PHARM CH 4

What is the autonomic nervous system (ANS)?

The ANS is the part of the nervous system that controls involuntary body functions, such as:
Heart rate (HR)

Blood pressure (BP)

Digestion

Breathing

Sweating

Pupil size

💡 Tip: “Auto = automatic = no thinking needed!”

🧠 . 2

What are the two branches of the autonomic nervous system?

Sympathetic Nervous System (SNS) – “Fight or Flight”

Parasympathetic Nervous System (PNS) – “Rest and Digest”

💡 Tip: SNS = Stress, PNS = Peace

🧠 . 3

What is the role of the sympathetic nervous system (SNS)?

It prepares the body for emergencies or stress by:
Increasing HR, BP, and respiratory rate

Dilating pupils

Decreasing GI activity

🧠 . 4

What is the role of the parasympathetic nervous system (PNS)?

It promotes relaxation and normal body maintenance by:
Decreasing HR

Increasing digestion, salivation, and urination

Constricting pupils

💊 . 5

Why is the autonomic nervous system (ANS) important in pharmacology?

Because many medications work by stimulating or blocking the ANS to treat:
Cardiac conditions: hypertension (HTN), angina, arrhythmias, shock

Pulmonary issues: asthma, COPD

Neurological diseases: Alzheimer’s, Parkinson’s

GI/GU disorders: overactive bladder, benign prostatic hyperplasia (BPH)

🧪 . 6

What are the key neurotransmitters involved in the ANS?

Acetylcholine (ACh) – in PNS

Norepinephrine (NE) – in SNS

Epinephrine – from adrenal medulla (SNS)

Dopamine – has dose-dependent effects in SNS

🧪 . 7

What receptors does acetylcholine (ACh) affect in the ANS?

Nicotinic receptors

Muscarinic receptors

(Both are part of the parasympathetic system)

🧪 . 8

What receptors do norepinephrine and epinephrine act on in the ANS?

Alpha receptors

Beta receptors

(Part of the sympathetic system)

🧪 . 9

What receptors does dopamine stimulate and how?

Dopamine affects:
Dopamine receptors at low doses

Beta receptors at moderate doses

Alpha receptors at high doses

💡 Tip: “DA → β → α” as dose increases

📊 . 10

What is the SLUDGE mnemonic used for?

It helps remember anticholinergic side effects (things that get “dried up”):
Salivation ↓

Lacrimation ↓

Urinary retention

Drowsiness/Dizziness

GI upset

Eye dryness / blurry vision

💡 Memory Trick: “SLUDGE dries you out”

📊 . 11

What is the DUMBBELSS mnemonic used for?

It helps remember cholinergic (muscarinic) side effects:
Diarrhea

Urination

Miosis (pupil constriction)

Bradycardia

Bronchospasm

Emesis (vomiting)

Lacrimation

Salivation

Sweating

💡 Memory Tip: “DUMBBELSS = Leaky body”
🔍 . 12

How does the ANS connect to the body from the CNS?

Through two neurons:
Preganglionic neuron (from CNS) → releases ACh

Postganglionic neuron:

SNS: releases norepinephrine (adrenergic)

PNS: releases acetylcholine (cholinergic)

🧠 . 13

What neurotransmitter is released by preganglionic neurons in both SNS and PNS?

Acetylcholine (ACh)

🧠 . 14

What neurotransmitter is released by postganglionic neurons in the sympathetic nervous system?

Norepinephrine (NE)

🧠 . 15

What neurotransmitter is released by postganglionic neurons in the parasympathetic nervous system?

Acetylcholine (ACh)

💊 . 16

What receptors and drug types are associated with the sympathetic nervous system?

Receptors: Alpha-1, Alpha-2, Beta-1, Beta-2

Drug types: Adrenergic agonists & antagonists

💊 . 17

What receptors and drug types are associated with the parasympathetic nervous system?

Receptors: Muscarinic and Nicotinic

Drug types: Cholinergics & Anticholinergics

🧪 . 18

What happens when Alpha-1 receptors are stimulated?

