Chapter 13-Drugs affecting the autonomic nervous system

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Ms. Riles St. Pete College Nsg II-Pharmacology

autonomic nervous system

Exert involuntary control over the contraction of smooth muscle and cardiac muscle, and glandular activity.

central nervous system (CNS)

A major division of the nervous system that consists of the brain and spinal cord.

fight-or-flight response

The response that is initiated under conditions of stress.

parasympathetic nervous system

Activated under nonstressful conditions and produces symptoms called the rest-and-digest response.

peripheral nervous system

A major division of the nervous system that consists of all nervous tissue outside the CNS, including sensory and motor neurons.

rest-and-digest response

A response initiated under non-stressful conditions under the parasympathetic nervous system.

somatic nervous system

Consists of nerves that provide voluntary control over skeletal muscle.

sympathetic nervous system

Activated under conditions of stress, and produces a set of actions called the fight-or-flight response.

synapse

Also called the juncture, along the nerve that the action potential travels along.

ganglionic synapse

As the action potential travels along the first nerve, it encounters the first synapse, or juncture. This connection occurs outside the CNS and is therefore called?

preganglionic neuron

The nerve carrying the impulse exiting the spinal cord.

postganglionic neuron

The nerve on the other side of the ganglionic synapse, waiting to receive the impulse.

synaptic transmission

The process of propagating a signal from one cell to another via a synapse.

norepinephrine (NE)

A primary neurotransmitter of the autonomic nervous system.

acetylcholine (Ach)

A primary neurotransmitter of the autonomic nervous system.

catecholamines

Norepinephrine belongs to this class of agents all of which are involved in neurotransmission.

adrenergic

Receptors at the ends of postganglionic sympathetic neurons, which comes from the word adrenalin.

alpha receptors

One of two types of adrenergic receptors.

beta receptors

One of two types of adrenergic receptors.

monoamine oxidase (MAO)

Enzymatically destroys norepinephrine that is not returned to the vessicles for future use.

cholinergic

Nerves releasing acetylcholine (Ach).

nicotinic receptors

Receptors for Ach in the ganglia. Present in skeletal muscle.

muscarinic receptors

Ach receptors with actions closely resembling the poisonous mushroom Amanita muscaria. They are affected by a number of medications.

acetylcholinesterace (AchE)

Rapidly destroys Ach in the synaptic cleft by this enzyme.

sympathomimetics

Drugs that stimulate the sympathetic nervous system, also called adrenergic agents.

adrenergic antagonists

Inhibits the sympathetic nervous system, also called sympatholytics.

sympatholytics

Also called adrenergic antagonists.

parasympathomimetics

Stimulates the parasympathetic nervous system, producing the characteristics of the rest-and-digest response, also called cholinergic agents.

anticholinergics

Inhibit the parasympathetic nervous system, also called cholinergic-blocking agents, parasympathlytics, or muscarinic blockers.

myasthenia gravis

A disease characterized by destruction of nicotinic receptors on skeletal muscle.

Key point

The peripheral nervous system is divided into a somatic portion, which is under voluntary control, and an autonomic portion, which is involuntary and controls smooth muscle, cardiac muscle, and glandular secretions.

Key point

Stimulation of the sympathetic division of the autonomic nervous system causes symptoms of the fight-or-flight response, whereas stimulation of the parasympathetic branch induces rest-and-digest responses.

Key point

Drugs can affect nervous transmission across a synapse by preventing the synthesis, storage, or release of the neurotransmitter; by preventing the destruction of the neurotransmitter; or by binding neurotransmitters to the receptors.

Key point

Norepinephrine is the primary neurotransmitter released at adrenergic receptors, which are divided into alpha and beta subtypes. Acetylcholine is the other primary neurotransmitter of the autonomic nervous system.

Key point

Acetylcholine is the primary neurotransmitter released at cholinergic receptors (nicotinic and muscarinic) in both the sympathetic and parasympathetic nervous systems. It is also the neurotransmitter at nicotinic receptors in skeletal muscle.

Key point

Autonomic drugs are classified by the receptors they stimulate or block: Sympathomimetics stimulate sympathetic nerves, and parasympathomimetics stimulate parasympathetic nerves; adrenergic antagonists inhibit the sympathetic division, whereas anticholinergics inhibit the parasympathetic branch.

