NUR 354 Exam 1

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What are the two major divisions of the nervous system?

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What are the two major divisions of the nervous system?

-Central nervous system (CNS) -Peripheral nervous system (PNS)

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What are the two primary components of the CNS?

-Brain -Spinal cord

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What are the two subdivisions of the peripheral nervous system?

-Somatic nervous system (controls voluntary movements) -Autonomic nervous system (controls involuntary responses)

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What are the two subdivisions of the autonomic nervous system?

-Sympathetic division -Parasympathetic division

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What is the characteristic set of signs and symptoms produced when the sympathetic nervous system is activated?

Fight-or-flight response

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What is the set of signs and symptoms produced when the parasympathetic nervous system is activated?

Rest-and-digest response

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What are signs and symptoms are shown when the sympathetic nervous system is activated?

-Dilates pupils -Inhibits salivation -Accelerates heart rate, contractility -Dilates bronchioles -Stimulates release of glucose

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What are signs and symptoms are shown when the parasympathetic nervous system is activated?

-Constricts pupils -Stimulates salivation -Slows heart rate, contractility -Constricts bronchioles

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What is the primary neurotransmitter of the parasympathetic nervous system?

Acetylcholine (ACh)

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What is the role of acetylcholinesterase (AChE)?

An enzyme that destroys acetylcholine (ACh)

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What are the receptors of the parasympathetic nervous system called?

Cholinergic

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What are drugs that inhibit the parasympathetic nervous system?

Anticholinergic

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What are examples of acetylcholinesterase (AChE)/cholinesterase inhibitors?

-Donepezil (Aricept) -Galantamine (Razadyne) -Rivastigmine (Exelon)

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What is the MOA of donepezil (Aricept)?

Increases the amount of acetylcholine (ACh) by inhibiting acetylcholinesterase (AChE)

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What is the indication of acetylcholinesterase (AChE)/cholinesterase inhibitors?

Alzheimer's disease

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What is the indication of bethanechol (Urecholine)?

Urinary retention

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What is the MOA of bethanechol (Urecholine)?

Binds to cholinergic receptors to produce the rest-and-digest response that relaxes the bladder

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What is a cholinergic crisis?

Symptoms that occur when a patient is given too much cholinergic medication

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What are symptoms of a cholinergic crisis?

Salivation Lacrimation Urination Defecation Gastrointestinal distress Emesis

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What is the MOA of anticholinergics?

Blocks the effect of acetylcholine and causes sympathetic nervous system actions to predominate

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What is the indication of ipratropium (Atrovent) and tiotropium (Spiriva)?

-Asthma -COPD

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What is the indication for scopolamine (Transderm-Scop)?

-Motion sickness -Adjunct to anesthesia

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What is the indication for atropine (AtroPen)?

-Increase heart rate -Dilate pupils

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What is the indication for dicyclomine (Bentyl)?

Irritable bowel syndrome

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What is the indication for benztropine (Cogentin)?

Parkinson's disease

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What are therapeutic uses of anticholinergics?

-GI disorders (IBS) -Ophthalmic procedures -Cardiac rhythm abnormalities (bradycardia) -Anesthesia adjuncts -Asthma and COPD -Overactive bladder (urge incontinence) -Parkinson's disease

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What is physostigmine used for?

Too much atropine (anticholinergic)

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What is used as a reversal agent in the event that a patient has too much of the effects of an anticholinergic?

Physostigmine

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What is the primary neurotransmitter of the sympathetic nervous system?

Norepinephrine

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What are other neurotransmitters of the sympathetic nervous system?

-Dopamine -Epinephrine

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What are the receptors of the sympathetic nervous system called?

Adrenergic receptors

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What are the two types of adrenergic receptors?

-Alpha receptors -Beta receptors

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What are the subdivisions of alpha receptors and beta receptors?

-Alpha-1/α1 -Alpha-2/α2 -Beta-1/β1 -Beta-2/β2 -Beta-3/β3

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What are responses of alpha-1/α1 adrenergic agonist receptor?

-Constriction of blood vessels -Dilation of pupils

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What is an example of an alpha-1/α1 adrenergic agonist?

Phenylephrine (Neo-Synephrine)

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What is the indication of phenylephrine (Neo-Synephrine)?

-Hypotension -Nasal congestion -Ophthalmic hyperemia

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What is a response of alpha-2/α2 adrenergic agonist receptor?

Inhibition of release of norepinephrine (puts the "brakes on") and prevents vasoconstriction

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What is an example of an alpha-2/α2 adrenergic agonist?

Clonidine (Catapres, Kapvay)

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What is the indication of clonidine (Catapres, Kapvay)?

-Hypertension -ADHD -Pain

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What is a response of beta-1/β1 adrenergic agonist receptor?

Increased heart rate and force of contraction (directly) and will indirectly increase blood pressure

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What is an example of a beta-1/β1 adrenergic agonist?

