Module 2: Stress, Adrenergics, Cholinergics, and Urology

What is the General Adaptation Syndrome (GAS)?

A model describing the body's response to stress, which includes three stages: alarm, resistance, and exhaustion.

Describe the Alarm Stage

•Secretion of hormones and catecholamines to prepare for emergency reaction

Describe the Resistance stage

•Mobilization of body's resources to handle sustained challenge

Describe the exhaustion stage

•Overactivation of adaptive systems

•Leads to stress-related disorders

•Highly individualized

Stress response is regulated by the

Hypothalamic-Pituitary-Adrenal (HPA) Axis

The Hypothalamus is

the control center for hormones including (corticotropin-releasing hormone (CRH))

What hormone is primarily associated with stress responses?

Cortisol, which has widespread effects on the body during extended periods of stress.

What are the primary neurotransmitters involved in the Autonomic Nervous System (ANS)?

Norepinephrine and acetylcholine.

Acetylcholine

A neurotransmitter that enables learning and memory and also triggers muscle contraction in both the parasympathetic and sympathetic nervous system

What is the role of adrenergic agonists in the sympathetic nervous system?

They stimulate adrenergic pathways, triggering the fight or flight response.

What are sympatholytics?

adrenergic antagonists

What are sympathomimetics?

adrenergic agonists

What are Parasympathomimetics?

cholinergic agonists

What are Parasympatholytics?

Anticholinergics

What is Anticholinesterase?

A drug that inhibits acetylcholinesterase

*parasympathetic effect

What are the actions of a Sympatholytic?

Decrease pulse rate

Decrease BP

Constrict Bronchioles

What are the actions of a Parasympatholytic?

Increase pulse rate

Decrease secretions

Decrease GI motility

Increase Urinary retention

Dilate Pupils

What are the four main sympathetic receptors?

Alpha1, Alpha2, Beta1, and Beta2 receptors.

Where are the adrenergic receptor sites?

•Heart, bronchi, GI tract

•Urinary bladder, ciliary eye muscles

Which neurotransmitters do adrenergic agonists stimulate?

Epinephrine and Norepinephrine

What is the prototype drug for sympathomimetics?

Epinephrine, which acts as an adrenergic agonist.

What are the effects of Adrenergic Alpha 1 receptors?

Increases cardiac contractility & Vasoconstriction

Dilates pupils

Increases blood pressure

Increases bladder relaxation & urinary sphincter contraction

What are the effects of Adrenergic Alpha 2 receptors?

Promotes vasodilation & decreased blood pressure

Decreases GI motility & tone

What are the effects of Adrenergic Beta 1 receptors?

Increases cardiac contractility

Increases BP & heart rate

What are the effects of Adrenergic Beta 2 receptors?

Bronchodilation, decreases GI tone & motility

Increases blood flow in skeletal muscles

Relaxes smooth muscles of uterus

Activates liver glycogenolysis & increases blood glucose

What do catecholamines cause?

sympathetic response

What are examples of Endogenous Catecholamines?

•Epinephrine, Norepinephrine, Dopamine

What are some examples of synthetic catecholamines?

Isoproterenol, Dobutamine

What are some examples of non-catecholamines?

•Phenylephrine, Metaproterenol, Albuterol

What are direct-acting Sympathomimetics?

Drugs that directly activate adrenergic receptors

Examples of direct-acting Sympathomimetics

epinephrine and norepinephrine

What are indirect-acting Sympathomimetics?

stimulate the release of norepinephrine from the terminal nerve endings

Example of indirect-acting Sympathomimetics

amphetamine

What are mixed-acting Sympathomimetics?

combine both direct and indirect actions

Examples of mixed-acting Sympathomimetics

ephedrine and pseudoephedrine

adrenergic agonist prototype drug

Epinephrine

Prototype Drug: Action of Epinephrine

-Increases vasoconstriction, BP, heart rate, and cardiac output

-Promotes bronchodilation

What conditions is epinephrine used for?

anaphylactic shock

Bronchospasms

Cardiogenic shock

Cardiac arrest

What are the side effects/ adverse reactions of epinephrine?

