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36 Cards in this Set

  • Front
  • Back
What are afferent nerves?
CNS receives signals from sensory receptors (vision, pressure, pain, cold, warmth, touch, smell) throughout the body that are transmitted to the spinal cord and brain by way of *afferent nerves*.
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What are efferent nerves?
The CNS processes signals & controls body response by sending signals through *efferent nerves*, which leaves the CNS to carry impulses to other parts of body.
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Divisions of efferent system?
1. Motor nervous system = skeletal muscle contractions

2. Autonomic nervous system = regulate body functions like HR, BP, temp, light regulation by eyes, etc...
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Name the most common neurotransmitters
Acetylcholine (ACh)
Dopamine
Serotonin
Norepinephrine
Epinephrine
GABA
Glutamate
Glycine
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Regulates pain
Substance P, enkephalins, endorphins
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Two major NTs of the ANS?
ACh & NE
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Nerve endings that secrete Ach?
cholinergic fibers
(Parasympathetic nervous system)
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Nerve endings that secrete NE (norepinephrine)?
adrenergic fibers
(Sympathetic nervous system)
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Drugs that mimic Ach?
Drugs that block or inhibit Ach?
cholinergic drugs
Anticholinergic agents
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Drugs that mimic NE?
Drugs that block or inhibit NE?
Adrenergic drugs &
Adrenergic-blocking agents
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The 3 catecholamines are synthesized in this order: _____, _____, _____
Dopamine, Norepinephrine, Epinephrine
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Name the ANS receptors.
Alpha (1, 2), Beta (1, 2), dopaminergic
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In general, stimulation of alpha-1 receptors...
vasoconstriction of blood vessels
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In general, alpha-2 receptors...
prevent further release of NE thru negative feedback
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In general, beta-1 receptors...
Increase in HR
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In general, beta-2 receptors...
Cause relaxation of smooth muscle in the bronchi (bronchodilation), uterus (relaxation), and peripheral arterial blood vessels (vasodilation)
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In general, dopaminergic receptors...
Improve sx of Parkinson's disease and increase urine OP r/t stimulation of receptors in kidneys that result in better renal perfusion.
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Nursing process for adrenergic agents
ASSESSMENT:
1. Baseline vitals (HR & BP)
2. Other premed assessments (drug specific)

EVALUATE:
Adverse effects are usually dose related.
Watch for pts who are more at risk.
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Patients potentially more sensitive to adrenergic agents....
Impaired hepatic function,
thyroid disease,
HTN,
heart disease
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BBs should be used with extreme caution in which pts?
--respiratory conditions (bronchitis, emphysema, asthma or allergic rhinitis)

-- DM and pts susceptible to hypoglycemia. All BBs mask most of the s/sx of acute hypoglycemia.
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Serious adverse effects of adrenergic agents & what do you do?
CV: dysrythmias, chest pain, severe HTN/hypotension, anginal pain.
GI: N/V

Nursing: DC meds, call MD, ask if any change in scrip or herbal meds
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SEs to expect from adrenergic agents
Palpitations, tachycardia, skin flushing, dizziness, tremors --> These are usually mild and tend to resolve. Encourage pt to continue on med and not D/C without consulting MD.

orthostatic hypotension --> Monitor BP qd in supine and standing. Anticipate development of postural HTN and take measures to prevent. Teach pt to rise slowly from supine to sitting. Sit or lie down if feeling faint.
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Non-selective beta-blockers.
Define and list.
Non-selective BBs have equal affinity for beta-1 (heart) and beta-2 (bronchi) receptors and inhibit both.
Propanolol
Nadolol
Pindolol
Penbutolol
Carteolol
Sotalol
Timolol
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Selective Beta-blockers.
Define and list.
Block beta-1 receptors (cardioselective), not beta-2 receptors of the bronchi.
Esmolol
Metoprolol
Acebutolol
Betaxolol
Bisoprolol
Atenolol
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What pts would benefit from selective BBs?
Asthma pts becasue nonselective BBs may induce bronchospasm.
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What do we use BBs for?
HTN,
angina pectoris,
cardiac arrhythmias,
sxs of hyperthyroidism,
"stage fright"
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What are alpha-blockers used for?
diseases associated with vasoconstriction. EX: Raynaud's disease and Buerger's disease.
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Define catecholamine.
*"Fight-or-flight" hormones (DA, NE, E) released by the adrenal glands in response to stress.
*Part of the sympathetic nervous system.
* They are derived from the amino acid tyrosine.
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Cholinergic actions in body include...
- slowing of the heart, sometimes decrease in BP,
- increased GI motility,
- increased contractions of urinary bladder, with relaxation of muscle sphincter,
- increased secretions & contractility of bronchial smooth muscle,
- sweating,
- miosis of the eye, which reduces intraocular pressure,
- increased force of skeletal muscle
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Nursing evaluation (SEs) for cholinergic agents...
Expect: N/V, diarrhea, abdom cramping --> dose related
dizziness & hypotension --> monitor BP and pulse. Teach to rise slowly and also perform exercises to reduce blood pooling
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In general, anticholinergic agents do these things in body.
* mydriasis of the pupil with increased intraocular pressure ,
* dry, tenacious secretions of the mouth, nose, throat and bronchi,
* dec. secretions & motility of the GI tract,
* inc. HR
* dec. sweating
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Uses of anticholinergic agents
* GI and ophthalmic DOs
* bradycardia
* Parkinson's disease
* genitourinary DOs

Also, pre-op drying agent and to prevent vagal stimulation from skeletal muscle relaxants or placement of an endotracheal tube (maintain patent airway)
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Premedication assessment for anticholinergic agents
1. Screen for closed-angle glaucoma b/c anticholinergic agents may precipitate an acute attack.
2. Ck for hx of enlarged prostate. If present, anticholinergic agents may cause temporary inability to void.
3. Baseline vitals
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Common adverse effects of anticholinergic agents & nursing action.
Sensory: Blurred vision
--- Teach pt blurred vision may occur and make appropriate suggestions for safety.
GI: Constipation, dryness of mucosa in mouth/nose/throat
--- Suck hard candy, ice chips, chew gum. Give stool softeners as prescribed. Encourage fluid intake and foods that provide sufficient bulk.
GU: Urinary retention.
--- Assess for bladder distention. Contact HCP for further eval.
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Serious adverse effects of anticholinergic agents and nrsg action.
Sensory: Glaucoma
--- Screen all pts for *closed*-angle glaucoma. OK for open-angle. Monitor intraocular pressures.
Psych: Confusion, depression, nightmares, hallucinations.
--- Baseline psych assessment before therapy. Regular subsequent evals and report changes.
CV: Orthostatic hypotension
--- Monitor BP in both supine & standing. Anticipate development and take measures to prevent. TEACH.
--- Contact HCP if palpitations & dysrhythmias.
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What is the difference between: Direct-acting adrenergic drugs -and- Indirect-acting adrenergic drugs?
Direct-acting adrenergics act directly on adrenergic receptors. (EX: dobutamine, which acts of B1 receptors)

Indirect-acting adrenergics increase the activity of endogenous adrenergics by enhancing their release or inhibiting their reuptake.