Vasoconstriction → increased blood pressure
🧪 Example drug: Pseudoephedrine

🧪 . 19

What happens when Alpha-2 receptors are stimulated (in CNS)?

CNS vasodilation → lower blood pressure
🧪 Example drug: Clonidine

🧪 . 20

What happens when Beta-1 receptors are stimulated?

Increased heart rate (↑HR)

Increased contractility

🧪 Example drug: Dobutamine

💡 Memory Tip: “Beta-1 = 1 Heart”

🧪 . 21

What happens when Beta-2 receptors are stimulated?

Bronchodilation

Decreased uterine tone

🧪 Example drug: Albuterol

💡 Memory Tip: “Beta-2 = 2 Lungs”

🧪 . 22

What happens when nicotinic receptors are stimulated?

Skeletal muscle contraction

CNS stimulation

🧪 Example drug: Nicotine patch

🧪 . 23

What happens when muscarinic receptors are stimulated?

Smooth muscle contraction

Slower heart rate (↓HR)

Increased GI activity

🧪 Example drugs: Pilocarpine, Bethanechol

🩺 . 1

What vital signs should be evaluated before administering ANS medications?

Heart rate (HR)

Blood pressure (BP)

Respiratory rate (RR)

🩺 . 2

What contraindications should be checked before giving ANS medications?

Asthma

Glaucoma

Benign prostatic hyperplasia (BPH)

🩺 . 3

What other assessments should nurses perform for patients on ANS drugs?

Monitor intake & output (I&O)

Assess neurological status

Assess respiratory effort

🎯 . 4

What are common planning goals for patients on ANS medications?

Demonstrate correct medication use and understanding

Maintain stable vital signs

Recognize side effects early (e.g., dizziness, dry mouth, urinary retention)

💉 . 5

What are key implementation tips for administering ANS medications?

Know when to hold drugs

Hold beta-blockers if HR < 60 or SBP < 100 mmHg

Educate patient to:

Change positions slowly

Avoid other stimulants

Use inhalers/patches properly

Prepare for fall risk due to orthostatic hypotension

💡 Memory Tip: “Check vitals, teach slow moves, watch for falls!”

✅ . 6

What is an example of how to evaluate the effectiveness of an ANS drug?

If Tamsulosin is given for BPH, check if urine flow improves

Monitor for both therapeutic effects and adverse effects

What is the agonist and antagonist for nicotinic receptors, and what are they used for?

Agonist: Nicotine patch → Smoking cessation

Antagonist: None commonly used clinically

💊 . 8

What is the agonist and antagonist for muscarinic receptors, and what are they used for?

Agonist: Pilocarpine → Glaucoma

Antagonist: Atropine → Pre-op secretions, bradycardia

💊 . 9

What is the agonist and antagonist for Alpha-1 receptors, and what are they used for?

Agonist: Phenylephrine → Decongestant

Antagonist: Tamsulosin → BPH

💊 . 10

What is the agonist for Alpha-2 receptors, and what is it used for?

Agonist: Clonidine → Hypertension, ADHD

No common antagonist

💊 . 11

What is the agonist and antagonist for Beta-1 receptors, and what are they used for?

Agonist: Dobutamine → Shock, CHF

Antagonist: Metoprolol → HTN, arrhythmias

💡 Tip: Beta-1 = 1 Heart

💊 . 12

What is the agonist and antagonist for Beta-2 receptors, and what are they used for?

Agonist: Albuterol → Asthma

Antagonist: Propranolol (nonselective) → HTN (but may worsen asthma)

💡 Tip: Beta-2 = 2 Lungs. Blocking it = bad for breathing!

What are catecholamines, and what are the 3 examples you need to know?

Catecholamines are adrenergic agonists (activate alpha & beta receptors).
Examples:
Epinephrine

Norepinephrine

Dopamine

💊 . 14

What receptors does epinephrine stimulate, and what are its uses?