Dobutamine

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What is the indication of Dobutamine?

-Bradycardia -Cardiac stimulant (heart failure) -Shock

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What is a response of beta-2/β2 adrenergic agonist receptor?

Bronchodilation

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What is an example of a beta-2/β2 adrenergic agonist?

Albuterol (Proventil HFA, Ventolin HFA, VoSpire ER)

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What is the indication of Albuterol (Proventil HFA, Ventolin HFA, VoSpire ER)?

-Allergic reactions -Asthma -COPD

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What is a response of beta-3/β3 adrenergic agonist receptor?

Relaxation of the detrusor muscle (wall of the bladder)

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What is an example of a beta-3/β3 adrenergic agonist?

Mirabegron (Myrbetriq)

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What is the indication of mirabegron (Myrbetriq)?

Overactive bladder

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What causes the effects of norepinephrine to terminate?

Monoamine oxidase (MAO)

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Which adrenergic receptor causes increased contractility?

Beta-1/β1

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Which adrenergic receptor causes bronchodilation?

Beta-2/β2

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What effect would you expect from an alpha-1 agonist?

Vasoconstriction

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What effect would you expect from an alpha-1 adrenergic antagonist (alpha blockers)?

Vasodilation

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What is the indication of alpha-1 adrenergic antagonists (alpha blockers)?

-BPH -Hypertension

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What are examples of alpha-1 adrenergic antagonists (alpha blockers)?

-Alfuzosin (Uroxatral) -Doxazosin (Cardura) -Terazosin (Hytrin)

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What is the indication of beta-1 adrenergic antagonists (beta blockers)?

-Anxiety -Hypertension

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What are examples of beta-1 adrenergic antagonists (beta blockers)?

-Metoprolol (Lopressor, Toprol XL) -Propanolol ( Inderal, Innopran XL)

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What is an adverse effect of beta-1 adrenergic antagonists (beta blockers)?

Bronchoconstriction

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What patients should not receive beta-1 adrenergic antagonists (beta blockers)?

Patients with respiratory conditions such as asthma or COPD

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Where is epinephrine produced in the body?

Adrenal glands

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What is pheochromocytoma?

A rare, catecholamine-secreting tumor on the adrenal gland that may precipitate life-threatening hypertension

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What is the difference between an adrenergic agonist and a sympathetic?

These terms are used interchangeably

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What physiologic reaction would you expect from a sympathomimetic?

Fight-or-flight

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What is th emost common adverse effect of alpha blockers?

Orthostatic hypotension

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What are two indications for phentolamine?

-Infiltration of adrenergic (too much) -Pheochromocytoma

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What is the advantage of lidocaine with epinephrine?

It stops the bleeding because epinephrine causes vasoconstriction

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Which adrenergic receptor does clonidine (Minipress) act on?

Alpha-2/α2

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What are the 5 cardinal symptoms of Parkinson's disease?

-Tremors (shakiness) -Muscle rigidity (stiffness) -Bradykinesia (difficulty chewing, swallowing, or speaking) -Postural instability (easily lose balance) -Affective flattening (little facial expression or blinking of the eyes)

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What is the wearing-off effect?

Periodic loss of drug effect experienced by patients receiving prolonged antiparkinson pharmacotherapy which appears gradually near the end of a dosing interval

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What is the first line of treatment for Parkinson's disease?

Levodopa-Carbidopa

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What are adverse effects of levodopa-carbidopa?

-Involuntary movements -Loss of appetite -Nausea, vomiting -Orthostatic hypotension

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What is a contraindication with levodopa-carbidopa?

Should be avoided within 2 weeks of therapy with monoamine oxidase inhibitors (MAOIs)

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What can be given in the case of levodopa-carbidopa toxicity?

Pyridoxine (vitamin B6)

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What drug class does apomorphine (Apokyn) belong to?

Dopamine agonists

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What is the MOA of amantadine (Gocovri)?

Causes the release of dopamine

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What is the MOA of entacapone (Comtan)?

Inhibits the body from getting rid of dopamine

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What drugs are indicated for Parkinson's disease?

-Levodopa-Carbidopa -Benztropine (Cogentin) -Apomorphine (Apokyn) -Amantadine (Gocovri) -Entacapone (Comtan)

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What CAM is sometimes used OTC for the treatment of Alzheimer's disease?

Gingko biloba

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What is the symptom of Alzheimer's disease?

Progressive loss of cognitive function

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What is the primary drug class that is indicated for the treatment of Alzheimer's disease?

Acetylcholinesterase inhibitors

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What are other indications for acetylcholinesterase inhibitors?

-Glaucoma -Myasthenia gravis

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What is a chief side effect of cholinesterase inhibitors?

NVD

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What is the MOA of memantine (Namenda)?

Reduces abnormally high levels of glutamate

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What are the most common mental health disorders in those with Alzheimer's disease?

-Anxiety -Depression

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