Cardiac dysrhythmias, palpitations

Tachycardia, hypertension

Dizziness, headache, paresthesias

Agitation, restlessness, tremors

Hyperglycemia, oliguria

What are the drug interactions of epinephrine?

Beta blockers decrease epinephrine action

Digoxin causes cardiac dysrhythmias

TCAs and MAOIs intensify and prolong effects

Concept of Adrenergic Agonists (CJMM)

Perfusion

Recognize Cues of Adrenergic Agonists (CJMM)

Record baseline vital signs for future comparisons.

Assess patient's drug history.

Analyze cues and prioritize hypothesis of Adrenergic Agonists

Decreased tissue perfusion, hypotension

Generate solutions of Adrenergic Agonists (CJMM)

Patient's vital signs will be within normal range.

Take Action for Adrenergic Agonists (CJMM)

Record patient's vital signs.

Report tachycardia, palpitations, tremors, dizziness, hypertension, increased BP and extra heartbeats

Monitor IV site for infiltration.

Avoid cold medicines and diet pills if hypertensive, diabetic, CAD, or has dysrhythmia.

Avoid continuous use of adrenergic nasal sprays.

What are the effects of adrenergic antagonists at alpha1 receptors(selective)?

They inhibit responses at alpha-adrenergic receptor sites, affecting vasodilation, dizziness, orthostatic hypotension, reflex tachycardia, pupil constriction, suppresses ejaculation.

What are the effects of adrenergic antagonists at beta1 receptors(nonselective)?

Decreases BP and HR

What are the effects of adrenergic antagonists at beta2 receptors(nonselective)?

•Bronchoconstriction

Bronchospasms

Contracts Uterus

Inhibits glycogenolysis (hypoglycemia)

•Use with caution in patients with COPD or asthma

What is the prototype drug for beta1 blockers?

Atenolol, which is an adrenergic antagonist.

What is atenolol used for?

Angina

acute myocardial infarctions

hypertension

What is the onset of atenolol?

1 hour

What is the peak of atenolol?

2-4 hours

What are the two types of cholinergic agonists?

Direct-acting and indirect-acting cholinergic agonists.

What are the types of cholinergic receptors?

nicotinic and muscarinic

Which neurotransmitter does cholinergic agonists mimic?

Mimic parasympathetic neurotransmitter acetylcholine

Where are muscarinic receptors found?

Heart, GI, GU, glands

What is the cholinergic prototype drug?

Bethanechol chloride

What does Bethanechol chloride do?

increase urination

What conditions is Bethanechol chloride used for?

treat non-obstructive urinary retention, neurogenic bladder

What are side effects/adverse reactions of Bethanechol chloride?

•Hypotension, diaphoresis, miosis

•Increased salivation & gastric acid

•Nausea, vomiting, diarrhea, abdominal cramps

What are the life threatening effects of Bethanechol chloride?

Bronchospasm, wheezing

What are the contraindications of Bethanechol chloride?

•Bradycardia, hypotension, peptic ulcer

•Parkinsonism, hyperthyroidism

Urinary tract obstruction

What is the prototype drug for direct-acting cholinergic agonists?

Bethanechol, which promotes bladder contraction.

What are the side effects of anticholinergics?

hot as hare, blind as a bat, mad as a hatter, red as a beet, dry as a bone..... Can't SEE PEE SHIT SPIT!!!

Mydriasis → pupil dilation

(when you're crazy, mad as a hatter, your eyes get BIG)

BRONCHODILATION! (ANTIcholinergics are ANTI bronchospasm)

Anticholinergics are the rhymes... rhymes are weird... we are ANTI rhymes

What is the function of atropine?

