ANS Drugs and Disease Management Review

What division of the ANS is fight or flight (thoracolumbar)

Sympathetic (SNS)

What receptors are in the Sympathetic Nervous System

Adrenergic (Alpha I and II + Beta I and II)

What division of the ANS is rest/digest/urinate (craniosacral)

Parasympathetic (PNS)

What receptors are in the Parasympathetic Nervous System

Cholinergic (Nicotinic and Muscarinic)

Cholinergic agonists are known as ____, which ____ PNS activty

Parasympathomimetics, increase (ex: help treat urinary retention and glaucoma)

Anticholinergics or muscarinic antagonists are known as ____, which ___ PNS activity

Parasympatholytics, decrease (ex: help treat overactive bladder, COPD, bradycardia)

Adrenergic agonists are known as ____, which ____ SNS activtiy

Sympathomimetics, increase (ex: help treat asthma, shock, and anaphylaxis)

Adrenergic antagonists are known as ____, which ____ SNS activity

Sympatholytics, decrease (ex: help treat HTN, arrhythmia, heart failure)

Which drug is an adrenergic alpha I agonist

Phenylephrine

Phenylephrine is an adrenergic alpha I agonist that works by

Stimulating vasoconstriction and increases blood pressure

Patients should take phenylephrine which is an adrenergic alpha I agonist if they have

Nasal congestion and hypotension

What is the main ADR of phenylephrine which is an adrenergic alpha I agonist

Hypertension (DO NOT take if you have severe hypertension or glaucoma)

Which drug is an adrenergic alpha 2 agonist

Clonidine

Clonidine is an adrenergic alpha 2 agonist that works by stimulating CNS receptors thus

Reducing sympathetic outflow and decreasing blood pressure

Patients should take clonidine which is an adrenergic alpha 2 agonist if they have

Hypertension, ADHD, opioid withdrawal symptoms

What is the main ADR of clonidine which is an adrenergic alpha 2 agonist

Drowsiness, dry mouth, and rebound hypertension (if abruptly discontinue) (DO NOT take if you have severe bradycardia)

Which drug is an adrenergic beta I agonist

Dobutamine

Dobutamine is an adrenergic beta I agonist that works by

Increasing heart rate and contracility

Patients should take dobutamine which is an adrenergic beta I agonist if they have

Heart failure and cariogenic shock

What is the main ADR of dobutamine which is an adrenergic beta I agonist

Hypertension, arrhythmia, tachycardia

Which drug is an adrenergic beta 2 agonist

Albuterol

Albuterol is is an adrenergic beta 2 agonist that works by

Bronchodilating and relaxing muscles (allows for easier airflow)

Patients should take albuterol which is an adrenergic beta 2 agonist if they have

Asthma (inhaler) or COPD

What is the main ADR of albuterol which is an adrenergic beta 2 agonist

Tremors, tachycardia, nervousness, hypokalemia (DO NOT take if have hypersensitivity or a history of cardiovascular disease)

Which drug is an adrenergic alpha I antagonist

Prazosin

Prazosin is an adrenergic alpha I antagonist that works by

Vasodilating and decreasing blood pressure

Patients should take prazosin which is an adrenergic alpha I antagonist if they have

Hypertension

What is the main ADR of prazosin which is an adrenergic alpha I antagonist

Orthostatic hypotension, dizziness (DO NOT take if have severe hypotension)

Which drug is an adrenergic beta I antagonist (selective blocker)

Metoprolol

Metoprolol is an adrenergic beta I antagonist that works by

Decreasing heart rate and blood pressure (contractility)

Patients should take metoprolol which is an adrenergic beta I antagonist if they have

Hypertension

What is the main ADR of metoprolol which is an adrenergic beta I antagonist

Bradycardia, hypotension, fatigue, dizziness (DO NOT take if have severe bradycardia)

Which drug is an adrenergic non-selective beta I and 2 antagonist

Propranolol

Propranolol is an adrenergic beta I and 2 antagonist that works by

Decreasing heart rate and blood pressure

Patients should take propranolol which is an adrenergic beta I and 2 antagonist if they have

Hypertension (also arrhythmias or migraine prophylaxis)

What is the main ADR of propranolol which is an adrenergic beta I and 2 antagonist

Bradycardia and hypotension (bronchospasm) (DO NOT take if have asthma)