Key point

Sympathomimetics act by directly activating adrenergic receptors, or indirectly by increasing the release of norepinephrine from nerve terminals. They are used primarily for their effects on the heart, bronchial tree, and nasal passages.

Key point

Adrenergic antagonists are used primarily for hypertension and are the most widely prescribed class of autonomic drugs.

Key point

Parasympathomimetics act directly by stimulating cholinergic receptors or indirectly by inhibiting acetylcholinesterase. They have few therapeutic uses because of their numerous side effects.

Key point

Anticholinergics act by blocking the effects of acetylcholine at muscarinic receptors, and are used to dry secretions, treat asthma, and prevent motion sickness.

CNS & PNS

The two primary divisions of the nervous system.

Autonomic

This nervous system provides involuntary control over smooth muscle, cardiac muscle, and glands.

Fight or flight response

Produced by the sympathetic nervous system.

Rest and digest response

Produced by the parasympathetic nervous system.

presynaptic, synapse cleft, and postsynaptic

Three parts of a synapse.

adrenergic

Sympathetic nerves are often called this, a term coming from the word adrenaline.

cholinergic

Parasympathetic nerves are called this.

parasympathetic and sympathetic

Increased heart rate, bronchodilation, decreased motility in the GI tract, mydriasis, and decreased secretions from glands are physiologic responses associated with inactivation of this nervous system or activation of the what nervous system.

adrenergic

These blockers are primarily used for hypertension, and comprise the most commonly prescribed autonomic medications.

sympathomimetic or adrenergic drugs

This class of drugs is named after the fight-or-flight response and primarily used for increasing the heart rate, dilating the bronchi, and drying secretions resulting from colds.

cholinergics

These drugs are named after the rest-and-digest response, and are commonly used to stimulate the urinary or digestive tracts following general anesthesia.

Cholinergic (muscarinic) blockers

Cause dry mouth, constipation, urinary retention, and increased heart rate.

Alpha1-blockers

Relax vascular smooth muscle and dry nasal secretions.

Beta2-agonists

Cause bronchodilation.

Alpha2-agonists

Lower blood pressure without affecting the heart.

Beta1-blockers

Decrease heart rate.

Anticholinergic

Scopolamine (Hyoscine)

Sympathomimetic

Phenylephrine (Neo-Synephrine)

Parasympathomimetic

Bethanechol (Urecholine)

Adrenergic blocker

Propranolol (Inderal)

Sympathomimetic

Dobutamine (Dobutrex)

Return for lab tests to monitor renal function

A patient is discharged with a newly prescribed antagonist for control of hypertension. The nurse gives discharge instructions. It is inappropriate to include which of the following instructions prior to the patient's leaving?

Inhibition of the sympathetic nervous system

An adrenergic blocker is most directly related to which of the following?

Stimulates cholinergic receptors

How does bethanechol (Urecholine) exert its effects?

Sympatholytics

What drugs block the action of norepinephrine at alpha- and beta-receptors?

Monitor patency throughout the infusion

A nurse is to give phenylephrine parenterally. What safety precaution would be necessary especially with this drug?

myasthenia gravis

Parasympathomimetics are safe for patients diagnosed with which of the following?

Blocks the beta-receptors

How does propanolol (Inderal) exert its effects?

Hypertension, insomnia, and tachycardia

Pseudoephedrine has been ordered for a patient with nasal congestion. The nurse knows the drug can give which of the following side effects?

Decreases gastric acid secretions

Anticholinergics may be used in treatment of peptic ulcers. What action makes this drug useful in this condition?

Adrenergic agonists

What are sympathomimetics also called?

It causes more autonomic side effects.

Epinephrine is a nonselective adrenergic agonist. What is the disadvantage of this nonspecific action?

Take drug on a full stomach

A patient is prescribed Mestinon for myasthenia gravis. Which of the following would be inappropriate to teach the patient?

Cholinergic blocker

Neostigmine is an example of which of the following?

Atropine (Isopto Atropine)

Which of the following drugs would dry up body secretions?

Increase in intraocular pressure

Atropine is usually not prescribed for any patient with glaucoma. The nurse knows the contraindications is due to which of the following effects of atropine?

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