NUR 354 Exam 1

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