cholinesterase Inhibitors Examples

* Neostigmine * Pyridostigmine * Ambenonium chloride * Edrophonium

Reversible Cholinesterase Inhibitors Side Effects

* Muscle cramps * Bradycardia * Hypotension * Blurred vision * Hypersalivation * Seizures

Cholinesterase Inhibitor used to treat patient with Alzheimer's because these patients have decreased acetocholine.

Donepezil

Irreversible Cholinesterase Inhibitor

* Potent agents due to long-lasting effects * Used to produce pupillary constriction (treatment for glaucoma * Effects can last from days to weeks because there body has to regenerate cholinesterase

Anticholinergics

Inhibit action of ACh by occupying ACh receptors

Cholinergic Antagonists effects of Heart, Lungs, GI

Heart: large doses increase HR; small doses decrease HR Lungs: Bronchodilation, decrease secretions GI: Relax smooth muscle tone, decrease motility and peristalsis, decrease secretions

Cholinergic Antagonists GU, Eye, Glands, CNS

GU: Relax detrusor muscle, increase sphincter constriction Eye: Dilate pupils, decrease accommodation Glands: Decrease salivation and perspiration CNS: Decrease tremors and rigidity of muscles

Atropine (Anticholinergics) Action

* Increase HR | * Decrease GI motility, spasms, peristalsis, salivary and gastric secretions

Atropine Side Effects/adverse reactions

* Tachycardia, photophobia, headache, blurred vision * Abdominal distention, nausea, constipation * Dry mouth and skin, decreased sweating * Urinary retention, impotence * Palpitations, dysrhythmias

What is contraindicated in glaucoma?

Anticholinergics

Atropine Nursing Interventions

* Monitor vital signs, urine output, bowel sounds * Monitor safety, bedside rails, driving motor vehicles * Provide mouth care * Avoid hot environments * Wear sunglasses in bright light

Antiparkinsonism Anticholinergics

Benztropine

Benztropine Side Effects

* Tachycardia, headache * Blurred vision, ocular hypertension * Dry mouth/skin constipation * Urinary retention

Benztropine uses

* Parkinson's disease | * Pseudoparkinsonism

Anticholinergics for motion sickness

* Antihistamine * Scopolamine:treats motion sickness, nausea, vomiting * Transdermal patch delivers dose over 3 days

Anticholinergics for motion sickness Side Effects

* Tachycardoa, hypotension * Dry mouth, constipation * Blurred vision, flushing * Muscle weakness, drowsiness * Urinary retention

Insomnia treatments

Sedative-hypnotics

Sleep stages and length

REM (hard to wake someone up & most dreams) NREM Cycles last around 90 minutes

How many stages are in the NREM

4

Children have long of what sleep stage?

Stage 3 and 4 of NREM sleep and older adults have a decreased of this stage.

Sedatives do what?

Calm or slow brain activity

Hypnotics do what?

Cause sleep •Short acting (help you get to sleep) •Intermediate acting (help to stay asleep) can cause "hangover"

What is the mildest form of CNS depression?

Sedation

OTC sleep aids examples

* Antihistamines (diphenhydramine) | * Tylenol PM

Barbiturates classifications are:

Long acting Intermediate acting Short acting

Barbiturate long acting group includes

Phenobarbital which is used to control seizures in epilepsy

Intermediate acting barbiturates include

Butabarbital which is used as sleep sustainers for maintaining long periods of sleep. They usually take 1 hour for onset

Short acting Barbiturates

Can be used for procedure sedation and vital signs should be monitored closely

Barbiturates are classified as a

Controlled Substance Schedule II for short acting Schedule III for intermediate acting Schedule IV for long acting

Sedative Hypnotic General Side Effects

``` •Residual drowsiness (hangover) •Vivid dreams, nightmares •Drug dependence •Drug tolerance •Excessive Depression Respiratory depression •Hypersenitivity ```

Barbiturates should be restricted to use for how long?

2 weeks

Barbiturate Interactions

* Alcohol, opioids, other sedative-hypnotics | * Decrease effects of oral anticoagulants, glucocorticoids, tricyclic antidepressants, quinidine

Secobarbital sodium is used for

Surgery also.

Pentobarbital can increase

Hepatic enzymes which increases metabolism of other drugs like: •Oral anticoagulants, glucocorticoids, tricyclic antidepressants, and quinidine

Benzodiazepines used as hypnotics are

* Flurazepam * Alprazolam * Temazepam * Triazolam * Estazolam * Quazepam

Benzodiazepines are classified as

Controlled substances Schedule IV

Benzodiazepines are what at low does?

Anxiolytics