Week 3 - Drugs affecting the autonomic nervous system

The nurse caring for a patient who is receiving beta-1 agonist drug therapy needs to be aware that these drugs cause which effect? (SATA)

A. increased cardiac contractility

B. Mydriasis (pupil dilation)

C. Increased heart rate

D. Vasoconstriction

E. Increased GI tract motility

A. Increased cardiac contractility

C. Increased heart rate

Beta-1 = heart, agonist = stimulate

During a teaching session for a patient who is receiving inhaled salmeterol, the nurse emphasizes that the drug is indicated for which condition?

A. Rescue treatment of acute bronchospasm

B. Prevention of bronchospasms

C. Reduction of airway inflammation

D. Long-term treatment of sinus congestion

B. Prevention of bronchospasms

(long-acting beta-2 agonist aka LABA)

For a patient receiving a vasoactive drug such as IV dopamine, which action by the nurse is most appropriate?

A. Monitor the respiratory rate closely to assess the dopamine affect

B. Assess the patient's cardiac function by checking the radial pulse

C. Assess the IV site hourly for possible infiltration

D. Administer the drug by IV boluses according to the patient's blood pressure

C. Assess the IV site hourly for possible infiltration

Dopamine cause intense vasoconstriction, if the IV site infiltrates, the drug can cause severe local tissue damage and necrosis

A patient is receiving dobutamine for shock and is complaining of feeling more "skipping beats" than yesterday. What will the nurse do next?

A. Monitor for other signs of a therapeutic response to the drug

B. Titrate the drug to a higher dose to reduce the palpitations

C. Discontinue the dobutamine immediately

D. Assess the patient's vital signs and cardiac rhythm

D. Assess the patient's vital signs and cardiac rhythm

When a drug is characterized as having a negative chronotropic effect, the nurse knows to expect which effect?

A. Reduced blood pressure

B. Decreased heart rate

C. Decreased ectopic beats

D. Increased force of cardiac contractions

B. Decreased heart rate

chronotropic = heart rate

inotropic = force of contraction

dromotropic = conduction speed

The nurse is monitoring a patient who is receiving an infusion of a beta-adrenergic agonist. Which adverse effects may occur with this infusion? (SATA)

A. Mild tremors

B. Bradycardia

C. Tachycardia

D. Palpitations

E. Drowsiness

F. Nervousness

A. Mild tremors

C. Tachycardia

D. Palpitations

F. Nervousness

Beta-adrenergic agonists stimulate the SNS

The nurse is reviewing the home medications for a newly admitted patient and notes that the patient takes Mirabegron. The nurse will conclude that the patient has which condition?

A. Asthma

B. Overactive bladder

C. Urinary retention

D. Orthostatic hypotension

B. Overactive bladder

Mirabegron (Myrbetriq) is a beta-3 adrenergic agonist used for symptoms of an overactive bladder (OAB); it relaxes the bladder muscles and reduces urinary urgency, frequency, and incontinence

The order reads "Dopamine 3 mcg/kg/min IV". The solution available is 400 mg in 250 mL D5W, and the patient weighs 176 pounds. The nurse will set the IV infusion pump to run at how many mL/hour?

A. 6 mL/hour

B. 9 mL/hour

C. 12 mL/hour

D. 14 mL/hour

B. 9 mL/hour

176 lbs / 2.2 = 80 kg

80 x 3 mcg = 240 mcg/min = 0.24 mg/min → 14.4 mg/hour (desired)

desired (D)/on hand (H) x quantity

When a patient has experienced extravasation of a peripheral infusion of dopamine, the nurse will inject the alpha blocker phentolamine into the area of extravasation and expect which effect?

A. Vasodilation

B. Vasoconstriction

C. Analgesia

D. Hypotension

A. Vasodilation

Works by blocking alpha-1 and alpha-2 receptors

When administering beta blockers, the nurse will follow which guidelines for administration and monitoring?