Alpha: Vasoconstriction → ↑BP

Beta-1: ↑HR, ↑Contractility

Beta-2: Bronchodilation

Uses: Anaphylaxis, cardiac arrest, asthma, shock, local vasoconstriction

💊 . 15

What are key nursing considerations for epinephrine?

Avoid injecting into fingers, nose, ears, toes, genitals

Monitor HR, BP, RR

If IV: monitor IV site for extravasation (leakage)

Discard discolored solutions

💡 Tip: Epinephrine = emergency alert! Monitor closely.

💊 . 16

What are the common side effects of epinephrine?

Tachycardia

Hypertension

Restlessness, tremor

Angina

Hyperglycemia

📘 . 17

How do you teach a patient to use an EpiPen?

Inject into outer thigh

Hold for 10 seconds

Seek emergency help immediately

Store at room temperature and protect from light

Effects wear off in 15–20 minutes

What is the prototype drug for nicotinic receptor agonists?

Nicotine Patch

🔬 . 2

What is the mechanism of action (MOA) of the nicotine patch?

It stimulates nicotinic acetylcholine receptors in the brain, mimicking the effects of nicotine to reduce withdrawal symptoms during smoking cessation.

💊 . 3

What are the indications for using a nicotine patch?

To aid in smoking cessation

To prevent nicotine withdrawal symptoms

⚠️ . 4

What precautions should nurses take when handling the nicotine patch?

It is a hazardous drug — use gloves when handling

Check for allergy to adhesives

⚠️ . 5

What conditions are contraindicated when using a nicotine patch?

Avoid in patients with:
Recent myocardial infarction (MI)

Severe arrhythmias

Worsening angina

Peripheral vascular disease (PVD) or vasospastic disease

⚠️ . 6

What special considerations apply when a patient is taking MAOIs while using a nicotine patch?

Patients taking monoamine oxidase inhibitors (MAOIs) need lower doses of nicotine.

⚠️ . 7

What are some sleep-related side effects of the nicotine patch, and how should they be managed?

It may cause vivid dreams or sleep disturbances. Solution: remove the patch before bedtime if needed.

⚠️ . 8

How can skin irritation be prevented when using the nicotine patch?

Rotate application sites daily to avoid irritation.

💥 . 9

What are common side/adverse effects of the nicotine patch?

Nausea

Dizziness

Insomnia

Palpitations / rapid heartbeat

Nicotine overdose symptoms: vomiting, weakness, headache, anxiety

💡 Tip: Nicotine stimulates the nervous system—watch for signs of “too much buzz.”

🩺 . 10

What are the administration instructions for the nicotine patch?

Apply one patch daily at the same time

Remove old patch before applying new one

Press and hold for 10 seconds to secure

Dispose of patch in childproof container

Do not use with other nicotine products (gum, vape, etc.)

📘 . 11

What health teaching should be given to patients using a nicotine patch?

Completely stop smoking before starting the patch

Educate on signs of nicotine overdose

Keep patches away from children and pets

What is the prototype drug for muscarinic receptor agonists?

Pilocarpine

🔬 . 2

What is the mechanism of action (MOA) of Pilocarpine?

Stimulates muscarinic receptors in the eye → contracts the ciliary muscle → improves aqueous humor drainage → reduces intraocular pressure
🧠 This is why it’s used in glaucoma—to relieve fluid buildup inside the eye.

💊 . 3

What is Pilocarpine used to treat?

Glaucoma

⚠️ . 4

What nursing actions minimize systemic absorption of Pilocarpine?

Apply light pressure to the lacrimal sac for 2 minutes after administration.

⚠️ . 5

What should patients do before using Pilocarpine eye drops?

Remove contact lenses before use.

💥 . 6

What side effects of Pilocarpine can be remembered using the DUMBBELSS mnemonic?

Diarrhea

Urination

Miosis (pupil constriction)

Bradycardia

Bronchospasm

Emesis

Lacrimation

Salivation

Sweating

💡 Memory Tip: “Cholinergic = everything gets activated and wet!”

💥 . 7

What other side effects may occur with Pilocarpine?

Lightheadedness

Nausea

Abdominal cramps

🩺 . 8

How should Pilocarpine eye drops be administered?

