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What are the two major divisions of the nervous system?
-Central nervous system (CNS) -Peripheral nervous system (PNS)
What are the two primary components of the CNS?
-Brain -Spinal cord
What are the two subdivisions of the peripheral nervous system?
-Somatic nervous system (controls voluntary movements) -Autonomic nervous system (controls involuntary responses)
What are the two subdivisions of the autonomic nervous system?
-Sympathetic division -Parasympathetic division
What is the characteristic set of signs and symptoms produced when the sympathetic nervous system is activated?
Fight-or-flight response
What is the set of signs and symptoms produced when the parasympathetic nervous system is activated?
Rest-and-digest response
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
What are signs and symptoms are shown when the parasympathetic nervous system is activated?
-Constricts pupils -Stimulates salivation -Slows heart rate, contractility -Constricts bronchioles
What is the primary neurotransmitter of the parasympathetic nervous system?
Acetylcholine (ACh)
What is the role of acetylcholinesterase (AChE)?
An enzyme that destroys acetylcholine (ACh)
What are the receptors of the parasympathetic nervous system called?
Cholinergic
What are drugs that inhibit the parasympathetic nervous system?
Anticholinergic
What are examples of acetylcholinesterase (AChE)/cholinesterase inhibitors?
-Donepezil (Aricept) -Galantamine (Razadyne) -Rivastigmine (Exelon)
What is the MOA of donepezil (Aricept)?
Increases the amount of acetylcholine (ACh) by inhibiting acetylcholinesterase (AChE)
What is the indication of acetylcholinesterase (AChE)/cholinesterase inhibitors?
Alzheimer's disease
What is the indication of bethanechol (Urecholine)?
Urinary retention
What is the MOA of bethanechol (Urecholine)?
Binds to cholinergic receptors to produce the rest-and-digest response that relaxes the bladder
What is a cholinergic crisis?
Symptoms that occur when a patient is given too much cholinergic medication
What are symptoms of a cholinergic crisis?
Salivation Lacrimation Urination Defecation Gastrointestinal distress Emesis
What is the MOA of anticholinergics?
Blocks the effect of acetylcholine and causes sympathetic nervous system actions to predominate
What is the indication of ipratropium (Atrovent) and tiotropium (Spiriva)?
-Asthma -COPD
What is the indication for scopolamine (Transderm-Scop)?
-Motion sickness -Adjunct to anesthesia
What is the indication for atropine (AtroPen)?
-Increase heart rate -Dilate pupils
What is the indication for dicyclomine (Bentyl)?
Irritable bowel syndrome
What is the indication for benztropine (Cogentin)?
Parkinson's disease
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
What is physostigmine used for?
Too much atropine (anticholinergic)
What is used as a reversal agent in the event that a patient has too much of the effects of an anticholinergic?
Physostigmine
What is the primary neurotransmitter of the sympathetic nervous system?
Norepinephrine
What are other neurotransmitters of the sympathetic nervous system?
-Dopamine -Epinephrine
What are the receptors of the sympathetic nervous system called?
Adrenergic receptors
What are the two types of adrenergic receptors?
-Alpha receptors -Beta receptors
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
What are responses of alpha-1/α1 adrenergic agonist receptor?
-Constriction of blood vessels -Dilation of pupils
What is an example of an alpha-1/α1 adrenergic agonist?
Phenylephrine (Neo-Synephrine)
What is the indication of phenylephrine (Neo-Synephrine)?
-Hypotension -Nasal congestion -Ophthalmic hyperemia
What is a response of alpha-2/α2 adrenergic agonist receptor?
Inhibition of release of norepinephrine (puts the "brakes on") and prevents vasoconstriction
What is an example of an alpha-2/α2 adrenergic agonist?
Clonidine (Catapres, Kapvay)
What is the indication of clonidine (Catapres, Kapvay)?
-Hypertension -ADHD -Pain
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
What is an example of a beta-1/β1 adrenergic agonist?
Dobutamine
What is the indication of Dobutamine?
-Bradycardia -Cardiac stimulant (heart failure) -Shock
What is a response of beta-2/β2 adrenergic agonist receptor?
Bronchodilation
What is an example of a beta-2/β2 adrenergic agonist?
Albuterol (Proventil HFA, Ventolin HFA, VoSpire ER)
What is the indication of Albuterol (Proventil HFA, Ventolin HFA, VoSpire ER)?
-Allergic reactions -Asthma -COPD
What is a response of beta-3/β3 adrenergic agonist receptor?
Relaxation of the detrusor muscle (wall of the bladder)
What is an example of a beta-3/β3 adrenergic agonist?
Mirabegron (Myrbetriq)
What is the indication of mirabegron (Myrbetriq)?
Overactive bladder
What causes the effects of norepinephrine to terminate?
Monoamine oxidase (MAO)
Which adrenergic receptor causes increased contractility?
Beta-1/β1
Which adrenergic receptor causes bronchodilation?
Beta-2/β2
What effect would you expect from an alpha-1 agonist?
Vasoconstriction
What effect would you expect from an alpha-1 adrenergic antagonist (alpha blockers)?
