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231 Cards in this Set
- Front
- Back
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ANS regulates _______ fuctions
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involuntary
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the CNS is made up of _______ and _______
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brain and spinal cord
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the PNS are _______ leaving the _______ _______
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nerves leaving the spinal cord
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PNS controls the _______ and _______
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somatic and ANS
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the ANS is divided into two subcatagories calle d_______ and _______
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sympathetic and parasympathetic
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the three sites of action of neuropharmacological agent are a_______ c_______, s_______ t_______, and _______
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axonal conduction, synaptic transmission and receptors
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5 steps to the mechanism of neuropharm agents: TTTRT
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transmitter synth
transmitter storage transmitter release receptor biding termination of transmission |
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triple R of ANS function
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Regulate,
1. heart 2. secretory glands 3. smooth muscle |
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two sub categories of ANS
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sympathetic (adrenergic)
parasympathetic (cholinergic) |
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3 neurotransmitters of CNS
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gaba
dope sero |
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GABA is an _______ transmitter. and is very/not very prevalent. it is found in the CNS/PNS
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inhibitory
very CNS |
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dope is an a_______ neurotransmitter.
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adrenergic
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dope does/doesnt respond to epi and or norepi
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doesnt
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dope transmitters only activate _______ receptors
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dope
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dope is a CNS/PNS neurotransmitter
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CNS
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serotonin is a CNS/PNS neurotransmitter
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CNS
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serotonin inhibits _______ via pathways in the _______ _______
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pain
spinal cord |
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serotonin also effects _______ and _______
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sleep and mood
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5 neurotransmitters of the PNS are
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ACh
EPI NE dope dobutamine |
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EPI and NE are _______amines
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catacholamines
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PNS controls these 6 functions
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decrease HR
^ gastric secretion empty of bowel bladder focus eye for near vision constrict pupil contract bronchial |
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the man was sitting so his HR was down. as he walked, the sandwhich in his stomach digested and he realized he had to pee and have a bowel movement. he got to the toilet and his eyes constricted to see the close object better. while on the toilet he became out of breath from straining so hard
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PNS
decrease HR ^ gastric secrereation empty of b/b focus eye for near vision constrict pupil contract bronchial smooth muscle |
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SNS does 3 major things. RRF
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regulate CV
regulate temp fight/flight |
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the SNS controls the CV by _______ bloodflow like during excersize to the brain and is active when we loose a lot of _______
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increasing
blood |
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NE is a major neurotransmitter in the _______
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CNS
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NE is classifed as a c_______ and a_______ agonist
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catecholamine
adrenergic |
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NE is secreted by the _______ stem, h_______ neurons, and by most _______ ganglionic neurons of SNS
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brain
hypothalamus post |
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NE is _______ degraded. rather it is reabsorbed by _______
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not
MAO |
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EPI's half life is _______
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unknown
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EPI is made by the _______ medulla
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adrenal
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dope functions as an _______ transmitter in the _______
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inhibitory
periphery |
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a deficiency of dope in the brain can cause _______
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parkinsons
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ACh is produced by the _______ganglionic fibers
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pre
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ACh is _______down at the receptor bye _______
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broken
acetylcholinesterase |
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SNS stimulation causes the hear to change. how so?
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increased rate, force of contraction and conduction velocity
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SNS stimulation _______ the bronchi
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dialates
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SNS stimulation of the alpha 1 receptors _______ the blood vessels
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constricts
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SNS stimulation of the beta 2 receptors _______ the blood vessels
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dilates
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SNS stimulation causes the kidneys to r_______ r_______
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release renin
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SNS stimulation causes the pupils to _______
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dilate. remember fight or flight, you have to be able to see a lot to fight (or flight) well!
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stimulation of PNS _______ the bronchi
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constricts. rmemeber you dont have to breath as hard when you're resting and digesting
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stimulation of PSN _______ the pupils
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constricts. remember you dont have to see as far or as much when you're not fighting fools.
