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NRS 255 ANS Study Guide QUESTIONS & ANSWERS
LATEST 2025
What physiological responses occur when a beta 1 receptor is stimulated?
__________ heart rate
__________ chronotropic activity
__________ inotropic activity
__________ renin secretion
__________ blood pressure
increased heart rate
Positive chronotropic activity
Positive inotropic activity
Increased renin secretion
Increased blood pressure
What physiological responses occur when a beta 2 receptor is stimulated?
__________ bronchioles
__________ blood vessels
__________ blood pressure
dilation of bronchioles
dilation of blood vessels
decreased blood pressure
What physiological responses occur when an alpha 1 receptor is stimulated?
__________ blood vessels
__________ blood pressure
Constricted blood vessels
Increased blood pressure
What physiological responses occur when an alpha 2 receptor is stimulated?
__________heart rate
__________ blood pressure ******
decreases HR
decreases blood pressure
What physiological responses occur when a beta 1 receptor is blocked?
__________ heart rate
__________ blood pressure
decreased heart rate
decreased blood pressure
What physiological responses occur when a beta 2 receptor is blocked?
__________ bronchioles
constriction of bronchioles
What are common indications for an inhaled Beta 2 selective agent?
Bronchodilation
Which receptor do nasal decongestants activate to result in relief of symptoms?
Alpha 1
A critically ill patient in shock requires cardiovascular support. List 5 drugs that can be used in this event and list if they effect the Alpha 1, Beta 1, beta 2 or a combination of the receptors
a. ______________________________
b. ______________________________
c. ______________________________
d. ______________________________
e. ______________________________
What enzymes are responsible for the breakdown of
Norepinephrine?
a. ____________________
b. ____________________
Acetylcholine?
c. ____________________
a. Monoamine Oxidase
b. Catechol-O-Methyltransferse (COMT)
c. Acetylcholinesterase
Name 5 beta 2 selective adrenergic agents that are used for bronchodilation.
Albuterol (Proventil)
Formoterol (Foridil)
Levalbuterol (Xopenex)
Salmeterol (Serevent)
Pirbuterol (Maxair)
Define mydriasis:
dilation of the pupil of the eye.
Name two diseases that are treated with cholinergic drugs (outside of the ANS)?
a. ____________________________
b. ____________________________
Myasthenia Gravis
Alzheimer's disease
Which drug to treat Alzheimer's dementia is formulated for use in patients that have dysphagia?
Rivastigmine
Which drug to treat Alzheimer's dementia has a once a day dosing regimen?
Donepezil
Explain the difference between direct and indirect cholinergic agents
Diret Cholinergic Agents: Occupy receptor sites for ACh on the membranes of the effector cells of the postganglionic cholinergic nerves
Cause increased stimulation of the cholinergic receptor
Indirect Cholinergic Agents: React with the enzyme acetylcholinesterase and prevent it from breaking down the ACh that was released from the nerve
What class drug can be used to treat BPH and Hypertension?
Alpha Blocker
First dose syncope is an extreme case of ______________ _____________ seen with alpha blockers.
decreased bp
Name 3 non selective beta blockers
a. ___________________
b. ___________________
c. ___________________
Propranolol
Sotalol
Timolol
What actions should a nurse always take before giving a beta blocker?
a. ____________________
b. ____________________
Check BP
Check HR
Hold the drug if the BP is less than 100 and/or the HR is less than 60
Name 6 effects of Beta Blockers
a. _______________________
b. _______________________
c. _______________________
d. _______________________
e. _______________________
What are the major effects of anticholinergic agents? How does this compare to adrenergic agents?
Anticholinergics:
--Block or inhibit the acetylcholine receptors
--Inhibit the parasympathetic nervous system
Response is similar to adrenergic agonist which stimulate the Sympathetic Nervous system
Name the indication for each of the following drugs?
Atropine:
Dicyclomine:
Glycopyrrolate:
Oxybutynin:
Scopolamine:
Atropine: Cholinergic Crisis
Dicyclomine: treatment of irritable bowel syndrome
Glycopyrrolate: adjunct to treatment of ulcers, used to decrease bronchial and GI secretions prior to surgery
Oxybutynin: are used to relax smooth muscle in the bladder to treat incontinence
Scopalamine (Transderm): motion sickness
What are the signs and symptoms of an cholinergic crisis? (8)
fever
tachycardia
dysphagia
ataxia
reduced urine output psychomotor agitation confusion
hallucinations
Describe the physiological actions of stimulation of the sympathetic nervous system.
