Chapter 13/Drugs affecting the autonomic nervous system

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Acetycholine (Ach)

Primary neurotransmitter of the parasympathetic nervous system; also present at somatic neuromuscular junctions and at sympathetic preanglionic nerves

Acetylocholinesterase (AchE)

Enzyme that degrades acetylcholine within the synaptic cleft, enhancing effects of the neurotransmitter

Adrenergic

Relating to nerves that release norepinephrine or epinephrine

Adrenegic antagonist

Drug that blocks the actions of the sympathetic nervous system

Alpha receptor

Type of subreceptor found in the sympathetic nervous system, adrenergic receptor

Anticholinergic

Drug that blocks the actions of the parasympathetic nervous system

Autonomic nervous system

Portion of the peripheral nervous system that governs involuntary actions of the smooth muscle, cardiac muscle and glands

Beta receptor

Type of subreceptor found in the sympathetic nervous system

Catecholamines

Class of agents secreted in response to stress that include epinephrine, norepinephrine and dopamine, involved in neurotransmission

Central nervous system (CNS)

Division of the nervous system consisiting of the brain and spinal cord

Cholinergic

Relating to nerves that release acetycholine

Fight or flight response

Characteristic set of signs and symptoms produced when the sympathetic nervous system is activated, readies the body for an immediate response to a potential threat

Ganglionic synapse

The juncture between two multipolar neurons located outside of the central nervous system (CNS) where axon terminals from the first neuron make contact with cell bodies and extensions of the second neuron

Manoamine oxidase (MAO)

Enzyme that destroys norepinephrine in the nerve terminal

Muscarinic

Type of cholinergic receptor found in smooth muscle, cardiac muscle and glands

Myasthenia gravis

Motor disorders caused by a destruction of nicotinic receptors on skeletal muscles and characterized by profound muscular fatigue

Nicotinic

Type of cholinergic receptor found in ganglia of both the sympathetic and parasympathetic nervous system

Norepinephrine (NE)

Primary neurotransmitter in the sympathetic nervous system

Parasympathetic nervous system

Portion of the autonomic nervous system that is active during periods of rest and that results in the rest-or-relaxation response.

Peripheral nervous system

Division of the nervous system containing all nervous tissue outside the CNS, including the autonomic nervous system, including sensory and motor neurons

Postganglionic neuron

Automatic nerve after the ganglionic synapse transmitting impulses to the target tissue

Preganglionic neuron

Automatic nerve before the ganglionic synapse carrying impulses from the spinal cord

Rest-and-digest response

Signs and symptoms produced when the parasympathetic nervous system is activated

Somatic nervous system

nerve division that provides voluntary control over skeletal muscle

Sympathetic nervous system

Portion of the autonomic system that is active during periods of stress and results in the fight-or-flight response

Sympatholytics

A drug that blocks the actions of the sympathetic nervous system

Sympathomimetic

Drug that stimulates or mimics the sympathetic nervous system

Synapse

Junction between two neurons consisting of a presynaptic nerve, a synaptic cleft, and a postynaptic nerve

Synaptic transmission

Process by which a neurotransmitter reaches receptors to regenerate the action potential

Motor Neurons

carry signals between the CNS and the rest of the body

Sensory Neurons

carry signals to the CNS from sensory organs

Somatic Nervous System

controls voluntary movements by activating skeletal muscles

Autonomic Nervous System

controls involuntary responses by influencing organs, glands and smooth muscle

Sympathetic Division

prepares the body for stressful or energetic activity fight or flight, to Adrenergic Receptors to Alpha & Beta

Parasympathetic Division

dominates during times of rest and digestion, directs maintenance activities, to cholinergic receptors

sensory division

neurons recognize changes to the environment

motor division

respond to neurons by moving muscles or secreting chemicals

What organs are regulated by the neurons from the automatic nervous system?

heart, digestive tract, respiratory tract, reproductive tracts, arteries, salivary glands, and portions of the eye