A. The drug may be discontinued at any time

B. Postural hypotension rarely occurs with this drug

C. Tapering off the medication is necessary to prevent rebound hypertension

D. The patient needs to stop taking the medication at once if he or she gains 3 to 4 lb in a week

C. Tapering off the medication is necessary to prevent rebound hypertension

Remember - start low and go slow!

The nurse providing teaching for a patient who has a new prescription for beta1 blockers will keep in mind that these drugs may result in which effect? (SATA)

A. Tachycardia

B. Impotence (Erectile dysfunction)

C. Bradycardia

D. Bradypnea

E. Fatigue

B. Impotence (erectile dysfunction)

C. Bradycardia

E. Fatigue

Blocked SNS stimulation leads to decreased heart rate, reduced cardiac output and oxygen to muscles and brain leads to fatigue, reduction in blood flow affects erections

A patient who has recently had a myocardial infarction has started therapy with a beta blocker. The nurse explains that the main purpose of the beta blocker for this patient is to:

A. cause vasodilation of the coronary arteries

B. prevent hypertension

C. increase conduction through the SA node

D. protect the heart from circulating catecholamines

D. Protect the heart from circulating catecholamines -

Catecholamines - dopamine, norepinephrine, epinephrine (from the nerve tissues and adrenal glands) increase heart rate, contractility, and the heart's O2 demand

Before initiating therapy with a nonselective beta blocker, the nurse will assess the patient for a history of which condition?

A. Hypertension

B. Liver disease

C. Pancreatitis

D. Asthma

D. Asthma

ex. propranolol, both beta-1 and beta-2 would be affected and bronchoconstriction would trigger asthma attack

A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effects? (SATA)

A. Orthostatic hypotension

B. Increased blood pressure

C. Increased urine flow

D. Headaches

E. Bradycardia

A. Orthostatic hypotension

C. Increased urine flow

D. Headaches

Smooth muscle relaxation in the prostate but if non-selective affect alpha receptors in other parts of the body, vasodilation leads to headaches

A patient has been receiving a dopamine infusion. This morning, while on rounds, the nurse noted that the IV has infiltrated. After stopping the infusion, the nurse prepares to administer phentolamine. The ordered dose is 10 mg, mixed with 10 mL normal saline, then injected into the area of extravasation. The medication is available in vials that contains 5 mg in 2 mL. How many milliliters of phentolamine will the nurse mix with the normal saline?

A. 2 mL

B. 3 mL

C. 4 mL

D. 5 mL

C. 4 mL

D = 10 mg, disregard 10 mL

H = 5 mg/2 mL

D/H x q, 10 x 2 / 5 = 4 mL

The nurse is reviewing the mechanism of action of alpha adrenergic drugs. Adrenergic blockade at the alpha receptors leads to which effects? (SATA)

A. Miosis

B. Vasodilation

C. Vasoconstriction

D. Bradycardia

E. Reduced blood pressure

A. Miosis (pupil constriction)

B. Vasodilation

E. Reduced blood pressure

Alpha blockers may cause reflex tachycardia in response to the lowered BP

The nurse is reviewing the use of bethanechol in a patient who is experiencing postoperative urinary retention. Which statement best describes the mechanism of action of bethanechol?

A. It causes decreased bladder tone and motility

B. It causes increased bladder tone and motility

C. It increases the sensation of a full bladder

D. It causes the sphincters in the bladder to become tighter

B. It causes increased bladder tone and motility

Bethanechol is a cholinergic agonist used to increase gut and bladder motility after surgery

The family of a patient who has recently been diagnosed with Alzheimer's disease is asking about a new drug prescribed to treat this disease. The patient's wife says, "I'm so excited that there are drugs that can cure this disease! I can't wait for him to start treatment." Which reply from the nurse is appropriate?