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blood vessels are innervated by _______ only
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SNS
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SNS and PNS innervate _______ except the blood vessels
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EVERYTHING!!! Ahhhhh!!
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adrenergic receptors are _______1,2 and _______1,2
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alpha
beta |
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EPI affects _______ receptors
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all
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NE has ______ or ______effect on beta 2 receptors
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limited or no
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ACh works on ______ gaps only
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presynaptic
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alpha 1 receptor functions are: dilate ______, constrict ______ and ______, promote ______, contract ______ ______ and ______ ______
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dilate pupils
constrict arterioles and veins promote ejaculation contract bladder neck and prostatic capsule |
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alpha 2 works on ______ ______ to ______ neurotransmitter release. there is ______ clinical usefulness
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presynaptic terminals
inhibit limited |
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beta 1 receptors increase ______, force of ______ and veleocity ______ ______ ______
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heart rate
contractions through the av node |
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in the kidney, beta 2 activation dilates ______, ______; uterine ______; ______ glycogenolysis
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bronchi
arterioles relaxation increased |
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ACh is secreted by ______ ______
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pyramidal cells
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ACh is a ______transmitter
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neuro
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ACh is secreted by pyramidal cells of these structures: MC, BGN, SMG, PPG, NPNS, PNSNS
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motor cortx
basal ganglial neurons skeletal muscle ganglia pre/post ganglionic neurons of PNS preganglionic neurons of SNS |
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ACh binds to these receptors: NNM
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nicotinic N, M
muscarinic these are all locaed on postjunctional cells |
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ACh is stored in ______
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vesicles
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ACh is degraded into ______ and ______ by ______
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acetate
choline acetylcholinesterase |
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botulinum, the bacteria, can interfere with ACh ______
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release
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SLIDE 33
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SLIDE 33
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PNS
_______hr _______resp _______bronchi |
decrease
decrease constrict |
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PNS
_______pupils _______GI secretions/motility |
constrict
increase |
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ACh is the a_______ e_______ of c_______
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aetyle
ester choline |
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synthesis of ACh involved _______
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acetate
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Margaret Floy Washburn
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1st Female PhD in Psychology
Became 2nd female president of APA in 1921. Only allowed as a guest student, later received Doctorate from Cornell in 1894. Wrote influential book "Animal Mind", published in 1908 |
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once in the nerve the choline binds with _______ to form _______
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Acetyl Co A
acetylcholine |
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acetylcholine is stored in the _______
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vessicles
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an a_______ p_______ will stimulate the release of ACh into the _______
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action potential
synapse |
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acetylcholine is inactivated by _______
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acetylcholinesterase AChE
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What kind of receptor is Nicotinic N?
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cholernergic
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Nicotinic N receptors act on A_______ g_______ and a_______ m_______
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ANS ganglia
adrenal medulla |
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what kind of receptors are nicotinic M?
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cholinergic
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nicotinic m act on the n_______
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neuroMUSCULAR
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muscarinic receptors act on the p_______ target organs
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parasympathetic
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nicotinic N are found in the a______ m______ and in the A______ g______
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adrenal medulla
ANS ganglia |
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these receptors when stimulated cause release of NE
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Nicotinic N
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nicotinic M are present at the n______ junction
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neuromuscular junction
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these receptors are responsible for contraction of skeletal muscle
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nicotinic M
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muscarinic stimulation effects 5 body systesm
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eyes
heart lungs bladder GI |
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activating muscarinic receptors will ______ pupils
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constrict
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muscarinic receptors, when activated would cause a patients ______ ______ to increase and v______ d______
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heart rate
vaso dilate |
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muscarinic stimulation will cause your ______ to constrict and produce more secretions
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bronchials
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relaxation of the ______ is caused by stimulation of muscarinic receptors. race horses love this!
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bladder
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if you're patient's muscarinic receptors are activated a lot will happen to his bowels. name 5
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increase gastric secreations
increase glandular secretions increase GI tone increase bowel movements increase salivation HURRY get the bed pan!! |
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what class is of drugs is bethanechol in?
