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Ch 13
Drugs Affecting the Autonomic Nervous System
63
Nursing
Graduate
04/10/2014

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Cards

Term
3 basic functions of the nervous system
Definition
  • Recognize changes in the internal and external environments
  • Process and integrate the environmental changes that are perceived
  • React to the environmental changes by producing an action or response
Term
Central Nervous System (CNS)
Definition
  • Includes: Brain & spinal cord
Term
Peripheral Nervous System (PNS)
Definition
  • Transmits signals b/t CNS and rest of body
  • All nervous tissue outside of CNS
  • Sensory & motor neurons
  • Somatic NS: voluntary control over skeletal muscle
  • Autonomic NS (ANS): Involuntary contorl of smooth & cardiac muscle, digestion, glandular secretions
Term
Divisions of ANS
Definition
  • Sympathetic: activated under stress, "fight or flight" "bear in the woods"
  • Parasympathetic: Activated under nonstressful conditions, "rest and digest"
  • ANS= sympathetic +parasympathetic
Term
Sympathetic NS stimulation effects
Definition
  • Pupils: Dilate
  • Tear glands: No effect
  • Salivary stimulation: Inhibited
  • Heart rate: Increases
  • Arterioles: Constrict
  • Bronchi: Dilation
  • GI motility: Inhibited 
  • Pancreas: Inhibited
  • Bladder: Relaxes
  • Erection/Ejaculation: Stimulates ejaculation
Term
Parasympathetic NS stimulation effects
Definition
  • Pupils: constrict
  • Tear glands: stimulated
  • Salivary stimulation: stimulated
  • Heart Rate: Decreases
  • Arterioles: Dilate
  • Bronchi: Constrict
  • GI motility: stimulated
  • Pancreas: Stimulated
  • Erection/Ejaculation: Stimulates erection
Term
Sympathetic/Parasympathetic Physiology
Definition
  • Two neuron chain: Presynaptic nerve in CNS (preganglionic)-->synapes postsynaptic nerve of PNS (postganglionic)-->connets to organ or tissue
  • Connection happens outside CNS at ganglion (ganglionic synapse)

 

Term
Neurotransmitters (NT) of the ANS
Definition
  • Sympathetic NS: Catecholamines- Norepinephrine (NE), Epinephrine (Epi) & Dopamine (DA)
  • Parasympathetic NS: Acetylcholine (Ach)
Term
Key pharmacologic implications related to NTs
Definition

There are drugs to:

Increase NT release

Decreses NT degredation

Act as receptor agonist or antagonist 

Term
Adrenergic nerves
Definition
  • Release catecholamines
  • Postganglionic in the sympathetic NS
Term
Cholinergic nerves
Definition
  • Release Acetylcholine
  • All preganglionic nerves (remember these are CNS)
  • Postgangilonic nerves of the parasympathetic NS
Term
Anatomy and receptor types
Definition
  • Sympathetic:
  • nerves originate in the thoracic & lumbar spine
  • alpha1, alpha2, beta1, beta2 receptors
  • Parasympathetic:
  • nerves originate in cranial and sacral spine
  • nicotinic and muscarinic receptors
Term
Alpha1 receptor stimulation effects
Definition
  • Vasoconstriction
  • Pupil dialtion
  • Decreased secretions
  • Decreased GI motility

 

 

Term
Alpha1 receptor select agonist action and uses
Definition
  • Smooth muscle contraction
  • Mydriasis during eye exams 
  • Treatmen of nasal congetesion and hypotenstion
Term
Alpha2 receptor stimulation effects
Definition
  • Decreased CNS sympathetic outflow 
  • Decreases NE release
  • Decreases insulin release
Term
Alpha2 receptor select agonist action and uses
Definition
  • Smooth muscle contraction & NT inhibition
  • Treatment of hypertension (activation of recpetors reduces NE release)
Term
Beta1 receptors stimulation effects
Definition
  • Increases heart rate
  • Increases CO
  • Increases SV
  • Increases cardiac automaticity
  • Increases cardiac contractility
  • Increases renin secretion

 

 

Term
Beta1 receptor select agonist action and uses
Definition
  • Heart muscle contraction
  • Treatment of cardiac arrest, heart failure, shock
Term
Beta2 receptor stimulation effects
Definition
  • Bronchial relaxation
  • Uterine relaxation
  • Vasodilation to skeletal muscle vessels
Term
Beta2 receptor seletct agonist action and uses
Definition
  • Smooth muscle relaxation
  • Treatment of asthma & premature labor contractions
Term
albuterol (Proventil; Ventolin)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • b2 receptors
  • Tx asthma
Term
isoproterenol (Isuprel)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • b1 (increase HR, increase contractility)
  • b2 (vasodilation, bronchodilation) 
  • Tx of: astham, dsyrhythmia, heart failure
Term
salmeterol (Serevent)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • b2 
  • Tx of asthma
Term
terbutaline (Brethine)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • b2
  • Tx of asthma, rapid uterine contactions (slows them)
Term
epinephrine (Adrenaline)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • a & b receptors
  • Tx of cardiac arrest (increases HR), anaphylaxis (bronchodilation
Term
dobutamine (Dobutrex)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • b1
  • Tx of heart failure (cardiac stimulant)
Term
clonidine (Catapres)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • a2 in CNS
  • Tx of hypertension
Term
oxymetazoline (Afrin)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • Tx of nasal congestion
Term
pseudoephedrine (Sudafed)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • a>b
  • Tx of nasal congetion
Term
dopamine (Intropin)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • a1 & b1
  • Tx of shock
Term
norepinephrine (Levophed)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • a>b1
  • Tx of shock (vasoconstriction & HR increase)
  •  
Term
phenylephrine (Neo-Synephrine)
Definition
  • Adreneric agent/ adrenergic agonist/ sympathomimetic
  • a1, a2
  • Tx of shock (vasoconstriction; causes reflex tachycardia), nasal decongestion
Term
atenolol (Tenormin)
Definition
  • Adrenergic blocking agent/adrenergic antagonist/ sympatholytic
  • b1 specific
  • Tx of angina, hypertension
Term
timolol (Timoptic)
Definition
  • Adrenergic blocking agent/adrenergic antagonist/ sympatholytic
  • blocks b1 & b2
  • Tx of angina, glaucoma (decreases intraocular pressure), hypertension
Term
prazosin (Minipress)
Definition
  • Adrenergic blocking agent/adrenergic antagonist/ sympatholytic
  • blocks a1
  • Tx of BPH, hypertension


