Pharma: ANS pt 1- Sympathetic nervous system

autonomic system is also known as the ____ system

visceral

the ANS acts on __*_____*__ and _____

smooth muscles, glands

SNS and PNS acts on the same organs but produces ____ responses

opposite

SNS is also called the ____ system

adrenergic

NTs in the SNS system

norepinephrine, epinephrine

the 4 adrenergic receptors

alpha 1, alpha 2, beta 1, beta 2

synonyms for adrenergic agonists:

sympathomimetics

synonym for adrenergic antagonists

adrenergic blockers, sympatholytics

dilate pupils

sympathetic response

dilate bronchioles

sympathetic response

increase heart rate

sympathetic response

constrict blood vessels

sympathetic response

relax smooth muscles and GI tract

sympathetic response

relax bladder muscle

sympathetic response

relaxes uterine muscles

sympathetic response

constricts pupils

parasympathetic response

constricts bronchioles and increase secretions

parasympathetic response

decrease heart rate

parasympathetic response

dilate blood vessels

parasympathetic response

increase peristalsis

parasympathetic response

constricts bladder

parasympathetic response

increase salivation

parasympathetic response

where are alpha 1 receptors located?

blood vessels, eyes, bladder, prostate

where are alpha 2 receptors located?

postganglionic sympathetic nerve endings

where are beta 1 receptors located?

heart, kidneys

where are beta 2 receptors found?

smooth muscles of lung and GI tract, liver, uterine muscles

alpha 1 physiological responses

increase heart contraction force, vasoconstriction increases BP, mydriasis occurs, decrease salivary gland secretion, urinary bladder relax, urinary sphincter contraction increases

alpha 2 physiological responses

inhibits release of norepinephrine, vasodilation, decrease BP, decrease GI motility and tone

beta 1 physiological responses

increase heart rate and force of contraction, increases renin secretion, increase BP

beta 2 physiological responses

dilate bronchioles, promote GI and uterine relaxation, increase blood glucose through glycogenolysis in liver, increase blood flow in skeletal muscles

Other adrenergic receptors

dopaminergic

where are dopaminergic receptors located?

renal, mesenteric, coronary, cerebral arteries

what NT stimulates dopaminergic receptors?

dopamine

What response when dopaminergic response is stimulated?

vasodilation, increase blood flow

Transmitters are inactivated by:

1) reuptake of transmitters back into neuron (nerve cell terminal)

2) enzymatic transformation (degradation)

3) diffusion away from receptor

enyzmes that inactivate norepinephrine:

monoamine oxidase (MAO), catechol-O-methyltransferase (COMT)

monoamine oxidase (MAO) is _____ the neuron

inside

catechol-O-methyltransferase (COMT) is _____ the neuron

outside

Example of mixed-acting sympathomimetic

pseudophedrine

pseudoephedrine acts indirectly by

stimulating the release of a norepinephrine from the nerve terminals

pseudoephedrine acts directly on

the alpha-1 and beta-1 receptors

T/F: Pseudoephedrine is not as potent a vasoconstrictor as epinephrine.

TRUE

______, like epinephrine, increases heart rate

pseudoephedrine

The risk of ___ stroke and ___ crisis is less with pseudoephedrine.

hemorrhagic, hypertensive

T/F: Pseudoephedrine is an over-the-counter, but is not controlled.

FALSE- it is controlled

What does pseudoephedrine relieve?

nasal and sinus congestion without rebound congestion

Pseudoephedrine contradictions:

hypertension, closed-angle glaucoma, bronchitis, emphysema, urinary retention, use in caution with diabetes mellitus

catecholamines

chemical structures of a substance, either endogenous or synthetic, that can produce a sympathomimetic response

example of endogenous catecholamines

epinephrine, norepinephrine, dopamine

synthetic catecholamines

isoproterenol, dobutaminen

noncatecholamines examples

phenylephrine, metaproterenol, albuterol

What stimulates adrenergic receptors?

noncatecholamines

T/F: Most noncatecholamines have a longer duration of action than the endogenous or synthetic catecholamines.

