1
Q
Autonomic Nervous System
A
- Definition: involuntary or visceral nervous system
- Function: little conscious awareness of it’s internal function, regulate and integrate the the body’s internal functions, integrate of the CNS and PNS to react to changes in the internal and external environment
- Bodily functions regulated: BP, HR, respiration, temp, water balance, urinary excretion, and digestive function.
2
Q
Two divisions of the ANS
A
- Sympathetic
- Parasympathetic
3
Q
Sympathetic Nervous System
A
- Adregenic System
- Fight or Flight
- Actions dominated in times of physical or emotional stress
- Neurotransmitter: Norepinephrine
4
Q
Parasympathetic System
A
- Cholinergic System
- Rest and digest
- Neurotransmitter: Acetylcholine
- Aimed at conserving energy
5
Q
Alpha 1 receptors
A
- Division: SNS
- Location: peripheral blood vessels
- Action: increase BP
6
Q
Alpha 2 Receptors
A
- Division: SNS
- Location: presynaptic neurons
- Action: decrease in neurotransmitter release, therefore resulting in an antiandregenic effect
7
Q
Beta 1 Receptors
A
- Division: SNS
- Location: heart and kidney
- Action: increase heart rate and force of contraction, promoter release of renin, breakdown of stored fat into fatty acids
8
Q
Beta 2 Receptor
A
- Division: SNS
- Location: bronchial smooth muscle and blood vessel walls, brain scan heart
- Action: bronchodilation, uterus relaxes, increase blood flow to the heart, brain, and skeletal muscles
9
Q
Adrenergic Agonist
A
- Definition: sympathomimetic- mimic the effects of the SNS
- Uses: ophthalmic preps for dilating pupils and shock
- Nursing Considerations: assess for allergy and underlying disease, monitor BP, pulse, respirations, and urinary output, monitor labs, renal function, blood glucose, electrolytes, monitor cardiac status, ECG, monitor GI and GU status, avoid caffeine containing products and Ephedra
10
Q
Alpha- and Beta- Adregenic Agonist
A
- Nonselective
- Actions: HR increases, bronchi dilate, vasoconstriction, intraocular pressure decreases (simulate stimulating the SNS system)
- Indications: Treatment of hypotensive shock, bronchospasm, Pharmacokinetics: rapidly absorbed after injected or passage through the mucous membranes, metabolized in the liver and extremes in the kidneys.
- Contraindications: MI, tachyarrhythmias or ventricular fibrillation (too much stimulation), hypovolemia, Pheochromocytoma (hormone secreting tumor that is in the adrenal glands). CAUTION: peripheral vascular disease
- Adverse reactions: Arrhythmias, hypertension, palpitations, angina, dyspnea, nausea, vomiting, headache and sweating.
- Drug- to- Drug interactions: Tricyclic antidepressants, MAOI’s
11
Q
Alpha Adregenic Agonist
A
- Specific
- Definition: bind primarily to alpha and not beta receptors
- Actions: stimulation of Alpha receptors
- Adverse Reactions: (CNS) anxiety, restlessness, depression, fatigue, strange dreams, personality changes, blurred vision, sensitivity to light (CV) arrhythmias, ECG changes, BP changes, peripheral vascular problems (GI) nausea, vomiting, anorexia (GU) decreased urine output, difficulty urinating, dysuria, changes in sexual function (Other) do not suddenly stop these drugs- can lead to tachycardia, hypertension, arrhythmias, flushing and even death
12
Q
Beta Adrenergic Agonist
A
- Specific
- Actions: stimulate beta receptors, increase heart rate and contractility, bronchodilation, increase blood flow to skeletal muscles, relaxation of the uterus
- Adverse effects: restlessness, anxiety, fear, tachycardia, angina, MI, palpitations, difficulty breathing, cough, bronchspasm, nausea, vomiting, anorexia
13
Q
Adrenergic Antagonist
A
- Definition: Sympatholytic- lose or block the effects of the SNS
- Selective or Non-selective
- Action: prevent norepinephrine from activating the receptor
14
Q
Alpha 1 Selective Anti- Adrenergic Agents
A
- Specific
- Action: dilate blood vessels, decrease peripheral vascular resistance, relaxes smooth muscle
- Use: HTN, BPH (benign prostate hyperplasia), migraines
- Adverse reactions: hypotension, orthostatic hypotension, angina, MI, CVA, arrhythmia, weakness and dizziness
15
Q
Beta Anti- Adrenergic
A
- Non- selective or selective
- Action: block beta receptors, decrease HR, decrease myocardial contraction, decrease cardiac output, decreased release of renin from the kidneys
- Adverse Reactions: bradycardia, hypotension, nausea, vomiting
- Cautious: liver impairment, CAD
- Contraindicated: asthma, heart block, hypotension
- Nursing Implications: monitor pulse, BP and orthostatic changes, monitor respiratory status.
