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Functions of Parasympathetic Nervous
System (cholinergic nervous system)
Rest and Digestion Conserves Energy Restore Resources Cardiac Deceleration Increase GI Activity TERM 2
Functions of Sympathetic Nervous System
(adrenergic)
DEFINITION 2 Fight or Flight response Decreased GI motility* Increased heart rate* TERM 3
Three Catecholamines Naturally Occurring in
Body*
DEFINITION 3 Epinephrine Norepinephrine Dopamine TERM 4
receptor activation response
DEFINITION 4 Mostly excitatory, except for intestinal relaxation TERM 5
1, 2, 1, and 2 are receptors of which nervous
system?
DEFINITION 5 Sympathetic
Muscarinic and nicotinic are receptors of
which nervous system?
Parasympathetic TERM 7
Receptor activation response
DEFINITION 7 Inhibitory, except for cardiac cells TERM 8
Cholinergic (parasympathetic) drugs act as
mediators of the ______ nervous system. Ex:
_______
DEFINITION 8 parasympathetic Bethanechol TERM 9
Adrenergic drugs are mediators of the
__________ nervous system. Ex: ______
DEFINITION 9 sympathetic norepinephrine TERM 10
Cholinergic blocking drugs block the action of
the _______ nervous system Ex: ______
DEFINITION 10 Parasympathetic Atropine
Prominent Cholinergic and Anticholinesterase
Drugs (4) (Blueprint)
Urecholine/prostigmin/tacrine/physostigmine (anticholinesterase) TERM 17
Therapeutic uses for muscarinic agonists (4)
DEFINITION 17 Stimulating the intestine and bladder postoperatively (increase peristalsis and urination) Stimulating the bladder for clients with spinal cord injuries and urinary retention Lower intraocular pressure in clients with glaucoma Promoting salivation and sweating TERM 18
SLUDGE DUMBELS (effects of muscarinic
agents)
DEFINITION 18 Salivation or sweating Diarrhea Lacrimation Urination Urination Miosis Diarrhea Bronchoconstriction Gastrointestinal Upset Emesis or eye miosis Eyes: Miosis or emesis Lacrimation Salivation TERM 19
Neuromuscular Blocking Agents
DEFINITION 19 Succinylcholine (Anectine) Mivacurium (Mivacron) Atracurium (Tracrium) Cisatracurium (Nimbrex) Rocuronium (Zemuron) Vecuronium (Norcuron) Doxacurium (Nuromax) Pancuronium (Pavulon) Pipercuronium (Arduran) Tubocurarine TERM 20
bethanechol (Urecholine) How does it work?
DEFINITION 20 Stimulation of parasympathetic nervous system./ Predominant muscarinic action, especially on bladder and GI tract.
bethanechol (Urecholine) antidote
Atropine-betchanechol is a cholinergic, atropine is an anticholinergic TERM 22
bethanechol (Urecholine) Indications
DEFINITION 22 Treatment of postoperative and postpartum urinary retention/ Neurogenic atony of the bladder/ Relieve abdominal distention and gastric atony or stasis/ Reflux esophagitis associated with decreased pressure of the lower esophageal sphincter TERM 23
bethanechol (Urecholine) Adverse Effects
DEFINITION 23 Tachycardia/ Flushing/ Headache/ Abdominal cramping/ Diarrhea/ Nausea/ Vomiting/ Salivation/ Tearing/orthostatic hypotension Bronchospasm/diaphoresis TERM 24
Atropine Pharmacological Class
DEFINITION 24 Competitive muscarinic antagonist anticholinergic TERM 25
Atropine Effects On
Eye
DEFINITION 25 Pupil is dilated (mydriasis), ciliary muscle is relaxed (cycloplegia), increased intraocular pressure, photophobia
Atropine Antidote
physostigmine TERM 32
Atropine When to administer?
DEFINITION 32 30-60 minutes before meals for oral preparations TERM 33
Atropine Education
DEFINITION 33 Long-term use should follow consistent dental hygiene program Avoid being exposed to high environmental temperatures Wear dark glasses for a few days to protect eyes Driving a car is to be avoided TERM 34
*Adrenergic nerves contain _____ and ______
DEFINITION 34 Norepinephrine Epinephrine TERM 35
A nurse is preparing to give a dose of
vecuronium (Norcuron) to a client for
neuromuscular blockade so that the client can
tolerate being mechanically ventilated on a
respirator. What other type of medication
would the nurse want to administer
concurrently?
DEFINITION 35 An antianxiety agent
adrenergic effects (3)
Vasoconstriction of arterioles: increased BP Pupil dilation Relaxation of gut TERM 37
adrenergic effects (4) (Blue Print)
DEFINITION 37 Cardiac acceleration and increased contractility (b1) Vasodilation of arterioles supplying skeletal muscle (b2) Bronchial relaxation (b2) Uterine relaxation (b2) TERM 38
Nerves that contain acetylcholine are called
________.
DEFINITION 38 Cholinergic TERM 39
Antimuscarinic drugs block the _________ and
are also called _______ drugs.