Vasodilation
What is the indication of alpha-1 adrenergic antagonists (alpha blockers)?
-BPH -Hypertension
What are examples of alpha-1 adrenergic antagonists (alpha blockers)?
-Alfuzosin (Uroxatral) -Doxazosin (Cardura) -Terazosin (Hytrin)
What is the indication of beta-1 adrenergic antagonists (beta blockers)?
-Anxiety -Hypertension
What are examples of beta-1 adrenergic antagonists (beta blockers)?
-Metoprolol (Lopressor, Toprol XL) -Propanolol ( Inderal, Innopran XL)
What is an adverse effect of beta-1 adrenergic antagonists (beta blockers)?
Bronchoconstriction
What patients should not receive beta-1 adrenergic antagonists (beta blockers)?
Patients with respiratory conditions such as asthma or COPD
Where is epinephrine produced in the body?
Adrenal glands
What is pheochromocytoma?
A rare, catecholamine-secreting tumor on the adrenal gland that may precipitate life-threatening hypertension
What is the difference between an adrenergic agonist and a sympathetic?
These terms are used interchangeably
What physiologic reaction would you expect from a sympathomimetic?
Fight-or-flight
What is th emost common adverse effect of alpha blockers?
Orthostatic hypotension
What are two indications for phentolamine?
-Infiltration of adrenergic (too much) -Pheochromocytoma
What is the advantage of lidocaine with epinephrine?
It stops the bleeding because epinephrine causes vasoconstriction
Which adrenergic receptor does clonidine (Minipress) act on?
Alpha-2/α2
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)
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
What is the first line of treatment for Parkinson's disease?
Levodopa-Carbidopa
What are adverse effects of levodopa-carbidopa?
-Involuntary movements -Loss of appetite -Nausea, vomiting -Orthostatic hypotension
What is a contraindication with levodopa-carbidopa?
Should be avoided within 2 weeks of therapy with monoamine oxidase inhibitors (MAOIs)
What can be given in the case of levodopa-carbidopa toxicity?
Pyridoxine (vitamin B6)
What drug class does apomorphine (Apokyn) belong to?
Dopamine agonists
What is the MOA of amantadine (Gocovri)?
Causes the release of dopamine
What is the MOA of entacapone (Comtan)?
Inhibits the body from getting rid of dopamine
What drugs are indicated for Parkinson's disease?
-Levodopa-Carbidopa -Benztropine (Cogentin) -Apomorphine (Apokyn) -Amantadine (Gocovri) -Entacapone (Comtan)
What CAM is sometimes used OTC for the treatment of Alzheimer's disease?
Gingko biloba
What is the symptom of Alzheimer's disease?
Progressive loss of cognitive function
What is the primary drug class that is indicated for the treatment of Alzheimer's disease?
Acetylcholinesterase inhibitors
What are other indications for acetylcholinesterase inhibitors?
-Glaucoma -Myasthenia gravis
What is a chief side effect of cholinesterase inhibitors?
NVD
What is the MOA of memantine (Namenda)?
Reduces abnormally high levels of glutamate
What are the most common mental health disorders in those with Alzheimer's disease?
-Anxiety -Depression
What drugs are indicated for Alzheimer's disease?
-Donepezil (Aricept) -Galantamine (Razadyne) -Rivastigmine (Exelon) -Memantine (Namenda)
What drug is indicated as the first line of treatment for Alzheimer's disease?
Galantamine (Razadyne)
What is the goal of pharmacotherapeutics in Parkinson's disease?
Increase in dopamine level
What are the four types of multiple sclerosis (MS)?
-Relapse-remitting (RR) -Secondary-progressive (SP) -Progressive-relapsing (PR) -Primary-progressive
What is the most common type of multiple sclerosis (MS)?
Relapse-remitting (RR)
What drug is indicated as the first line of treatment for multiple sclerosis?
Interferon beta
What is the route of administration for interferon beta and glatiramer (Copaxone)?
-IM -Subcutaneous
What is a common side effect of interferon therapy?
Flulike symptoms
What is an adverse effect of interferon beta and what should the patient avoid?
-Hepatotoxicity -Avoid alcohol
What two classes of medications need to be used with caution in the patient on interferon?
-Chemotherapeutic agents -Immunosuppressants
What is the MOA of glatiramer (Copaxone)?
Stops the degeneration of myelin sheaths
What is the MOA of fingolimod (Gilenya)?
Suppresses symptoms and decreases the number of MS flare-ups
What drugs are indicated for the treatment of multiple sclerosis?
-Interferon Beta -Glatiramer (Copaxone) -Fingolimod (Gilenya)
What are three diagnoses that may require the use of muscle relaxants for symptom management?
-Medication related (antipsychotics, statin therapy) -Disease related (epilepsy) -Condition related (hypocalcemia, dehydration)
What is the first line of treatment for muscle spasms?
Nonpharmacologic therapies such as application of heat or cold, hydrotherapy, acupuncture, therapeutic ultrasound, supervised exercises, massage, physical therapy, manipulation
What is the second line of treatment for minor to moderate pain due to muscle spasms?
NSAIDs such as aspirin, naproxen, and ibuprofen