What physiologic changes occur with sympathetic stimulation? (9)
- pupils dilate
- inhibit salvia
- accelerate HR
- bronchodilation
- inhibits digestion
- stim release of glucose
- secrete Epi and NE
- relax bladder
- inhibit sex organs
What physiologic changes occur with parasympathetic stimulation? (8)
- constrict pupils
- stim saliva
- dec HR
- bronchoconstriction
- stim digestion
- stim gallbladder
- contract bladder
- stim sex organs
What NT is associated with the parasympathetic NS and what 2 receptors does it work on?
- NT : acetylcholine
- Receptor : nicotinic and muscarinic
What 3 NTs are associated with the sympathetic NS and what receptors do they work on?
- NE : alpha and beta
- Epi : alpha and beta
- ACh : muscarinic : sweat glands only
Dopamine is classified as what type of receptor?
adrenergic
What NS division is associated with cholinergic receptors?
What are the 2 types of cholinergic receptors?
- parasympathetic NS
- nicotinic and muscarinic
What NS division is associated with adrenergic receptors?
sympathetic
What is the general expected response of parasympathetic drugs?
What AE can occur?
- Expected : stim GI/urinary tract, dec HR and RR
- AE : abd discomfort : NVD, salivation, flushing, sweating, hypotension, bradycardia
What is the general expected response of an anticholinergic drug?
What are the AE ?
- expected : dry secretions, tx asthma, prevent motion sickness, dilate pupils
- AE : tachycardia, CNS stim, urinary retention, dry mouth, dry eye, constipation, heat intolerance –> can’t see pee spit or shit
What is the general expected response of sympathomimetic drugs?
what are the AE?
- expected : inc HR and BP, dec GI/urinary
- AE : hypertensive crisis, dysrhythmias, angina, necrosis from extravasation, hyperglycemia
What is the general expected response of anti-adrenergic drugs?
What are the AE?
- expected : dec HR and BP
- AE : orthostatic hypotension (esp 1st dose), dizzy, weak, HA, reflex tachycardia, nasal congestion
If a pt over dosed on an anticholinergic drug how would they present?
What could this be confused with, and why could that cause the situation to worsen?
- mc present with mentation changes (confusion / delirium), will also have dried secretion, fever, and vision problems
- could be confused with psychosis which would be treated with an anticholinergic - making the problem worse
What are the 4 different adrenergic receptors?
What does each receptor work on?
- Alpha 1 : BLOOD VESSELS (vasoconstriction), eyes, male sex organs, prostatic capsule and bladder
- Alpha 2 : nerve terminals, reg NT release
- Beta 1 : HEART (inc force of contraction, HR, and velocity of electrical impulse) and kidney
- Beta 2 : LUNGS (bronchodilator), uterus relaxation
Catecholamine vs Non-catecholamines
- both are adrenergic
- catecholamine : not PO (rapid degradation), cannot cross BBB, brief duration of action (EX : Epi)
- non-catecholamine : PO, longer 1/2 life / metabolized slower, can cross the BBB
Why would bethanechol be contraindicated in pts with asthma, bowel obstructions, or obstructive urinary retention?
- parasympathetic –> stim smooth muscle in GI and urinary tract and cause bronchoconstriction
- would not want to stimulate a bm or urination if there is an obstruction present –> risk of perforation
Why does atropine have similar effects to sympathomimetic drugs?
b/c it blocks ACh to induce SX of fight or flight
What are anticholinergic drugs contraindicated in pts with glaucoma
they cause pupil dilation which inc intra-ocular pressure
What is the antidote for an anticholinergic over dose?
physostigmine - cholinesterase inhibitor
What receptors does epinephrine work on?
What effect does it have?
- Alpha 1 & 2, Beta 1 & 2
- stimulates / activates all of them
What is the DOC for anaphylaxis?
Epinephrine
Why is reflex tachycardia a concern with prazosin?
- anti-adrenergic that specifically inhibits alpha receptors
- the vasodilation to dec BP can cause the HR to inc bc it is trying to compensate for the quick drop in BP
Why would nasal congestion be a SE of prazosin?
- anti-adrenergic : specifically blocks alpha = vasodilation
- nasal congestion is caused by vasodilation of vessels in the nose
Why is it important to wean a pt who is coming off of propranolol?
- anti-adrenergic : specifically blocking beta
- blocks sympathetic stimulation to the heart –> if suddenly stop the med it can cause rebound tachycardia
- the rebound tachycardia can be serious enough to cx HTN / MI