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muscarinic agonists
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these receptors when stimulated cause release of NE
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Nicotinic N
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nicotinic M are present at the n______ junction
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neuromuscular junction
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these receptors are responsible for contraction of skeletal muscle
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nicotinic M
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muscarinic stimulation effects 5 body systesm
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eyes
heart lungs bladder GI |
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activating muscarinic receptors will ______ pupils
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constrict
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muscarinic receptors, when activated would cause a patients ______ ______ to increase and v______ d______
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heart rate
vaso dilate |
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muscarinic stimulation will cause your ______ to constrict and produce more secretions
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bronchials
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relaxation of the ______ is caused by stimulation of muscarinic receptors. race horses love this!
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bladder
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if you're patient's muscarinic receptors are activated a lot will happen to his bowels. name 5
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increase gastric secreations
increase glandular secretions increase GI tone increase bowel movements increase salivation HURRY get the bed pan!! |
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what class is of drugs is bethanechol in?
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muscarinic agonists
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pharmacological functions of bethanechol are...
hint (8 of them!!) hint 2 (did bill put guns inside cabinets saturday pm?) |
decrease heart rate
bronchial constriction pulmonary secretion increase gastric secretions increased intestinal tone and motility increase contract bladder smoothe muscle relaxation pupils constrict |
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your patient is perscribed bethanechol IV BID x 7days. what should you call the MD about?
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the route. this drug is only given PO
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your patient has CHF, Afib, renal failure, and a history of red man syndrome. he is perscribed bethanechol. which of the latter are you most concerned about when giving this drug?
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renal failure. this drug is excreted via kidneys and could exacerbate kidney failure
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does bethanechol bind reversibly or irriversibly?
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reversibly. this means the drug effects will be temporary.drug action reversibility means the body does not have to make NEW substrates for the drug to NOT bind to, it just has to kick the drug OFF of the CURRENT substrate.
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name 4 indications for bethanechol
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urinary retension
GERD paralytic ileus post op abd distention |
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what is paralytic ileus?
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paralysis of the intestinal muscles
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name 6 AE of bethanechol. hint: think of what it does to the... heart, secretions, intestine...
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hypotension, bradycardia
excessive salivation ^gastric acid abd cramping diarrhea incontinence |
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your patient has bladder cancer and is full of tumors. he is not passing urine and you think that bethanechol is indicated. why might it not be?
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the tumors could be blocking the passage of urine. this would be considered a "urinary obstruction" and is contraindicated in bethanechol usage beacuse it could build pressure up and damage the organs
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you call the MD about the bladder cancer patient and his auria and the MD says the scans are clear of blockage go ahead and give bethanechol. looking through the rest of his dx the nurse finds these: asthma, diabetes, STD, CABG, and obesity. which of these contraindicates bethanechol?
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asthma
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your patient just took bethanachol at noon time and is now nauseated and vomiting. what is likely the problem?
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he took it with food. this drug causes n/v when taken with food. it is best taken on an empty stomach (1 hour before meal or 2 hours after)
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slide 42
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slide 42
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what is a non drug source of musarinic poisening?
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mushrooms
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muscarinic poisening can be from pharmacological overdoses such as taking too much m______ agonists or c______ inhibitors
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muscarinic
inhibitors |
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treatment for muscarinic poisening would be a m______ b______ a______ or m______ a______ (a______)
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muscarinic blocking agent
muscarinic antagonist atropine |
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atropine ______ heart rate
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increases
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atropine ______ secretions
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decrease
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atropine ______ bronchi
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relaxes
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atropine ______ bladder tone
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decreases
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atropine ______ GI tone and motility
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decreases
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atropine ______ pupil
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dialate
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what drug would you expect to give as a pre-anesthestic
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atropine
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why would atropine be given for eye exams or surgery
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because it dilates the pupil
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what heart problem would atropine be given for?
