Nurs 723 The Autonomic Nervous System And Targeted Pharmaceutical Therapies

Front 1

Central Nervous System's main function

Back 1

Receives and processes information; initiates action. Consists of brain and spinal cord.

Front 2

The Peripheral Nervous System's main function is to

Back 2

transmits signals from the CNS to the limbs and organs.

Front 3

Sensory neurons

Back 3

gather information about our surroundings
Heat, touch, pain

Front 4

Motor neurons

Back 4

signal to somatic and autonomic nerves

Front 5

Somatic motor neurons

Back 5

control voluntary movement (walking, reflexes)
Skeletal muscle

Front 6

Autonomic motor neurons

Back 6

control involuntary movement
Smooth muscle

Front 7

Peripheral Nervous System regulates

Back 7

-Regulates heart rate
-Regulates respiratory rate
-Regulates blood pressure
-Regulates temperature
-Regulates other nervous system functions, such as metabolism, water and sodium balance, sexual response, urination, and production of bodily fluids.

Front 8

involuntary "auto pilot" Regulates certain body processes

Back 8

Autonomic Nervous System

Front 9

Autonomic Nervous System consists of the ________________ division and the ______________ division.

Back 9

Sympathetic~ fight or flight
Parasympathetic~ is not fight or flight , rest and digest, feed and breed

Front 10

Parasympathetic stimulation causes:

Back 10

constricts pupil, stimulates saliva, slows heartbeat, constricts bronchi, stimulates peristalsis, stimulates the release of bile, and contracts bladder

Front 11

Sympathetic stimulation causes:

Back 11

dilates pupil, inhibits saliva, accelerates heart rate, dilates bronchi, inhibits peristalsis and secretion, conversion of glycogen to glucose, secretion of adrenaline and noradrenaline, inhibits bladder contraction

Front 12

Somatic Nervous System

Back 12

Voluntary control of body movements via skeletal muscles
Includes:
Spinal nerves
Cranial nerves
Association nerves

Front 13

Association nerves

Back 13

neurons found in the brain and spinal cord that conduct impulses between neurons such as from afferent to efferent neurons.

Front 14

Common Symptoms of ANS Disorders

Back 14

Orthostatic Hypotension
Gastroparesis
Erectile Dysfunction
Incontinence
Constipation
Urinary Retention

Front 15

Medical therapy of ANS disorders is designed to target...

Back 15

Medical therapy is designed to target the NeuroTransmitter or receptor to correct the problem in many cases

Front 16

Acetylcholine and Norepinephrine are _____________.

Back 16

Neurotransmitters. Chemical messengers used to communicate with the ANS (flight or fight)

Front 17

Nerve fibers that secrete ACh are ____________.

Back 17

cholinergic

Front 18

Nerve fibers that secrete norepi are ______________.

Back 18

adrenergic

Front 19

_____________ & ___________ are the 2 types of cholinergic receptors that BIND to Ach and then transmit signals

Back 19

Muscarinic and Nicotinic

Front 20

Cholinergic receptors respond to ______________. And control responses that occur in...

Back 20

Cholinergic receptors – respond to acetylcholine (ACh) Due to their location and reaction to acetylcholine, the cholinergic receptors control certain responses that occur in the heart and other organs, including the intestine, prostrate, and bladder.

Front 21

Muscarinic receptors are innervated by

Back 21

Muscarinic receptors – innervated by postganglionic parasympathetic neurons and sweat glands (sympathetic neurons)

Front 22

Nicotinic receptors are innervated by

Back 22

Nicotinic receptors – innervated by preganglionic parasympathetic neurons, preganglionic sympathetic neurons and somatic neurons

Front 23

Adrenergic receptors

Back 23

-respond to norepinephrine (NE)
-Innervated by postganglionic sympathetic neurons
-Alpha and beta receptors on the target organ
Alpha-1
Alpha-2
Beta-1
Beta-2

Front 24

Alpha 1 receptor location(s)

Back 24

blood vessels, bladder, liver, pupil

Front 25

Alpha 2 receptor location(s)

Back 25

CNS

Front 26

Beta 1 receptor location(s)

Back 26

heart

Front 27

Beta 2 receptor location(s)

Back 27

lungs, blood vessels, liver, bladder, GI tract, uterus

Front 28

Cholinergic Effects

Back 28

parasympathetic and responding to acetylcholine
Decreases heart rate
Constricts pupil
Causes salivation, lacrimation, urination and defecation (SLUDS)
Increases secretions
Bronchoconstriction