The automatic nervous system has two divisions:

sympathetic and parasympathetic nervous systems

What condition is the sympathetic nervous system activated and produces a set of?

conditions of stress, actions called fight or flight

What happens when the actions fight or flight are activated?

heart rate and blood pressure increase and more blood is shunted to skeletal muscles, the liver produces more glucose for energy, bronchi dilate to allow more air into the lungs, pupils dilate for better vision

What happens when the parasympathetic nervous system is activated?

activated under nonstressful situations and produces symptoms called the rest and digest response

What happens when the rest and digest response are activated?

digestive processes are promoted, heart and blood pressure decline, bronchi constrict

for information to be transmitted throughout the nervous system the neurons must?

communicate with each other and with muscles and glands

A large number of drugs affect autonomic function by altering?

neurotransmitter activity at the second synapse

Five ways by which drugs affect synaptic transmission?

Drugs affect synthesis of the neurotransmitter the the presynaptic nerve
prevent storage of the neurotransmitter in vesicles within the presynaptic nerve
prevent the normal destruction or reuptake of the neurotransmitter
bind to the receptor site on the postsynaptic target tissue

Drugs that decrease the amount of neurotransmitter synthesis will?

inhibit autonomic function

Prevention of neurotrnansmitter storage will inhibit?

autonomic function

Promoting neurotransmitter release will stimulate?

autonomic function

Drugs that cause the neurotransmitter to remain in the synapse for a longer time will stimulate?

autonomic function

Drugs that bind to postsynaptic receptors and stimulate target tissue will______autonomic function.

stimulate

In the sympathetic nervous system what neurontransmitter is released at almost all postganglionic nerves?

norepinephrine

noncatecholamine drugs

have a slightly different chemical structure than the catecholamines, such as ephedrine, phenylephrine, and terbutaline

How do many drugs affect autonomic function?

by influencing the synthesis, storage, release, reuptake or destruction of NE (norepinephrine)

How is epinephrine terminated?

through hepatic metabolism

What receptors are important in the treatment of Parkinsons disease?

Dopaminergic receptors in the CNS

Dopamine receptors in the peripheral nervous system are located?

in the arterioles of the kidney and other viscera

What are the two types of cholinergic receptors?

Nicotinic receptors and Muscarinic receptors

Activation of nicotinic receptors causes?

tachycardia, hypertension and increased tone and motility in the digestive tract

ganglionic blockers

only current therapeutic application of nicotinic receptors that produce relaxation during surgical procedures

Alpha 1 location

all sympathetic target organs except the heart

Alpha 2 location

Presynaptic adrenergic nerve terminals

Beta 1 location

Heart and Kidneys

Beta 2 location

All sympathetic target organs except the heart

Nicotinic

Postganglionic neurons

Muscarinic

Heart

Classifications of autonomic drugs

stimulation of sympathetic nervous system
inhibition of the sympathetic nervous system
stimulation of the parasympathetic nervous system
inhibition of the parasympathetic nervous system

What receptors does the sympathetic nervous system have?

alpha and beta

Alpha 1 receptor therapeutic action

treatment of nasal congestion or hypotension; causes mydriasis during opthalmic examination
alpha 1 blocker-relaxes smooth muscle and dries nasal secretion

Alpha 2 receptor therapeutic action

treatment of hypertention through a centrally acting mechanism (Autonomic alpha 2 receptors are also located on presynaptic membranes of postganglionic neuorns and serve as autoreceptors for naturally occurring NE in the sympathetic nervous system. Activation of alpha 2 receptors reduces the relase of NE
alpha 2 agonists-Lowers blood pressure w/o affecting heart
inhibits release of norepinephrine

Beta 1 receptor therapeutic action

treatment of cardiac arrest, heart failure, and shock
Beta 1 blocker- decreases heart rate
activations increases heart rate & force of contraction, increases release of renin

Beta 2 receptor

treatment of asthma and premature labor contractions
Beta 2 agonists- lowers blood pressure w/o affecting heart (BETA BLOCKERS)

Following administration of an adrenergic (sympathomimetic drug, the nurse would assess for what side effects?

insomnia, nervousness, and hypertension

Therapeutic uses for anticholinergics include:

peptic ulcer disease, bradycardia, irritable bowel syndrome

Adrenergic-blocking (antagonis drugs include all of the following adverse reactions?

tachycardia, edema, heart failure

Elderly patient taking bethanechol (Urecholine) need to be assessed more frequently because of what side effect?

