PHARM CH 4 PT 1

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

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 key implementation tips for administering ANS medications?

Han do you hold drugs,, what do pyu educate patients on/prepare for

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 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?

WHAT TO AVOID, MONITOR AND DISCARD

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 minute