16
Q
Beta 1 Anti- Adrenergic
A
- Uses: hypertension, angina, some cardiac arrhythmias
17
Q
Cholinergic Agonist
A
- Definition: chemicals that act as the same site as ACh (stimulate PNS)
- Action: parasymphomimetic- mimic the action of the PNS
- not limited to a specific site
- Adverse effects: hypotension, decrease HR, SOB, nausea and vomiting, abdominal cramps, diarrhea, headache, blurred vision
- Used for: glaucoma, atomic bladder, urine retention, GI atony, Myastthenia gravis, Alzheimer’s Disease
- Contraindications: urinary or GI obstruction, asthma, CAD, hyperthyroidism
- Nursing Implications: Monitor BP and pulse, assess GI and GU systems, monitor output, assess respiratory status and difficulty for breathing
18
Q
Direct- Acting Cholinergic Agonist
A
- Treat: urinary retention, neurogenic bladder atony
- Actions: mimic the effects of ACh adds parasympathetic stimulations
- Indications: increases the tone of the bladder and relax the bladder sphincter
- Adverse effects: nausea, vomiting, cramps, diarrhea, increase salivation, and involuntary dedication, bradycardia, heart block, hypotension, urinary urgency, flushing or increased sweating.
19
Q
Indirect acting Cholinergic
A
- Helps treat Alzheimer’s
- Action: delay destruction of ACh, slows neuronal degradation, delays the onset of cognitive decline, may bring a slight improvement in cognition and function
- Caution: liver impairment
20
Q
Anti- Cholinergic Agents
A
- Action: block ACh, lyse or block effects of the PNS, also called parasypatholytic. Act by blocking/ occupying receptor sites on muscarinic receptors (increase in heart rate, decrease in GI activity, decrease in urinary bladder tone and function, pupil dilation, cyclopedia, same as stimulating SNS)
- Uses: (CV) reverse heart block, bradycardia (Respiratory) relieve bronchocontriction (GI disorders) peptic ulcers, gastritis, irritable bowel (GU) overactive bladder, urinary frequency (Other) Parkinson’s disease, excessive oral, gastric and respiratory secretions
- Adverse Effects: tachycardia, dry mouth, blurred vision, constipation, drowsiness, sedation, agitation, urinary retention, decreased sweating
- Contraindication: BPH, GI obstruction, Myastenia gravis, narrow angle glaucoma, tachydysrhythmias, MI, heart failure
- Nursing Considerations: monitor for reactions that increase anti- Cholinergic effects, some herbs, keep well hydrated and room cool
- Patient Teaching: avoid over heating, drink water, rinse mouth, good oral hygiene, hard candy, void before taking, report eye pain, avoid machinery.
21
Q
Anti- spasmatics
A
- Action: GI smooth muscle relax, directly blocks ACh, decrease intestinal motility/ spasm and pain
- Use: Irritable Bowel Syndrome
- Other Action: directly relax smooth muscle and inhibits the effects of ACh
- Other Use: Overactive bladder
- Adverse effects: blurred vision, nausea and vomiting, dysphasia, urinary hesitancy, urinary retention, decreases sweating
- Caution: renal or hepatic disease
- Contraindications: hypersensitivity, glaucoma, urinary bladder neck obstruction, GI obstruction, BPH, myasthenia gravis
- Nursing Indication: prevent interactions (drug/ herb)
22
Q
SLUDGE
A
Salivation Lacrimation Urination Defication Gastrointestinal distress Emesis (Cholinergic Effects)
23
Q
Anti- Cholinergic Effects
A
Can’t see
Can’t pee
Can’t spit
Can’t shit