A. "The sooner he starts the medicine the sooner it can have this effect"

B. "These effects won't be seen for a few months"

C. "These drugs do not cure Alzheimer's disease. Let's talk about what the physician said to expect with this drug therapy"

D. "His response to this drug therapy will depend on how far along he is in the disease process"

C. These drugs do not cure Alzheimer's disease. Let's talk about what the physician said to expect with this drug therapy.

The nurse is giving a dose of bethanechol to a postoperative patient. The nurse is aware that contraindications to bethanechol include which of these? (SATA)

A. Bladder atony

B. Peptic ulcer

C. Urinary retention

D. Hyperthyroidism

E. Cardiac disease

B. Peptic ulcer

D. Hyperthyroidism

E. Cardiac disease

Cholinergic/muscarinic agonist increases PNS activity, smooth muscle of GI and bladder stimulated, leads to increase in stomach acid; pts with hyperthyroid have hypersensitive SNS and sensitive to changes in epi/norepi, can result in arrhythmias; stimulation of m2 (heart) and m3 (body) receptors = bradycardia, hypotension

While at home, a patient took an accidental overdose of a cholinergic drug. He comes to the emergency department with severe abdominal cramping and bloody diarrhea. Which drug would the nurse expect to use to treat this patient?

A. Atropine

B. Pilocarpine

C. Bethanechol

D. Phentolamine

A. Atropine

Atropine is an anticholinergic; pilocarpine and bethanechol are cholinergics, phentolamine is an alpha blocker used for infiltration

The nurse is reviewing the orders for a newly admitted patient and sees an order for edrophonium. The nurse expects that this drug was ordered for which reason?

A. To reduce symptoms and delay the onset of Alzheimer's disease

B. To treat the symptoms of myasthenia gravis

C. To aid in the diagnosis of myasthenia gravis

D. To reverse the effects of nondepolarizing neuromuscular blocking drugs after surgery

C. To aid in the diagnosis of myasthenia gravis

MG = not enough ACh, edrophonium temporarily increases ACh during the Tensilon test

The nurse must watch for symptoms of a cholinergic crisis when giving intravenous cholinergic drugs. Which of these are symptoms of a cholinergic crisis? (SATA)

A. Peripheral tingling

B. Hypotension

C. Dry mouth

D. Syncope

E. Dyspnea

F. Abdominal cramping

B. Hypotension

D. Syncope

E. Dyspnea

F. Abdominal cramping

SLUDGE (salivation/sweating, lacrimation, urination, diarrhea, GI upset, emesis) also muscle weakness, bronchospasm, pupil constriction

The nurse is teaching a patient about the possible adverse effects of donepezil for Alzheimer's disease. Which of these are possible adverse effects? (SATA)

A. Constipation

B. GI upset

C. Drowsiness

D. Dizziness

E. Blurred vision

B. GI upset

C. Drowsiness

D. Dizziness

Alzheimer's = not enough ACh, donepezil = cholinesterase inhibitor increases ACh, activation of PNS leads to increased GI activity and CNS effects (r/t hypotension)

The nurse is providing education about cholinergic-blocking drug therapy to an older adult patient. Which is an important point to emphasize for this patient?

A. Avoid exposure to high temperatures

B. Limit liquid intake to avoid fluid overload

C. Begin an exercise program to avoid adverse effects

D. Stop the medication if excessive mouth dryness occurs

A. Avoid exposure to high temperatures

Anticholinergics dry out/reduce sweating, impaired thermoregulation risk factor for hyperthermia

When assessing the adverse effects of cholinergic-blocking drug therapy, the nurse knows that the patient may experience which drug effect? (SATA)

A. Diaphoresis

B. Dry mouth

C. Dilated pupils

D. Urinary frequency

E. Constipation

B. Dry mouth

C. Dilated pupils

E. Constipation

Can't spit, can't see, can't pee, can't poop

The nurse administering a cholinergic-blocking drug to a patient who is experiencing drug-induced extrapyramidal effects would assess for which therapeutic effect?