It is an anticholinergic that:

Increase heart rate

promotes pupil dilation

decreases GI motility

spasms

peristalsis

salivary and gastric secretions

What are the common uses of atropine?

-Reduce Salivation

-Increase HR during bradycardia

What are the side effects of atropine?

dry mouth, decreased perspiration, blurred vision, tachycardia, constipation, and urinary retention

what are the adverse effects of atropine?

Tachycardia, paradoxical bradycardia, angina, ileus, seizures

Life-threatening: Dysrhythmias, laryngospasm, coma

What is the function of Benztropine?

•Decreases involuntary movement, tremors, & muscle rigidity

What disease is Benztropine used to treat?

Parkinson

What are the side effects of Benztropine?

Anticholinergic side effects, which include dry mouth, blurred vision, constipation, urinary retention, and memory impairment.

What is Tolterodine Tartrate used for?

Decrease urinary frequency, urgency, and nocturia not related to a urinary tract infection (OBS)

What are the side effects of Tolterodine Tartrate?

Drowsiness, dizziness, dry mouth and eyes, headache, blurred vision, confusion, diarrhea, abdominal pain, constipation, dyspepsia, dysuria, fatigue, weight gain, arthralgia, hallucinations, and urinary retention

What are the adverse effects of Tolterodine Tartrate?

Angioedema, chest pain, tachycardia, peripheral edema

What are the life threatening effects of Tolterodine Tartrate?

Life threatening: Stevens-Johnson syndrome

What is the most common cause of lower urinary tract infections (acute Cystitis)?

E. coli

Staphylococcus saprophyticus

Klebsiella

Proteus, Pseudomonas

What is the most common cause of upper urinary tract infections (acute pyelonephritis)?

•Most common organism, E. Coli

What is the prototype drug for urinary antiseptics/biotics?

Trimethoprim

trimethoprim-sulfamethoxazole

What is a urinary analgesic used for?

to relieve the pain, burning, and discomfort caused by infection or irritation of the urinary tract

What are the prototype drugs for Urinary analgesic?

•phenazopyridine hydrochloride

What are the symptoms of acute cystitis in females?

Symptoms may include frequent urination, urgency, and pelvic pain.

What is the prototype drug for urinary anticholinergics?

Solifenacin succinate, which helps relieve urinary frequency and urgency.

What is Solifenacin succinate used to treat?

treat overactive bladder and urinary incontinence

What are the side effects of treat Solifenacin succinate?

-Blurred vision, dizziness, fatigue, cough, pharyngitis, dry mouth

•nausea, vomiting, abdominal pain, constipation, dyspepsia

•cystitis, urinary retention, peripheral edema

What are some adverse effects of solifenacin succinate?

Tachycardia, hypertension, angioedema, GI obstruction

What are some life-threatening adverse effects of solifenacin succinate?

Life threatening!- dysrhythmias, hyperkalemia

What are some contraindications of solifenacin succinate?

•glaucoma, gastroparesis, GI obstruction or urinary retention

What should be monitored in patients receiving urinary anti-infectives?

Vital signs, lab results, and signs of infection.

What is the role of cholinergic antagonists?

They block the action of acetylcholine, affecting various bodily functions.

What is the difference between sympathomimetics and sympatholytics?

Sympathomimetics stimulate the sympathetic nervous system, while sympatholytics inhibit it.

What is the clinical judgment process for adrenergic agonists?

Recognize cues, record baseline vital signs, assess drug history, and monitor for adverse effects.

What are the effects of beta-adrenergic antagonists?

They decrease heart rate and contractility, reducing blood pressure.

What is the significance of the fight or flight response?

It prepares the body to respond to perceived threats through physiological changes.

What are the potential side effects of adrenergic agonists?

Tachycardia, palpitations, tremors, dizziness, and hypertension.

What is the role of indirect-acting cholinergic agonists?

They inhibit the breakdown of acetylcholine, prolonging its action at receptor sites.