Avoid touching the applicator to the eye

Monitor for systemic cholinergic effects (rare but serious)

📘 . 9

What should patients be taught about driving while using Pilocarpine?

Avoid driving at night due to pupil constriction, which impairs night vision.

📘 . 10

What symptoms should patients report while on Pilocarpine?

Increased eye watering

Light sensitivity

Breathing difficulties (possible bronchospasm)

What is the prototype drug for muscarinic receptor antagonists (anticholinergics)?

Atropine

🔬 . 2

What is the mechanism of action (MOA) of Atropine?

Blocks muscarinic receptors, which leads to:
↓ Salivary and bronchial secretions (low dose)

↑ Heart rate and pupil dilation (moderate dose)

↓ GI and urinary motility and ↓ acid secretion (high dose)

💡 Tip: Anticholinergic = blocks “rest & digest” → SNS takes over

💊 . 3

What are the indications for Atropine?

Pre-op drying of secretions

Bradycardia

Antidote for organophosphate or mushroom poisoning

⚠️ . 4

What are key nursing considerations for giving Atropine?

Use caution in elderly → may cause confusion or agitation

Avoid use in hot environments due to risk of heatstroke

Antidote for atropine overdose is physostigmine

💥 . 5

What is the mnemonic to remember atropine’s side effects?

“Red as a beet” – flushed skin

“Dry as a bone” – dry mouth

“Blind as a bat” – blurred vision

“Mad as a hatter” – delirium/confusion

💡 Tip: Classic signs of anticholinergic toxicity!

💥 . 6

What are other common side/adverse effects of Atropine?

Urinary retention

Constipation

Tachycardia

🩺 . 7

What are the administration considerations for Atropine?

Monitor:

Heart rate

Urinary output

GI motility

Give IV slowly

Watch for cardiac rhythm changes

📘 . 8

What health teaching should you give to a patient taking Atropine?

Encourage frequent oral hygiene for dry mouth

Report urinary retention or heat intolerance

Be aware it can worsen BPH symptoms in men

What are the prototype drugs for Alpha-1 Adrenergic Agonists?

Pseudoephedrine

Phenylephrine

🔬 . 2

What is the mechanism of action (MOA) of Alpha-1 agonists?

Stimulate alpha-1 receptors → vasoconstriction in nasal mucosa → ↓ mucosal swelling → increased airway patency
💡 Tip: Think “tight blood vessels = clearer nose”

💊 . 3

What are the indications for Alpha-1 agonists like pseudoephedrine and phenylephrine?

Nasal congestion (from URI or allergies)

Phenylephrine is often used instead of pseudoephedrine due to abuse potential (meth production)

⚠️ . 4

What patients should avoid using Alpha-1 agonists?

Those with:
Hypertension

Glaucoma

BPH

MAOI use (risk of hypertensive crisis)

⚠️ . 5

What should the nurse monitor when a patient is taking Alpha-1 agonists?

Blood pressure (BP)

Urinary retention

Central nervous system stimulation (restlessness)

💥 . 6

What are the common side/adverse effects of Alpha-1 agonists?

Rebound congestion (if nasal spray is used >3 days)

Restlessness and excitability

Headache

Bradycardia (reflex)

💡 Tip: Spray too long = rebound stuffy nose

🩺 . 7

What are key administration tips for Alpha-1 agonists?

Avoid giving within 2 hours of bedtime (may cause insomnia)

Educate about legal limits of pseudoephedrine sales (meth precursor)

📘 . 8

What should patients be taught when taking Alpha-1 agonists?

Limit nasal spray use to <3 days

Avoid other stimulants (like caffeine or other decongestants)

Report:

Palpitations

Urinary hesitancy

Vision changes

What is the prototype drug for Alpha-1 Adrenergic Antagonists?

Tamsulosin

🔬 . 2

What is the mechanism of action (MOA) of Tamsulosin?

Blocks alpha-1 receptors in the smooth muscle of the bladder neck and prostate, causing:
Muscle relaxation

Improved urinary flow

💡 Tip: “Tam” lets the pee come out

💊 . 3

What is Tamsulosin used to treat?