Term
tamsulosin (Flomax)
Definition
  • Adrenergic blocking agent/adrenergic antagonist/ sympatholytic
  • blocks a1
  • Tx of BPH
Term
esmolol (Brevibloc)
Definition
  • Adrenergic blocking agent/adrenergic antagonist/ sympatholytic
  • b1 specific
  • Tx of tachyarrhythmias, hypertension


Term
propranolol (Inderal)
Definition
  • Adrenergic blocking agent/adrenergic antagonist/ sympatholytic
  • Blocks b1 & b2
  • Tx of dysrhythmias (decreases HR), HF, HTN
Term
metoprolol (Lopressor)
Definition
  • Adrenergic blocking agent/adrenergic antagonist/ sympatholytic
  • b1 specific
  • Tx of hypertension
Term
Nicotinic receptors
Definition
  • Located at the ganglionic synapse of both sympathetic and parasympathetic 
  • Stimulated by Ach
Term
Muscarinic receptors
Definition
  • Located on organs for parasympathetic stimulation
  • Stimulated by Ach
Term
Acetylcholinesterase (AchE)
Definition
  • Enzyme
  • Metabolizes Ach in the synaptic cleft into choline & acetate for reuptake into presynaptic nerve terminals
Term
Parasympathetic effects are alos known as
Definition
Cholinergic effects
Term
2 ways that drugs can mimic the parasympathetic NS
Definition
  • Directly binding (direct-acting) to acetylcholine receptors
  • Inhibiting AchE
Term
Clinical effects of muscarinic stimulation
Definition
  • Decrease HR
  • Increase GI motility
  • Increase urination
  • Increase sweating
  • Increase salivation
  • Increase nasal secretions
  • Increase bronchial secretions
  • Increase bronchoconstriction
  • Miosis
Term
pilocarpine (Isopto Carpine)
Definition
  • Direct-acting muscarinic agonist/ parasympathomimemtic
  • Tx of glaucoma
Term
bethanechol (Urecholine)
Definition
  • Direct-acting muscarinic agonist/ parasympathomimetic
  • Tx of urinary retention
Term
donepezil (Aricept)
Definition
  • Cholinesterase inhibitor
  • Tx of Alzheimer's
Term
glantamine (Razadyne)
Definition
  • Cholinesterase inhibitor
  • Tx of Alzheimer's 
Term
physostigmine (Antrilium)
Definition
  • Cholinesterase inhibitor
  • Tx of anticholinergic overdose (revereses anticholinergic effects, not found to be safe and effective)
Term
edrophonium (Tensilon)
Definition
  • Cholinesterase inhibitor
  • Use of diagnosis of myasthenia gravis
Term
pyridostigmine (Mestinon)
Definition
  • Cholinesterase inhibitor
  • Tx of myasthenia gravis
Term

Cholinergic Blocker/Anticholinergic/Muscarinic Antagonist

Clincial effects

Definition
  • Increase HR
  • Decrease GI motility (IBS)
  • Decrease gastric acid secretion (peptic ulcer disease)
  • Decrease urination (incontinence)
  • Decrease sweating
  • Decrease salivation (anesthesia)
  • Decrease nasal secretions
  • Decrease bronchial secretions (anesthesia)
  • Decrease broncoconstriction aka bronchodilation
  • Mydriasis
Term
Saying to describe anticholinergic symptoms
Definition

Blind as a bat, dry as a bone, red as a beet, mad as a hatter, and hot as a hare

Term
ipratropium bromide (Atrovent)
Definition
  • Cholinergic blocker/ anticholinergic/ muscarinic antagonist
  • dilates bronchi
  • Tx of COPD
Term
atropine
Definition
  • Cholinergic blocker/ anticholinergic/ muscarinic antagonist
  • Tx of bradycardia, urinary incontnence, diarrhea; used to decrease secretions during anesthesia
Term
dicyclomine (Bentyl)
Definition
  • Cholinergic blocker/ anticholinergic/ muscarinic antagonist
  • Tx of IBS
Term
propantheline (Pro-Banthine)
Definition
  • Cholinergic blocker/ anticholinergic/ muscarinic antagonist
  • Tx of IBS, urinary incontinence, neurogenic bladder
Term
scopolamine (Transderm-Scop)
Definition
  • Cholinergic blocker/ anticholinergic/ muscarinic antagonist
  • Tx of motion sickness
Term
benztropine (cogentin)
Definition
  • Cholinergic blocker/ anticholinergic/ muscarinic antagonist
  • Tx of Parkinson's 
Term
trihexyphenidyl (Artane)
Definition
  • Cholinergic blocker/ anticholinergic/ muscarinic antagonist
  • Tx of Parkinson's
Term
Alpha1 blockers end in
Definition

-zosin

-osin

Term
Beta blockers end in
Definition
-olol
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