A. Decreased muscle rigidity and tremors

B. Increased heart rate

C. Decreased bronchial secretions

D. Decreased GI motility and peristalsis

A. Decreased muscle rigidity and tremors

EPS - tremors, stiffness, restlessness (akathisia), involuntary spasms (dystonia), uncontrollable facial movements (tardive dyskinesia)

During the assessment of a patient about to receive a cholinergic-blocking drug, the nurse will determine whether the patient is taking any drugs that may potentially interact with the anticholinergic, including which of these?

A. Opioids, such as morphine sulphate

B. Antibiotics, such as penicillin

C. Tricyclic antidepressants, such as amitriptyline

D. Anticonvulsants, such as phenobarbital

C. Tricyclic antidepressants (amitriptyline)

TCAs also effect muscarinic and alpha receptors

A patient has been given a prescription for transdermal scopolamine patches for motion sickness for use during a vacation cruise. The nurse will include which instructions? (SATA)

A. "Apply the patch as soon as you board the ship"

B. "Apply the patch 4 to 5 hours before boarding the ship"

C. "The patch needs to be placed on a non-hairy area just behind your ear"

D. "Change the patch every 3 days"

E. "Rotate the application sites"

B. Apply the patch 4-5 hours before boarding the ship

C. The patch needs to be placed on a non-hairy area just behind your ear

D. Change the patch every 3 days

E. Rotate application sites

Anticholinergic medication used to prevent n/v

The nurse is assessing a patient who has a prescription for dicyclomine. Which condition is considered a contraindication to this medication?

A. GI atony

B. Irritable bowel syndrome

C. Overactive bladder

D. Diabetes mellitus

A. GI atony

Dicyclomine = anticholinergic/antispasmodic for IBS - slows GI motility by blocking ACh and relaxing smooth muscle

GI atony = paralysis or very slow GI motility

The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems?

A. Central nervous system

B. Somatic nervous system

C. Sympathetic nervous system

D. Parasympathetic nervous system

C. Sympathetic nervous system

When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased heart rate, which is known as what type of effect?

A. Positive inotropic

B. Antiadrenergic

C. Positive chronotropic

D. Positive dromotropic

C. Positive chronotropic

chronotropic = heart rate

inotropic = force of contraction

dromotropic = conduction speed

When a patient is taking an adrenergic agonist drug, the nurse expects to observe which effect?

A. Decreased heart rate

B. Bronchodilation

C. Constricted pupils

D. Increased intestinal peristalsis

B. Bronchodilation

An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs?

A. Volume restoration

B. Increased cardiac output

C. Decreased urine output

D. Reduced anxiety

B. Increased cardiac output

A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate?

A. "It takes time for a therapeutic response to develop."

B. "She is too young for this particular medication; it will be changed."

C. "She needs to take up to two puffs every 4 hours to ensure adequate blood levels."

D. "This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms."

D. This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms

Salmeterol is long-acting, albuterol is short-acting

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition?

A. Ephedra

B. Epinephrine

C. Phenylephrine

D. Pseudoephedrine

B. Epinephrine

Vasoconstriction (alpha-adrenergic), bronchodilation (beta-adrenergic), inhibits histamine inflammatory response

The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?

A. Dopaminergic

B. Beta-1 adrenergic

C. Beta-2 adrenergic

D. Alpha-1 adrenergic

C. Beta-2 adrenergic

The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the sympathetic nervous system? (SATA)

A. Dilation of bronchioles

B. Constriction of bronchioles

C. Decreased heart rate

D. Increased heart rate

E. Dilated pupils

F. Constricted pupils

G. Glycogenolysis

A. Dilation of bronchioles

D. Increased heart rate

E. Dilated pupils

G. Glycogenolysis (glycogen → glucose)

A patient is going home with a new prescription for the beta-blocker atenolol. The nurse will include which content when teaching the patient about this drug?