Which drug is an cholinergic muscarinic agonist

Bethanechol

Bethanechol is a cholinergic muscarinic agonist that works by

Increasing bladder contraction and GI tract activity

Patients should take bethanechol which is a cholinergic muscarinic agonist if they have

Postoperative urinary retention

What is the main ADR of bethanechol which is a cholinergic muscarinic agonist

Hypotension and bradycardia (diarrhea, sweat and excess salvation)

Which drug is an cholinergic muscarinic agonist in the eye

Pilocarpine

Pilocarpine is a cholinergic muscarinic agonist that works by

Constricting pupils (miosis) and reducing intraocular pressure by increasing aqueous humor outflow

Patients should take pilocarpine which is a cholinergic muscarinic agonist if they have

Glaucoma

What is the main ADR of pilocarpine which is a cholinergic muscarinic agonist

Hypotension, bradycardia, blurred vision, eye irritation

Which drug is an anticholinergic muscarinic antagonist (heart rate)

Atropine

Paitents should take atropine which is an anticholinergic muscarinic antagonist if they have

Bradycardia

Atropine is a anticholinergic muscarinic antagonist that works by

Decreasing vagal tone at SA node to increase heart rate

What is the main ADR of atropine which is an anticholinergic muscarinic antagonist

Dry mouth, blurred vision, tachycardia, urinary rentention

Which drug is an anticholinergic muscarinic antagonist (smooth muscle)

Ipratropium

Patients should take ipratropium which is an anticholinergic muscarinic antagonist if they have

COPD or Asthma (adjunct bronchodilator)

Ipratropium is a anticholinergic muscarinic antagonist that works by

Bronchodilating smooth muscle and decreasing mucous secretion

What is the main ADR of ipratropium which is an anticholinergic muscarinic antagonist

Dry mouth, throat irritation, blurred vision, urinary retention

Which drug is an anticholinergic muscarinic antagonist (M3 muscarinic)

Oxybutynin

Oxybutynin is a anticholinergic muscarinic antagonist that works by

Blocking M3 muscarinic receptors in bladder to decrease detrusor contraction and decrease urinary urgency (increase bladder capacity)

Patients should take oxybutynin which is an anticholinergic muscarinic antagonist if they have

Overactive bladder urge urinary incontinence

What is the main ADR of oxybutynin which is an anticholinergic muscarinic antagonist

Dry mouth, constipation, urinary retention, cognitive impairment

Which drug is a cholinesterase inhibitor (indirect cholinergic agonist)

Physostigmine

Physostigmine ____ acetylcholinesterase (prevents breakdown of ACh) which ___ PNS activity

Enhances

What is the main ADR of physostigmine which is an indirect cholinergic agonist

Bradycardia, increased salivation, bronchospasm, diarrhea, sweating, seizures

Antiadrenergic toxicity is excessive ___ of adrenergic receptors which is an overdoes of ___ ___

Blockage, beta blockers

What are the symptoms of someone with antiadrenergic toxicity

Bradycardia, hypotension, dizziness, fatigue, cold extremites

What is the treatment for someone with antiadrenergic toxicity

Glucagon to increase heart rate and cardiac output

Adrenergic toxicity is excessive ____ of adrenergic receptors (ex: epi overdose)

Stimulation

What are the symptoms of someone with adrenergic toxicity

Hypertension, tachycardia, tremors, anxiety

What is the treatment for someone with adrenergic toxicity

Benzodiazepines (decrease CNS stimulation), alpha blockers (treat severe hypertension)

Cholinergic toxicity is the excessive ____ of muscarinic and nicotinic receptors due to ___ accumulation

Stimulation, acetylcholine

What are the symptoms of someone with cholinergic toxicity (bradycardia and bronchospasm)

SLUDGE (salvation, lacrimal, urination, diarrhea, GI cramps, emesis)

What is the treatment for someone with cholinergic toxicity (maintain airway/ventalation)

Atropine (reverse muscarinic effects), pralidoxime (restores ACh activity in organophosphate poisoning)

Anticholinergic toxicity is the excessive ___ of muscarinic receptors (ex: antihistamines)

Blockage

What is the treatment for someone with anticholinergic toxicity

Physostigmine (acetylcholinesterase inhibitor that crosses the BBB)

What are the symptoms of someone with anticholinergic toxicity (can’t see, spit, eat, shit)

Hyperthermia (dry skin and mucous membranes) and tachycardia (hot, red, mad)