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pnm- pharm > week 4-Autonomic Nervous System > Flashcards

week 4-Autonomic Nervous System Flashcards

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1
Q

SNS-sympathetic

A

Neurotransmitters are epinephrine, norepinephrine and dopamine

Receptors are alpha 1 and alpha 2, beta 1 and beta 2, and dopaminergic receptors

Fight of flight

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2
Q

PSNS-parasympathetic

A

Neurotransmitter is acetylcholine (Ach)

Receptors are centrally located nicotinic and peripherally located muscarinic

Rest and digest

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3
Q

sns + psns =

A

ans

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4
Q

adrenergics

A

large group of both exogenous (synthetic) and endogenous (naturally occurring) substances.

they also stim the SNS

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5
Q

catecholamines

A

substances that can produce a sympathic response

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6
Q

Adrenergic Agents: Definition

A

Drugs that stimulate the sympathetic nervous system (SNS)
Referred to as “fight or flight response”
Also known as:
 Adrenergic agonists
 Sympathomimetics

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7
Q

Catecholamines

A

Mimic the effects of the SNS neurotransmitters:
 norepinephrine (NE)
 epinephrine (EPI)
 dopamine

Direct-Acting: Designed to stimulate & act like a neurotransmitter (bind to receptor sites and creates a response)
 Non catecholamine adrenergic drugs
 ie. Phenylephrine, salbutamol

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8
Q

Adrenergic receptors (receptor sites for catecholamine norepi and epi)

A

are located throughout the body where adrenergic drugs bind and produce the desired effect.

Are receptors for the sympathetic neurotransmitters

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9
Q

Adrenergic receptors are divided into two

A

–alpha-adrenergic and beta adrenergic receptors

Subdivided into alpha 1 & 2 and beta 1 & 2

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10
Q

Alpha-adrenergic receptors:

A

respond to NE

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11
Q

Beta-adrenergic receptors:

A

respond to EPI***

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12
Q

Dopaminergic receptors:

A

respond to dopamine

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13
Q

Alpha 1 located on post synaptic effector cells

A

(on the muscle or organ that the nerve stimulates)

located on post synaptic effector cells

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14
Q

Alpha 2 located

A

on pre- and post-synaptic nerve terminal (sympatholytic effects)

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15
Q

Predominant Alpha-Adrenergic Agonist Responses

A

Vasoconstriction

CNS stimulation

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16
Q

Beta-Adrenergic Receptors are located

A

on postsynaptic effector cells

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17
Q

Beta1-adrenergic receptors —

A

located primarily in the heart resulting in cardiac stimulation

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18
Q

Beta2-adrenergic receptors —

A

located in smooth muscle of the bronchioles, arterioles, and visceral organs resulting in bronchial, GI and uterine smooth muscle relaxation (dilation)

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19
Q

Dopaminergic Receptors

A

An additional adrenergic receptor
Stimulated by dopamine

Causes dilation of the following blood vessels, resulting in increased blood flow
	Renal
	Mesenteric
	Coronary
	Cerebral
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20
Q

Indirect-acting sympathomimetic

A

Causes the release of catecholamine from the storage sites (vesicles) in the nerve endings
The catecholamine then binds to the receptors and causes a physiological response

ie. amphetamines

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21
Q

Mixed-acting sympathomimetic

A

Mixed-acting sympathomimetic

Directly stimulates the receptor by binding to it
and
Indirectly stimulates the receptor by causing the release of stored neurotransmitters from the vesicles in the nerve endings

ie. ephedrine

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22
Q

Responses to Stimulation

A

Location/ Receptor/ Response

Cardiovascular:
Blood vessels- alpha1 and beta2 / Constriction/dilation
Cardiac muscle/ beta1 / Increased contractility
AV Node beta1 / Increased / heart rate
SA Node beta1 / Increased / heart rate

Gastrointestinal:
Muscle/beta2 / Decreased motility
Sphincters/ alpha1 / Constriction