A. Never stop taking this medication abruptly.

B. The medication will be stopped once symptoms subside.

C. If adverse effects occur, stop taking the drug for 24 hours, and then resume.

D. Be watchful for first-dose hypotension.

A. Never stop taking the medication abruptly

During rounds, the nurse notes that a dobutamine infusion has extravasated into the forearm of a patient. After stopping the infusion, the nurse follows standing orders and immediately injects phentolamine subcutaneously in a circular fashion around the extravasation site. What is the mechanism of action of the phentolamine in this situation?

A. It neutralizes the extravasated dobutamine immediately.

B. It causes arterial vasoconstriction and reduces pain and swelling at the site.

C. It increases peripheral vascular resistance and reduces arterial pressure at the site.

D. It increases blood flow to the ischemic site by vasodilation to prevent tissue damage.

D. It increases blood flow to the ischemic site by vasodilation to prevent tissue damage

Nonselective alpha-adrenergic antagonist - peripheral vasodilation

A 58-year-old man has had a myocardial infarction, has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol and becomes upset after reading the patient education pamphlet. "I don't have high blood pressure—why did my doctor give me this medicine?" Which explanation by the nurse is correct?

A. "This medication will prevent blood clots that may lead to another heart attack."

B. "Beta blockers will improve blood flow to the kidneys."

C. "This drug is prescribed to prevent the high blood pressure that often occurs after a heart attack."

D. "Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack."

D. Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack.

Reduce the workload and O2 demand of the heart to prevent arrhythmias

The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause serious problems if the patient takes this medication?

A. Angina

B. Hypertension

C. Glaucoma

D. Asthma

D. Asthma

Crossover in inhibition leads to bronchospasm

A patient is experiencing Class II heart failure. The nurse expects which beta blocker to be ordered for this patient?

A. Atenolol

B. Carvedilol

C. Labetalol

D. Esmolol

B. Carvedilol

For chronic heart failure (Class II-IV), carvedilol, metoprolol, or bisoprolol are the beta blockers of choice to improve survival and cardiac function

A patient has a new prescription for tamsulosin as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug?

A. Levothyroxine for hypothyroidism

B. Sildenafil, an erectile dysfunction medication

C. Omeprazole, a proton pump inhibitor

D. Low-dose aspirin for stroke prevention

B. Sildenafil, an erectile dysfunction medication

Both meds cause vasodilation which can lead to hypotension and dizziness

A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect?

A. Orthostatic hypotension

B. Increased blood pressure

C. Decreased urine flow

D. Discolored urine

A. Orthostatic hypotension

Alpha-blockers relax smooth muscle throughout the body leading to vasodilation and hypotension

When monitoring a patient who is taking a cholinergic drug, the nurse will watch for which cardiovascular effect?

A. Bradycardia

B. Tachycardia

C. Vasoconstriction

D. Palpitations

A. Bradycardia

Stimulate PNS, bradycardia, hypotension

The nurse notes in a patient's medication history that the patient is taking pilocarpine. Based on this finding, the nurse interprets that the patient has which disorder?

A. Anticholinergic poisoning

B. Glaucoma

C. Bladder atony

D. Myasthenia gravis

B. Glaucoma

Pilocarpine - cholinergic agonist, lowers intraocular pressure, pupil constriction

A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote?

A. Atenolol

B. Bethanechol

C. Dobutamine

D. Atropine sulfate

D. Atropine sulfate

A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse will teach this patient to look for which therapeutic effect?

A. Decreased pulse rate

B. Abdominal cramping

C. Passage of flatus

D. Decreased urge to void

C. Passage of flatus

The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer's disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil. What is the drug's expected action?