Front 29

Anticholinergic effects

Back 29

Increases heart rate
Pupil dilation
Dries up airway
Decrease lacrimation
Urinary retention
Constipation

Front 30

Excessive cholinergic blockade is called

Back 30

cholinergic syndrome

Front 31

cholinergic syndrome symptoms

Back 31

Mad as a hatter - psychosis and seizures
Dry as a bone - secretions are decreased; dry mouth, dry skin
Blind as a bat - eye cannot accommodate ‑ can't see close; pupil cannot constrict ‑ photophobia
Red as a beet - cutaneous blood vessels dilate
Hot as a hare - skin feels warm
deSLUDS
Decreased salivation, lacrimation, urination, defecation, sweating

Front 32

somatic cholinergic blockade causes ____________.

Back 32

Blocking of ACh receptors at the neuromuscular junction and thus causes muscle paralysis

Front 33

Adrenergic Effects

Back 33

Stimulates Sympathetic Nervous System
Mimics effects of alpha and beta
Alpha- vessels
Beta 1- primary heart
Beta 2- smooth muscles and bronchioles

Front 34

Anti-Adrenergic Effects aka blockade

Back 34

Inhibits signals from NE, E
Alpha and beta blockers
Decreases BP 2ndary to vasodilation
Bronchial constriction
Decreases heart rate and contractility
Increase GI peristalisis

Front 35

____________ are stimulating at receptor site

Back 35

agonist

Front 36

____________ are blocking at the receptor site

Back 36

antagonist

Front 37

Muscarinic Agonists MOA

Back 37

directly stimulates cholinergic muscarinic receptor. decrease heart rate, increase salivia and bronchoconstriction

Front 38

You would NOT use muscarinic agonists in pts with....

Back 38

asthma, PUD, heart conduction abnormalities

Front 39

Muscarinic Agonist, Bethanechol (Urecholine®), clinical uses:

Back 39

GERD and Urinary Retention
Clinical use: increases GI motility and contracts bladder wall

Front 40

Muscarinic Agonist, Pilocarpine, clinical uses:

Back 40

Glaucoma, Sjogren’s syndrome
Clinical uses: Causes contraction of muscles and secretions (such as saliva)

Front 41

Muscarinic Antagonists MOA

Back 41

competitively blocks muscarinic receptors. Think the opposite of cholinergic effects
Increase heart rate, dry up secretions

Front 42

You would NOT use muscarinic antagonists in pts with....

Back 42

benign prostatic hypertrophy, urinary retention, GERD, increased intraocular pressure, tachycardia

Front 43

Muscarinic Antagonist, Atropine, clinical uses:

Back 43

Atropine: dilate pupil for eye exam, treat bradycardia; reverse toxicity of agent that causes excess muscarinic stimulation

Front 44

Muscarinic Antagonist, Scopolamine, clinical uses:

Back 44

decrease secretions

Front 45

Mydriasis

Back 45

Toxicity r/t scopolamine. Mydriasis (dilation of pupil) can be caused by rubbing the eye after applying scopolamine patch.

Front 46

Muscarinic Antagonist, Ipratropium (Atrovent®), clinical uses:

Back 46

Ipratropium (Atrovent®)
Asthma/COPD- good for brochodilation

Front 47

Muscarinic Antagonist, Dicyclomine (Bentyl®), clinical uses:

Back 47

Dicyclomine (Bentyl®)
Clinical use: decrease movement and secretion of gut, used in irritable bowel syndrome

Front 48

Muscarinic Antagonist, Oxybutynin (Ditropan®), clinical uses:

Back 48

Oxybutynin (Ditropan®), tolterodine (Detrol®)
urinary incontinence

Front 49

Nicotinic Antagonists for Neuromuscular Junction

Back 49

MOA: Non-depolarizing: competitively block the action of ACh at the neuromuscular junction
Depolarizing: depolarizes the muscle fiber, prevents action of ACh released from neuron (succinylcholine)

Front 50

Nicotinic Antagonists, Atracurium, Pancuronium, and succinylcholine, clinical uses:

Back 50

Clinical use: adjunct to general anesthesia, mechanically ventilated patients, intubation

Front 51

Nicotinic Antagonists, Atracurium, Pancuronium, and succinylcholine, toxicity:

Back 51

Toxicity: respiratory paralysis, hyperkalemia (succinylcholine)