TRUE

What adrenergic sites does epinephrine act on?

alpha-1, beta-1, beta-2

Is epinephrine selective or non-selective?

non-selective

Epinephrine affects:

increase BP, pupil dilation, increase HR, bronchodilation

What condition is epinephrine used for?

anaphylactic shock

How does epinephrine help anaphylactic shock?

increase BP, HR, and airflow through lungs

Epinephrine onset is ____.

RAPID

How can epinephrine be administered?

IM, IV, (endotracheal tube) ETT

T/F: epinephrine can be given PO and SQ

FALSE

Epinephrine is used to treat anaphylaxis and is a potent ____

inotropic

National regulatory measures control pseudoephedrine drug sales with individual limits of __ g/day and __ g within 30 days

3\.6 g/day, 9g within 30 days

Decongestants have an ____ effect.

additive

____ blockers antagonize the action of epinephrine.

Beta

____ and ____ intensify and prolong effect of epinephrine.

TCAs, MAOIs

Epinephrine: Side Effects and Adverse Reactions

* hypertension
* tachycardia and dysrhythmia
* palpitations and restlessness
* tremors
* dizziness
* urinary retention
* nausea and vomiting
* dyspnea
* pulmonary edema

Albuterol sulfate is selective for _____ receptors.

beta-2

What does albuterol sulfate do?

relaxes bronchial smooth muscle and bronchodilation to prevent and treat bronchospasm

A client with asthma may tolerate ___ better than isoproterenol.

albuterol

Isoproterenol activates which adrenergic receptors?

beta-1, beta-2

Albuterol sulfate route of administration:

PO, inhalation

Albuterol sulfate: common side effects

tremors, headaches, nervousness

____ may inhibit the action of albuterol.

beta antagonists (beta blockers)

Albuterol sulfate activates beta-2 receptors in the smooth muscles of the ___ and ___.

lungs, uterus

High doses of albuterol may affect beta-1 receptors, causing an increase in _____.

HR

other side effects of albuterol:

tachycardia, palpitations, dizziness, dysrhythmia, nausea, vomiting, urinary retention

Epinephrine half-life:

less than 5 min (IV)

Epinephrine is metabolized in the __ and excreted in the __.

liver, urine

Central-acting alpha antagonists work directly on part of the ____ that controls ____.

brain, BP

Selective alpha2-adrenergic agonists that are used primary to treat hypertension:

clonidine, methyldopa

clonidine: side effects/adverse affects

bradycardoa, hypotension, sedation, dry mouth at very low doses

Why is methyldopa not used as much as antihypertensives?

Other hypertensives have fewer side effects

central-acting alpha agonists: side effects/adverse reactions

headache, nasal congestion, drowsiness, nightmares, constipation, edema, ejaculation dysfunction, elevated hepatic enzymes may occur

adrenergic antagonists synonyms

“adrenergic blockers”, “sympatholytics”

What do adrenergic antagonists do?

block effects of norepinephrine and epinephrine

What receptors does adrenergic antagonists effect?

alpha1, beta1, beta2

alpha-adrenergic antagonists are also known as

“alpha blockers”

alpha-adrenergic antagonists are both

selective and non-selective

alpha-adrenergic antagonists physiologic effects:

promote vasodilation, decrease BP

alpha-adrenergic antagonists: indications

people with peripheral vascular disease, Benign Prostatic Hyperplasia (BPH)

alpha-adrenergic antagonists may cause what condition?

orthostatic hypotension

selective alpha-adrenergic antagonists drugs

* phenatolamine mesylate
* doxazosin mesylate
* prazosin HCL
* terazosin HCL

non-selective alpha-adrenergic antagonists drugs

* phenoxybenzamine
* phentolamine
* tolazoline

beta-adrenergic antagonist are useful in treating:

mild to moderate hypertension, angina, heart failure, myocardial infarction

beta-adrenergic antagonist: physiologic effects

decreases HR, decrease BP, bronchoconstriction

beta-adrenergic antagonist: contraindications

asthma

propranolol hydrochloride is the first beta blocker prescribed to treat __*___, ,*__ and ___

angina, cardiac dysrhythmia, hypertension, heart failure

propranolol hydrochloride is used to treat what condition?

migraine prohpylaxis

propranolol hydrochloride had many side effects due to _____ response (blocking beta 1 and 2)

non-selective