A. Prevents memory loss in later stages.

B. Reverses the course of Alzheimer's disease.

C. Provides sedation to prevent agitation and restlessness.

D. May help to improve the mood and decrease confusion.

D. May help to improve the mood and decrease confusion

Donepezil - cholinesterase inhibitor that increases ACh; used for mild to moderate Alzheimer's

A patient who has been diagnosed with Sjögren's syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect?

A. Reduction of salivation

B. Stimulation of salivation

C. Reduction of gastrointestinal peristalsis

D. Improvement of fine-motor control

B. Stimulation of salivation

Sjögren's syndrome - autoimmune disorder where body attacks tear and saliva glands

xerostomia aka dry mouth

The nurse is about to administer a stat dose of intravenous atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse will monitor the patient closely for which adverse effect?

A. Tachycardia

B. Bradycardia

C. Ectopic beats

D. Cardiac standstill

A. Tachycardia

A patient has a prescription for oxybutynin, an anticholinergic drug. When reviewing the patient's medical history, which condition, if present, would be considered a contraindication to therapy with this drug?

A. Diarrhea

B. Hypertension

C. Neurogenic bladder

D. Uncontrolled angle-closure glaucoma

D. Uncontrolled angle-closure glaucoma

Anticholinergic - pupil dilation - increased intraocular pressure

The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs block the effects of which nervous system?

A. Central nervous system

B. Somatic nervous system

C. Sympathetic nervous system

D. Parasympathetic nervous system

D. Parasympathetic nervous system

A patient has received an accidental overdose of intravenous atropine. Which drug will the nurse prepare to administer?

A. Atenolol

B. Bethanechol

C. Dicyclomine

D. Physostigmine

D. Physostigmine

Physostigmine is a fast-acting, reversible acetylcholinesterase inhibitor used as an antidote for severe anticholinergic toxicity ex. from atropine, scopolamine

The nurse will monitor for which adverse effect when administering an anticholinergic drug?

A. Excessive urination

B. Diaphoresis

C. Dry mouth

D. Pupillary constriction

C. Dry mouth

The nurse is reviewing a patient's medication history and notes that the patient is taking the cholinergic blocker tolterodine. Which is an indication for this medication?

A. Irritable bowel disease

B. Induction of mydriasis

C. Urge incontinence

D. Reduction of secretions preoperatively

C. Urge incontinence

Anticholinergics decrease gut and bladder secretion/motility (antispasmodics)

A patient has been taking tolterodine, but today her prescriber changed her to a newer drug, darifenacin. What advantage does darifenacin have over the tolterodine?

A. The newer cholinergic-blocker drugs are more effective.

B. It helps reduce urinary retention.

C. It can be used in patients with narrow-angle glaucoma.

D. The incidence of dry mouth is much lower with darifenacin.

D. The incidence of dry mouth is much lower with darifenacin

In preparation for eye surgery, the nurse monitors for which desired drug effect in a patient who is receiving a cholinergic-blocking eyedrop medication?

A. Miosis

B. Mydriasis

C. Increased intraocular fluid production

D. Enhanced tear production

B. Mydriasis (pupil dilation)

A patient has a new prescription for the transdermal form of scopolamine. The nurse knows that this form of scopolamine is used for which condition?

A. Angina

B. Chronic pain

C. Hypertension

D. Motion sickness

D. Motion sickness

Scopolamine is an anticholinergic medication used to prevent n/v

The nurse is reviewing the indications for atropine sulfate. Atropine is appropriate for which of these patients? (SATA)

A. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats/min

B. A patient who has suddenly developed symptomatic tachycardia with a heart rate of 180 beats/min

C. A patient with severe narrow-angle glaucoma

D. A patient who is about to have surgery

E. A patient newly diagnosed with myasthenia gravis

F. A patient with anticholinesterase inhibitor poisoning

A. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats/min

D. A patient who is about to have surgery

F. A patient with anticholinesterase inhibitor poisoning

Atropine increases heart rate, anticholinergic effects reduce salivary/respiratory secretions during surgery, counteracts muscarinic stimulation