Benign prostatic hyperplasia (BPH)

→ Relieves urinary symptoms like difficulty starting urine stream and weak flow

⚠️ . 4

What drugs should not be combined with Tamsulosin?

Other alpha-blockers → ↑ risk of severe hypotension

CYP3A4 inhibitors (e.g., ketoconazole) → ↑ blood levels and side effects

💡 Tip: Too many blockers = blood pressure crash

⚠️ . 5

What should the nurse monitor when a patient starts Tamsulosin?

Orthostatic blood pressure (especially after first dose)

Watch for dizziness or fainting

💥 . 6

What are the common side effects of Tamsulosin?

First-dose hypotension

Dizziness

Fatigue

Weakness

💡 Memory Tip: “Tam-falls-u-soon” = fall risk from low BP

🩺 . 7

What are the administration instructions for Tamsulosin?

Take at the same time daily, typically 30 minutes after the same meal

Monitor for dizziness or falls, especially in elderly patients

📘 . 8

What health teaching should be given to a patient on Tamsulosin?

Rise slowly from sitting or lying positions

Report dizziness, fainting, or worsening urinary symptoms

Continue follow-up appointments to monitor prostate status

💊 . 1

What is the prototype drug for Alpha-2 Adrenergic Agonists?

Clonidine

🔬 . 2

What is the mechanism of action (MOA) of Clonidine?

Stimulates alpha-2 receptors in the central nervous system (CNS) →
↓ Sympathetic outflow →
↓ Heart rate, ↓ Blood pressure, ↓ Peripheral resistance
💡 Memory Tip: Alpha-2 “Calms You”

💊 . 3

What are the main indications for Clonidine?

Hypertension (HTN)

Attention-deficit hyperactivity disorder (ADHD)

Off-label uses: opioid withdrawal, menopausal symptoms

⚠️ . 4

What should nurses monitor in patients taking Clonidine?

Blood pressure (BP)

Heart rate (HR)

⚠️ . 5

What are special safety concerns with stopping Clonidine?

Do not stop suddenly → may cause rebound hypertension (dangerously high BP)

💡 Tip: Clonidine must be “clung to”—no sudden stopping!

⚠️ . 6

What patients should use Clonidine with caution?

Elderly patients

People with depression

💥 . 7

What are the common side effects of Clonidine?

Hypotension

Bradycardia

Sedation

Rebound hypertension if stopped abruptly

Depression

🩺 . 8

What are the administration options for Clonidine?

Oral tablets

Transdermal patch (changed weekly)

→ Rotate sites, avoid heat over patch

📘 . 9

What teaching should be given to patients taking Clonidine?

Take at the same time daily

Do not stop abruptly

Avoid alcohol and hot environments (can increase BP risk)

Watch for mood changes or drowsiness

What is the prototype drug for Beta-1 Adrenergic Agonists?

Dobutamine

🔬 . 2

What is the mechanism of action (MOA) of Dobutamine?

Stimulates Beta-1 receptors in the heart, which leads to:
↑ Heart rate

↑ Contractility

↑ Conduction speed

→ Result: Improved cardiac output

💡 Tip: “Do-better-mine” = helps the heart pump better

💊 . 3

What are the indications for Dobutamine?

Cardiogenic shock

Acute heart failure

Hypoperfusion with low cardiac output

⚠️ . 4

What are key nursing considerations when administering Dobutamine?

IV only – must be diluted properly

Requires continuous monitoring of:

ECG

Blood pressure

Urine output

Cardiac output

⚠️ . 5

When should Dobutamine be used with caution?

In patients with myocardial infarction (MI) or unstable angina

→ Can increase oxygen demand

In patients with dysrhythmias

💥 . 6

What are the common side effects of Dobutamine?

Tachycardia

Hypertension

Palpitations

Dyspnea

Chest pain

Arrhythmias

💡 Memory Tip: “Beta-1 agonist = heart races!”

🩺 . 7