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heart block
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why would atropine be given for someone who has increased gastric motility
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because it decreases GI tone and motility
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muscarinic agonist poisening can be combated by this drug
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atropine
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what are the adverse effects of atropine...
think of what atropine dose theraupetically.. adverse effects are these effects exaggerated |
dry mouth
blured vision photophobia increased intraocular pressure uriniary retention constipation tachycardia |
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what would you teach a patient who was experiencing dry mouth
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hard candy or ice
notify nurse |
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cholinesterase inhibitors prevent the b______ of A______ by a______
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breakdown
ACh acetylcholinesterase |
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two categories of cholinesterase inhibitors are
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reversible and irriversible
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reversible cholinesterase inhibitor example drug is
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neostigmine
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irreversible cholinesterase inhibtor example drug is
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di-isopropyl fluophosphate
insecticide |
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neostigmine would be used to treat which disease of the eye
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glaucoma
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neostigmine would be used to treat which disease associated with plaque build up in the brain
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alzhiemers
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muscarinic poisening can be fixed with administration of atropine. what is a brand name of atropine for this
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neostigmine
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myasthania gravis can be treated with this drug n______
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neostigmine
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neostigmine causes these muscarinic responses
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increased glandular secretions
increased GI tone and motility decreased HR urinary urgency bronchial constriction pupil constriction |
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irreversible cholinesterase inhibitors such as organophosphates have the same/different action as reversible cholinesterase inhibitors
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same
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irreversible cholinesterase inhibitors are are ______ acting than reversible cholinesterase inhibitors
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longer
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irreversible cholinesterase inhibitors are ______ toxic
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highly
these drugs are aka organophosphates |
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irreversible cholinesterase inhibitors are able to cross the BBB and placenta because it is h______ l______ s______
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highly lipid soluble
these drugs are organophosphates |
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organophosphates are commonly found in this non pharmocological agent
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insecticides
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clinical importance of an irreversible cholinesterase inhibitors like organophosphates are...
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poisening
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a therapeutic use of organophosphates is for this disease of the eye
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glaucoma
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your patient has been poisoned by an organophosphate. what are some treatments?
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oxygen
mechanical vent atropine pralidoxime chloride diazepam |
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neuromuscular blocking agents block these receptors
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nicotinic M receptors
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neuromuscular blocking agents cause muscle ______
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relaxation
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neuromuscular blocking agents are commonly used during these four procedures
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surgery
endotracheal intubation machanical ventilation diagnostic procedures |
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what is a common ganglionic blocking agent
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mecamylamine
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mecamylamine block these receptors..
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nicotnic N
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mecamylamine, a ganglionic blocking agent, has limited/wide therapeutic use
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limited
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mecamylamine, a ganglionic blocking agent, has been used for this CV disease
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HTN
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side effects of mecamylamine, a ganglionic blocking agent are
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antimuscarinic--parasympathetic blockade
hypotension--synaptic blockade |
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another ganglionic stimulant, nicotine, targets receptors in these structures
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adrenal medula
autonomic ganglia aortic arch carotid bodies CNS |
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receptor of nicotine are ______ and high doses and ______ at low doses
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blocked
stimulated |
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nicotine is absorbed by these routes
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mouth, skin, lungs
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nicotine is highly l______ s______ so it does cross BBB and placenta
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lipid soluble
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you take your patients blood pressure. while taking it, he says he just smoked a cigarette. what would you expect the bp and pulse to be?
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elevated
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nicotine can ______ gastric secretions, tone, and motility of the gut
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increase
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nicotine ______ the CNS
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stimulates
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adverse effects of nicotine can be..
(think about its effects on the CV) |
headache
dizzziness lightheadedness |
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nicotine can increase the metabolism of a few substances like...
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caffeine
theophylline apap insulin pentazone |
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sympathomimetics are aka
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adrenic agonists
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sympathomimetics produce their effects by activating a____ r____
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adrenergic receptors
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there are 5 adrenergic receptors.. what are they
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alpha 1,2
beta 1,2 dopamine |
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adrenergic receptor activation m____ actions of natural transmitters
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mimics
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amphetamines and EPI are adrenergic receptors that promote the release of..