"Fight or Flight"
Dilates Pupil
Inhibits Salivation
Accelerates Heart
Facilitates Breathing
Inhibits Digestion
Stimulates Release of Glucose
Secretes Epinephrine and Norepinephrine
Relaxes Bladder
Inhibits Sex Organs
Be able to differentiate the alpha one, alpha two, beta one and beta two response.
Neurotransmitters in the SNS and PSNS.
NeuroT of SNS:
Norepinephrine
Direct or indirect acting; drugs that stimulate and mimic the actions of the SNS. Also called sympathomimetics.
Direct acting-bind to the adrenergic receptors and cause the fight or flight response
Indirect acting-increase the amount of norepinephrine at the synapse
--Increasing the release of norepinephrine from the presynaptic neuron
--Decreasing the uptake of norepinephrine
--Inhibiting the destruction of norepinephrine
--MAO Inhibitors
alpha 1 & 2 agonist:
Alpha one agonists are used to treat:
--Hypotension
--Nasal congestion
--Relieve conjunctival congestion
--Mydriasis (dilation) for ophthalmic uses
Alpha two agonists are used to treat:
--Hypertension
beta agonist:
Beta one agonists are used to treat:
Cardiac arrest, heart failure, shock
Beta two agonists are used to treat:
Asthma and pre-term labor
cardioselective beta 1 agonist:
predominantly affect the heart
selective beta 2 agonist:
predominantly affect Lungs
Non-selective:
Effect alpha 1, Beta 1 and Beta 2
Selective:
Affects specific receptors:
Alpha selective (Alpha 1 and Alpha 2)
Alpha 2 selective
Beta Selective (Beta 1 and Beta 2)
B2 selective - predominantly affect Lungs
B1 selective - cardioselective - predominantly affect the heart
block the action of the ANS (by blocking the neurotransmitters) in the SNS division
alpha blocker:
Block the effects of alpha receptors
Vasodilation (used as anti-hypertensive agents)
Miosis (Constriction of the pupil)
Relaxation of smooth muscle at the base of the bladder and in the prostate
Inhibition of ejaculation
beta blocker:
Block the effects of beta receptors
Slows heart rate
Decreases conduction through the heart
Decreases myocardial contractility
Decreases myocardial oxygen demand
Bronchiole constriction
Suppresses the release of renin
non-selective beta blocker:
Affects both B1 and B2 receptors
causes:
Bradycardia (b1)
Decrease in cardiac contractility (b1)
Bronchoconstriction(b2)
anticholinergic:
Cholinergic antagonists
Inhibit parasympathetic impulses
Allows fight-or-flight response to take over
--Dilation of pupils
--Increased HR
--Dries secretions
--Relaxes bronchi
--Decreased GI activity
--Decreases urination
parasympatholytic:
Block the action of the ANS (block the neurotransmitter); work in PSNS
positive and negative inotrope:
SNS agonist drugs to know: phenylephrine (what receptors are stimulated), what are the therapeutic uses of the drug
Alpha 1 Adrenergic Agonist
Oral and intranasal to relieve nasal congestion
Parenteral for hypotension
SNS agonist drugs to know: pseudoephedrine (what receptors are stimulated), what are the therapeutic uses of the drug
Selective Alpha 1 Adrenergic Agonist
Nasal Decongestant
Nursing indications for administration of adrenergic agonists:
Pregnancy category C
Baseline Vital Signs (BP, HR)
Assess peripheral pulses, skin color and capillary refill
Assess respiratory status with breath sounds
Stinging with nasal administration
Take ophthalmic medications at night to minimize blurred vision
Teach subcutaneous injections to patients with Epi-Pen because of allergies
Alpha adrenergic nasal decongestants are contraindicated for:
High BP
Tachycardia
What are the therapeutic uses of administration of alpha one blockers? (4)
Vasodilation (used as anti-hypertensive agents)
Miosis (Constriction of the pupil)
Relaxation of smooth muscle at the base of the bladder and in the prostate
Inhibition of ejaculation
What are the adverse effects of administration of alpha one blockers? (8)
Orthostatic hypotension
First dose phenomenon (Syncopal episode) (Drop in BP common early in therapy,
give low dose of medication early in therapy, give medication at night)
Reflexive tachycardia
Nasal congestion
Impotence (suppression of ejaculation)
Nausea, vomiting, abdominal cramping
Incontinence
Blurred vision
What are nursing implications for administration of alpha 1 blockers?