Genitourinary:
Bladder / alpha1 / Constrictionsphincter
Penis/ alpha1/ Ejaculation
Uterus / alpha1 and beta2 / Contraction/relaxation
Bronchial / beta2 / Dilation/relaxationmuscles

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23
Q

Alpha Adrenergic Drug Effects

A

Stimulation of alpha-adrenergic receptors on smooth muscles results in:
 Vasoconstriction of blood vessels (used to increase BP)
 Relaxation of GI smooth muscles
 Contraction of the uterus and bladder
 Male ejaculation
 Decreased insulin release
 Contraction of the ciliary muscles of the eye
(dilated pupils)

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24
Q

Adrenergic drugs

A

drugs stay in the synaptic cleft where they induce a response

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25
Direct Acting – (Adrenergic drugs)
bind directly to the receptor ie epinephrine Used for glaucoma, shock due to trauma Do not use in toes, finger or nose due to the vasoconstriction effects
26
Isoporternol—beta 1 & beta 2 sympathomimetics
Anti-asthmatic agent Used to treat hypotension Increases stroke volume & 02 consumption to the myocardium Used for atropine, dopamine resistant bradycardia & or hypotension
27
Alpha 1 agonists: decongestants
Phenylephrine Pseudoephedrine Tetrahydrozoline
28
Alpha 2 agonists: antihypertensives, rehabilitation/ withdrawal
``` Clonidine Methyldopa (safe to use during pregnancy) ```
29
Indications (BETA 2)
-Bronchodilators: treatment of asthma and bronchitis  Agents that stimulate beta2-adrenergic receptors of bronchial smooth muscles, causing relaxation  Used for allergic reactions causing bronchoconstricton, viral or bacterial infections leading to bronchitis, pneumonia and wheeze  ie.Salbutamol(Ventolin), Salmeterol (Advair) -Reduction of intraocular pressure (IOP), mydriasis -pupil dilation and fluid regulation: -Treatment of open-angle glaucoma Cause mydriasis ie. phenylephrine -Temporary relief of conjunctival congestion by constricting the arteries which reduces the redness in the eye ``` -Decongestant Alpha-adrenergic receptors Examples: – epinephrine – phenylephrine – tetrahydrozoline (Visine) ``` -Nasal decongestant Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion Vasoconstriction of nasal mucosa causes shrinkage of the mucosa, decreased secretion and reduced blood flow to the engorged sites Abuse of nasal decongestants can cause rebound nasal congestion where the patient does not respond after chronic use - epinephrine
30
Tetrahydrozoline (Murine, visine)—
temporary relief of congestion, itchiness, minor irritation & redness Can be used for diagnostic procedures to dilate the pupils
31
Vasoactive Sympathomimetics (Pressors, Inotropes)
• Also called cardioselective sympathomimetics (Very potent vasoconstrictors)  Used to support the heart during cardiac failure or shock (↑BP)  Various alpha- and beta-receptors affected  ie. epinephrine, norepinephrine, dopamine
32
Pseudoephedrine (sudafed) & ephedrine
Stimulates both alpha & beta adrenergic receptors –large doses can elevate both blood pressure & heart rate Acts as decongestant by stimulating alpha adrenergic receptors of vascular smooth muscles—constricting dilated arterioles within the nasal mucosa & reducing blood to the engorged area.
33
Epinephrine
``` Indications: Anaphylaxis Shock/severe hypotension Part of infiltration anaesthesia Status asthmaticus Cardiac arrest ```
34
Side Effects: Alpha-Adrenergic