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norepinephrine
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cocaine and tricyclic antidepressants block the reuptake of this neurotransmitter
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NE
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MAO's inhibit NE a____
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activation
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catetcholamines are ____ agonist
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adrenergic
|
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your patient on the floor is perscribed a catecholamine. you know this drug will not be administered via this route...
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PO
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you give your patient the catecholamine drug. do you expect the effect of the drug to be long term or short?
|
short
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catecholamines cannot cross the BBB. why?
|
they're not lipid soluble
|
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list 5 major catecholamine drugs
|
EPI
NE isoproterenol dopamine dobutamine |
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non catecholamine adrenergic agonists are different than catecholamine agonists in 3 basic ways
|
they can be given PO
longer acting more lipid soluble |
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3 major non catecholamines are...
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ephedrine
phenylephrine terbutaline |
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therapeutic uses of alpha 1 receptor activation are..
|
hemostasis
increased BP mydriasis (dilation of pupil) nasal decongestion adjuct to anesthesia |
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|
alpha 1 receptors work this way
|
constriction of blood vessels
remember (alpha) 1 heart and (beta) 2 lungs |
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your patient was just started on an alpha 1 agonist. what are 3 adverse effects to be aware of?
think of the effects on the CV |
HTN
necrosis bradycardia |
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alpha 2 activation in the p_______ inhibits the release of n_______
|
periphreal
NE |
|
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what are the therapuetic indications for alpha 2 agonists
|
none
|
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what does alpha 2 agonists do to bp?
|
decrease it
|
|
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how do alpha 2 agonists effect the CV?
they reduces this outflow... |
reduce sympathetic outflow to heart and blood vessels
and subsequently reduce peripheral adrenergic stimulation |
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name a common centrally acting alpha 2 agonist
|
methyldopa (aldomet)
|
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methyldopa causes vaso dilation/constriction
|
it is a alpha 2 agonist remember? and it lowers BP so it vaso dilates
|
|
|
although methyldopa decreases BP, it does not decrease these two elements of the CVS
|
HR
CO |
|
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youre on the OB/GYN floor and your patient has a Dx of PIH. what drug would you expect to be giving her for this?
|
methyldopa.
pregnancy induced hypertension |
|
|
adverse effects of methyldopa include..
|
ED
orthostais hemolytic anemia hepatoxicity xerostomia cns effects |
|
|
your patient has been perscribed methyldopa. which lab would you be concerned about when giving this med?
Na 134 K+ 5 BUN 45 elevated liver enzymes |
elevated liver enzymes
the drug may can cause hepatotoxicity |
|
|
beta 1 agonists have 4 uses and all are aimed at the heart
|
cardiac arrest
HF shock AV block |
|
|
adverse effects of beta 1 agonists have to do with the heart
|
tachy
dysrhyth angina |
|
|
your patient comes in, pregnant, asthmatic, diabetic and having complications with preterm labor you would expect which beta cell agonist to be on the list of meds
|
beta 2
delays preterm labor and controls asthma |
|
|
after you see that your asthmatic, diabetic preterm labor woman is taking a beta 2 agonist, you make sure to monitor for what?
|
low BGL and tremors
these are adverse effects of drugs |
|
|
your patient is hypotensive, having a hard time breathing and her throat is swollen. what is happening?
|
looks like anaphylactic shock!
|
|
|
H1C
|
Nurses
|
|
|
which receptors do EPI effect?
|
all receptors!
|
|
|
alpha 1 activation by EPI cacuses vaso_______ and decreased e_______
|
constriction
edema |
|
|
beta 1 activation by EPI causes an increase in 3 CV aspects
|
HR
CO BP |
|
|
beta 2 activation by EPI does what to the lungs
|
dialates
|
|
|
there are 6 therapeutic uses of epinephrine.