Front 52

Nicotinic and Muscarinic Agonists are called

Back 52

Acetylcholinesterase (AChase) Inhibitors

Front 53

Acetylcholinesterase (AChase) Inhibitors MOA

Back 53

Neostigmine, pyridostigmine, physostigmine

MOA: reversibly blocks action of AChase
Neither neostigmine nor pyridostigmine enter the CNS because they are charged
Physostigmine penetrates the CNS because it is not charged

Front 54

Acetylcholinesterase (AChase) Inhibitors, Neostigmine, pyridostigmine, physostigmine clinical use:

Back 54

Neostigmine is used to reverse action of non-depolarizing NMBs (atracurium and pancuronium)
Pyridostigmine and neostigmine used for myasthenia gravis

Front 55

Acetylcholinesterase (AChase) Inhibitors, Neostigmine, pyridostigmine, physostigmine side effects:

Back 55

Muscarinic effects: nausea, diarrhea, increased salivation/bronchial secretions, bronchoconstriction
Nicotinic effects: muscle cramps

Front 56

Centrally acting Acetylcholinesterase (AChase) Inhibitors, Donepezil (Aricept®), galantamine (Reminyl®), and rivastigmine (Exelon®) side effects...

Back 56

Side effects: nausea, diarrhea, bradycardia, urinary incontinence
(when thinking about these agonist remember SE are usually bodily functions)

Front 57

Adrenergic Agonists, Primary Alpha-1, Beta-1, Dobutamine, dopamine, phenylephrine, norepinephrine, epinephrine, clinical use:

Back 57

Dobutamine, dopamine, phenylephrine, norepinephrine, epinephrine
Support cardiac function, vasoconstriction and/or increased force of contraction

Front 58

Epinephrine is also used for...

Back 58

anaphylaxis

Front 59

Phenylephrine also used as a...

Back 59

topical decongestant

Front 60

Adrenergic Agonists Beta-2, Albuterol, metaproterenol clinical use

Back 60

Clinical use: bronchodilator

Front 61

Adrenergic Agonists, Beta-2, Albuterol, metaproterenol side effects

Back 61

Side effects: tremor, tachycardia, palpitations

Front 62

Adrenergic Agonist, Alpha-2 agonist, Clonidine, clinical use

Back 62

Decreased CNS sympathetic outflow
Clinical use: hypertension, narcotic withdrawal
Effect on spinal cord causes analgesia

Front 63

Side effects from excessive beta-1 stimulation

Back 63

Beta-1: tachycardia, ischemia, arrhythmias

Front 64

Side effects from excessive beta-2 stimulation

Back 64

Beta-2: hypotension, tremor

Front 65

Side effects from excessive alpha-1 stimulation:

Back 65

Alpha-1: hypertension, decreased organ perfusion

Front 66

Side effects from excessive alpha 2 stimulation:

Back 66

Alpha-2: orthostatic hypotension

Front 67

Pt related variables for beta-1 and alpha-2....

Back 67

Patient related variables
Beta-1: ischemia heart disease
Alpha-1: hypertension, hypovolemia

Front 68

Adrenergic Antagonists
Alpha 1 and Alpha 2 blocker, Phentolamine, clinical use...

Back 68

Blocks alpha-1 and alpha-2 receptors
Clinical use: reverse local vasoconstricting effect of extravasated alpha agonist

Front 69

Strongest warning that the FDA requires, and signifies that medical studies indicate that the drug carries a significant risk of serious or even life-threatening

Back 69

Black box

Front 70

Adrenergic Antagonist Alpha 1 receptor blockers, Prazosin, terazosin, doxazosin, tamsulosin clinical use:

Back 70

Blocks alpha-1 receptors
Clinical use: hypertension, benign prostatic hypertrophy

Front 71

Adrenergic Antagonist Alpha 1 receptor blockers, Prazosin, terazosin, doxazosin, tamsulosin side effects:

Back 71

Side effects: orthostatic hypotension

Front 72

Adrenergic Antagonists Beta Blockers, Propanolol, metoprolol, and atenolol, clinical use:

Back 72

Clinical use: hypertension, angina, control heart rate

Front 73

Adrenergic Antagonists Beta Blockers, Propanolol, metoprolol, and atenolol, side effects:

Back 73

Side effects: bradycardia, bronchospasm

Front 74

Adrenergic Antagonists Beta Blockers, Propanolol, metoprolol, and atenolol, Patient related variables/contraindications:

Back 74

Patient related variables/contraindications: heart failure, asthma