CNS  Headache, restlessness, excitement, insomnia, euphoria Cardiovascular  Palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension Other  Anorexia, dry mouth, nausea, vomiting, taste changes (rare)
35
Alpha side effects
Headache, restlessness, excitement, CNS stimulation, euphoria, tachycardia, hypertension, palpitations, decreased appetite
36
beta side effects
CNS stimulation, tremors, nervousness, dizziness, headaches, palpitations, tachycardia, hypertension, arrhythmias, GI distress
37
Side Effects: Beta-Adrenergic
 CNS Mild tremors, headache, nervousness, dizziness  Cardiovascular Increased heart rate, palpitations (dysrhythmias), fluctuations in BP  Other Sweating, nausea, vomiting, muscle cramps
38
Do not administer similar drugs together
can cause severe hypertension, tachycardia, chest pain, palpitations with arrhythmias
39
Need to wait at least 4hrs between medications
/
40
Always administer IV drug through a pump,
never by gravity
41
Asthma – (nursing considerations)
bronchodilator & steroid—first bronchodilator to open bronchioles and steroids would be more effective. Wait 5mins between meds Inhalation isoproterenol can cause pink sputum due to medication—do not confuse with blood
42
Epinephrine (Adrenalin) | nursing considerations
should not be used in toes or fingers due to the potent vasoconstriction effects
43
Albuterol (Ventolin)
is indicated for the management of acute asthma symptoms
44
Overuse of nasal decongestants may cause
rebound nasal congestion or ulcerations
45
Administering two adrenergic agents together | may precipitate
severe cardiovascular effects such | as tachycardia or hypertension crisis
46
ANS=
SNS +PSNS
47
SPECFICI TARGERT RECEPTORS FOR CATECHOLAMINES EPI AND NOREPI ARE CALLED
ADRERGIC RECEPTORS.
48
TWO MAIN GROUPS OF ADRENERGIC RECEPTORS
A-DRENERGIC AND B-
49
A1-ADRENERGIC RECEPTORS ARE LOCATED ON
POSTSYNAPTIC EFFECTOR CELLS
50
A2-ADRENERGIC RECEPTORS ARE LOCATED ON
PRESYNAPTIC NERVE TERMINALS THEY CONTROL THE RELEASE OF NEUROTRANSIMITTERS
51
B1 ADRENERGIC RECEPTORS
IN THE HEART (B1, 1 HEART)
52
B2 ADRENERGIC RECPETIORS
IN THE LUNGS (2 LUNGS) | AND SMOOTH MUSCLE!!
53
THE PREDOMINATE A-ADRENERGIC AGONIST EFFECT IS
VASOCONSTRICTION AND CENTRAL NERVOUS SYSTEM STIMULATION
54
THE PREDOMINATE B-ADRENERGIC AGNOIST RESPONSE RESULTS IN
BRONCHIAL, GI, AND UTERINE SMOOTH MUSCLE RELAXATION ALSO HEART STIMULATION
55
DOPAMINERGIC RECEPTOR
WHEN STIMULATED BY DOPAMINE, VASODIALTION
56
ADRENERGICS
MIMIC THE EFFECTS OF NOREPI, EPI, AND DOPAMINE
57
CATECHOLAMINE DRUGS USED THERAPEUTICALLY PRODUCE THE SAME RESULT AS THE
ENDOGENOUS (NATURAL) EFFECTS.
58
B1-ADRENERGIC RECEPTORS HAVE THREE EFFECTS WHEN STIMUALTED
1. INCREASED FORCE OF CONTRACTION 2. INCREASE IN HEART RATE 3. NERVE CONDUCTION
59
B2- ADRENERGIC RECEPTORS PRODUCES
RELAXATION OF THE BRONCHI AND GLYCOGENOYSIS AND INCREASE RENIN SECRETION.
60
B2 IS MOST COMMON FOR
ASTHMA AND BRONCHITIS
61
PRESSOR DRUGS
USED TO SUPPORT THE CARDIOVASCULAR SYSTEM DURING SHOCK OR HEART FAILURE.
62
MIDODRIN USE
REQUIRES CAREFUL BP MONITORING
63
3. Stimulation of beta adrenergic receptors in the heart results in (3 THINGS)
1. *INTROPIC______(increased force of contraction), 2.*CHRONOTROPIC AGENTS_________(increased heart rate) 3. *DROMOTROPIC AGENTS_____(increased conduction through the AV node)
64
6. Alpha blockers cause both
1. ARTERY and 2. VEINS dilation which reduces 1. BLOOD RESISTANCE and 2. DECREASE BP

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