|
allergic reaction
cardiac arrest adjuct to general anesthesia bronchospasms hemostasis |
|
|
how can EPI be administered?
|
IV IM SQ INH Opth
|
|
|
what is the concept behind Adverse effects of epi?
|
all adverse effects of the drug are exagerations of the therapeutic actions
|
|
|
what drugs interact with EPI
|
MAO
tricyclic anti depressants general anestetics alpha blockers beta blockers |
|
|
administration of a dopamine agonists would do what to the kidneys?
|
dilate the vessels in them. this drug is used in shock
|
|
|
dopeamine agonists _______ cardiac output
|
enhance
|
|
|
how is dopamine administered
|
IV drip
|
|
|
if dopamine agonist is given, what adverse effects could you see?
|
tachycardia
rhythm disturbances angina |
|
|
dopamine agonists will increase/decrease diuretic action?
|
increase
|
|
|
dopamine has a positive/negative effect when mixd with MAO
|
negative
|
|
|
phenylephrine is an _______ agonist
|
alpha 1
used in nasal decongestion HTN very selective |
|
|
ephedrine effects _______ receptors. and is therapeutic for n_______ d_______ and n_______
|
nasal decongestion
narcolepsi |
|
|
terbutaline is _______ agonist used in a_______ and p_______ t_______ l_______ patients
|
beta 2
asthma pre term labor |
|
|
dobutamine targets _______ receptors and is used in heart _______
|
beta 1
failure |
|
|
thereapeutic uses of adrenergic antagonists
|
HTN
BPH pheochromocytoma raynauds overdose of alpha 1 |
|
|
adverse effects of adrenergic antagonists
|
orthostais
tachy nasal congestion ED Na retention |
|
|
_______ is a nonselective alpha adrenergic antagonist that is _______ selective and work by blocking _______ and _______ cells
|
phentolamine
non alpha 1 alpha 2 |
|
|
_______,_______, _______, _______, are examples of selective alpha adrenergic antagonists and only block _______ cells
|
prazosin
terazosin boxazosin tamsulosin OSINs!!! |
|
|
beta blockers are _______ competititve blocking agents
|
reversible
|
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beta blockers effectiely reduce _______ stimulation
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myocardial
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beta blockers reduce three CV aspects
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HR
CO BP |
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beta blockers vaso_______
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dilate
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although beta blockers dilate blood veseels, they _______ the bronchials
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constrict
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therapeutic effects of beta blockers include
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reduced HR, force of contraction and velocity of impuls conduction
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if beta blockers reduce almost everything about how the heart works.. then for what diseases could you use it for?
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agina
htn dysrhyth MI migraine hyperthyroid HF glaucoma |
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your patient is on a beta blocker. what adverse effects would you look for?
remember: what does it do to the heart? |
bradycardia
reduced CO HF AV block |
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where do non selective beta blockers work in the body? i mean... which receptors?
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beta 1,2
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where do selective beta blockers work in the body.. i mean which receptor?
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beta 1
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are beta blockers dose dependant?
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yes
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your patient was just put on a beta blocker. what are some side effects you can warn them about?
**laundry list |
insomnia
fatigue dizziness memory loss nightmares hallucinations depression sore throat dry eyes NV diarrhea ED rash fever hair loss |
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propranolol works by decreasing _______
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heart rate and ultimatly oygen consumption
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we would use propranolol in pt who are dx with..
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htn
svt mi pheochromocytoma tremor |
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propranol would interact with which drugs?
K+ diuretics CCB sivastatins insulin antipsychotics |
insulin,
ccb |
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propranolol is a non selective/selective beta blocker
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non selective
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metoprolol is a non selective/selective beta blocker
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selective
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an example of a selective beta blocker is..
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lopressor (metaprolol)
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what is the mechanism of metoprolol?
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same as propranolol but effects are limited to beta 1 receptors
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you have an asthma pt who has a new dx of htn. which beta blocker would you expect to be giving him?
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metoprolol.
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