DEFINITION 39 muscarinic effects of acetylcholine antichoinergic TERM 40
Two groups of cholinergic drugs available
DEFINITION 40 Direct acting Indirect acting
Direct acting Adrenergic Drugs work at
_________ receptors as _______.
Adrenergic Agonists TERM 47
Examples of naturally occurring direct-acting
adrenergic drugs (3)
DEFINITION 47 Norepinephrine Epinephrine Dopamine TERM 48
Examples of synthetic direct-acting
adrenergic drugs (2)
DEFINITION 48 Isoproterenol Dobutamine TERM 49
Routes of Epinephrine (7)
DEFINITION 49 Intracardiac Subcutaneous Intramuscular Auto-injector Inhalation Intrabronchial Nasal TERM 50
Physiological Effects of Dopamine (2)
DEFINITION 50 (Precursor to norepinephrine) Mesenteric and renal vasodilation Increases perfusion to the splanchnic organ systems
Indirect-acting adrenergic drugs act indirectly
on receptors by triggering release of
____&____, which then active the __ and __
receptors.
norepinephrine, epinephrine , TERM 52
Dual acting adrenergic drugs have ___ and ___
effects. Ex: (5)
DEFINITION 52 Indirect Direct Phenylephrine, mephentermine, metaraminol, methoxamine TERM 53
3 Categories of -adrenergic blocking agents
DEFINITION 53 Noncompetitive, long-acting antagonists Competitive, short- acting antagonists Ergot alkaloids, partial-acting antagonists TERM 54
Peripherally Active Adrenergic Inhibitors
DEFINITION 54 guanethidine (Ismelin) guanadrel (Hylorel) reserpine (Serpalan, Serpasil) TERM 55
Peripheral Active Adrenergic Inhibitors
Indications
DEFINITION 55 Hypertension unresponsive to other modalities
Epinephrine Adverse Effects
Nervousness Restlessness Insomnia Tachycardia Tremors Sweating Increased blood pressure Nausea Vomiting Pallor Weakness TERM 62
Dopamine hydrochloride , notify the
prescriber if pulse is > _____. **
DEFINITION 62 110 TERM 63
**Signs of dopamine extravasation
DEFINITION 63 Coolness and hardness TERM 64
Expected outcome with ergot alkaloids is that
the client will not experience ______.**
DEFINITION 64 Headaches TERM 65
Sign of ergot toxicity
DEFINITION 65 Muscle pain
Use a -adrenergic block cautiously in a client
with ________.
Insulin controlled diabetes mellitus. B blockers blockade the appearance of the warning signs and symptoms of acute hypoglycemia. TERM 67
Withhold dose of atenolol (Tenormin) if heart
rate is irregular or slower than ___.
DEFINITION 67 50 TERM 68
B blocker that affects b1 but not b
receptors
DEFINITION 68 Atenolol TERM 69
Client Education for Levodopa
DEFINITION 69 -Sit up slowly (hypostatic hypotension) -Have intraocular pressure checked -Know s/s of overdose (extrapyramidal effects) -Urine and sweat discoloration is normal -Divide portions of protein into equal amounts throughout the day and decrease pyridoxine TERM 70
Treatment of choice for Myasthenia Gravis
(Blue Print)
DEFINITION 70 Cholinesterase-inhibitor drugs Neostigmine, edrophonium, others
_____ _____ is a progressively debilitating
disorder of the CNS caused by degeneration
of the dopamine-producing neurons which
produces a dopamine/acetylcholine
imbalance.
Parkinson's disease TERM 77
_________ _______ is a progressive and
incurable disease characterized by the loss
of, or decrease in, acetylcholine receptors
caused by an autoimmune process resulting
in skeletal muscle weakness and fatigue.
DEFINITION 77 Myasthenia Gravis TERM 78
Two classes of drugs used in the treatment of
Parkinson's Central _____ activity Affect brain
____ levels
DEFINITION 78 anticholinergic dopamine TERM 79
Enhanced CNS effects can occur when
anticholinergic agents are given concurrently
with ___ and other anticholinergic or other
antimuscarinic medications.
DEFINITION 79 Alcohol TERM 80
Because of its method of secretion, dosage
reduction of amantadine is recommended for
clients with ____ impairment.
DEFINITION 80 Renal
The peripheral _____ inhibitors are used to
diagnose and treat myasthenia gravis and as
an antidote for the curariform effects of
tubocurarine and pancuronium.
Anticholinesterase TERM 82
Carbidopa-levodpa Adverse Effects
DEFINITION 82 Nausea/vomiting Orthostatic hypotension Dyskinesias Hallucinations TERM 83
amantadine (Symmetrel) Adverse Effects
DEFINITION 83 Confusion Livedo reticularis (reddish-blue mottling) Visual hallucinations TERM 84
amantadine (Symmetrel) Pharmacological
class
DEFINITION 84 Dopamine reuptake blocker (increases dopamine release) TERM 85
Sign of carbidopa-levodopa
toxicity
DEFINITION 85 Eyelid spasms or closing
tacrine (Cognex) Typical Dose
Four times a day with titration every six weeks TERM 92
tacrine (Cognex) Contraindiations
DEFINITION 92 hepatic insufficiency TERM 93
baclofen Indications
DEFINITION 93 Reduces pain in spastic clients Treatment of spasticity resulting from multiple sclerosis or from injury to the spinal cord Muscle relaxant TERM 94
baclofen Adverse Effects
DEFINITION 94 Transient drowsiness Vertigo** Confusion Sleepiness Weakness Nausea TERM 95
baclofen Adult Dose
DEFINITION 95 3x daily
Atropine Effects on Skin
Hot and dry, dry mouth, thirsty TERM 97
Atropine Effects on Respiratory System
DEFINITION 97 Bronchial tubes relax, airway widens, less effective than epinephrine TERM 98
Atropine Effects on Cardiovascular System
DEFINITION 98 larger IV doses increase heart rate, little effect on BP reddening of face and neck TERM 99
Atropine Effects on GI
DEFINITION 99 Decrease tone and peristalsis in stomachand small and large intestines TERM 100
Atropine Effects on Urinary Tract
DEFINITION 100 Relaxation of ureters, can cause urinary retention