Dizziness

The patient taking benztropine (Cogentin) should be assessed for"

constipation

The patient takint tacrine (Cognex) should be obervant for waht side effects that may signal a possible overdose has occurred?

excessive seating, salivation, and drooling

The two primary divisions of the nervous system are the ____nervous system comprised of the brain and spinal cord and the ______nervous system, comprised of sensory and motor pathways.

central, peripheral

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

autonomic

The sympathetic nervous system produces the _____ response; the parasympathetic nervous system produces symptoms called the ________ response.

fight or flight, rest and digest

_____ is the main neurotransmitter responsible for sympathetic nervous transmission

Norepinephrine

_____ is the main neurotransmitter responsible for sympahtetic nervous transmission.

Acetycholine

Sympathetic nerves are often called ____ a term coming from the word adrenaline; parasympathetic nerves are called_____

adrenergic, cholinergic

Increased heart rate, bronchodilation, decreased motility in the GI tract, mydriasis and decreased secretion from glands are physiologic responses associated with inactivation of the _____nervous system or activation of the ______nervous system.

parasympathetic, sympathetic

_____blockers, primarily used for hypertension, comprise the most commonly prescribed autonomic medications.

Adrenergic

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

Adrenergic (Sympathomimetics)

_____drugs names named after rest and digest response are commonly used to stimulate urinary or digestive tracts following general anesthesia.

Cholinergic

Albutrol

Beta 2-Asthma

Aldomet

Alpha 2 Hypertension

Alupent

Beta 2-Asthma

Atropine

anti-cholergnic, muscarinic acetycholine receptor antagonist, used for bradycardia, antrioventricular block, irritable bowel syndrome, anticholinesterase poisioning, antisecretory agent (surgery), peptic ulcers, treatment of ocular inflammation (relaxes iris and ciliary muscles)

Neo-Syndephrine

vasoconstrictor, decongestant, adrenergic antagonist, causes contraction of vascular smooth muscle and vasoconstriction, stimulates sympathetic nervous system

Atropine (Isopto Atropine) for?

pupil dilation during an eye exam

Bethanechol (Urecholine)

GI stimulation following surgery

Pyridostigmine (Mestinon)

myasthenia gravis

Doxazosin (Cardura)

hypertension

Albuterol (Proventil)

asthma inhalee

Scopolamine (hyoscine)

anticholinergic

Phenylephrine (Neo-synephrine)

sympathomimetic

Bethanechol (Urecholine)

parasympathomimetic

Propranolol (Inderal)

adrenergic blocker

Dobutamine (Dobutrex)

sympathomimetic

Following administration of an adrenergic (sympathomimetic dru, the nurse would assess for which adverse drug effects?

Insomnia, nervousness and hypertension

Potential adverse reactions associated with the use of adrenergic antagonist are?

tachycardia, edema and heart failure

Elderly patients taking bethanecholo (Urecholoine) need to be assessed more frequently because of what side effect?

constipation

The patient taking tacrine (Cognex) should be observant for which of the following adverse effects that may signal a possible overdose has occured.

excessive sweating, salivation, and drooling

Mini-Press

anti-cholergenic, inhibits sympahtetic nervous system, antihypertensive, M.O.A.

How is norepinephrine (NE) synthesized

in the nerve terminal, requires amino acides phenylalanine and tyrosine, conversion of dopamine to norepinephrine, NE in nerve terminal may be returned to vesicles for future use, or destroyed enzymatically by monoamine oxidase

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