pharm unit 3

sympathetic nervous system function

fight or flight

sympathetic nervous system catacolamines

epinephrine, norepinephrine, dopamine

sympathetic agonist

start fight or flight process

sympathetic antagonist

brings the body back to baseline

alpha 1 adrenergic agonist role

causes vasoconstriction to increase BP

alpha 2 adrenergic agonist role

CNS stimulation to release epinephrine, norepinephrine, dopamine into the body

beta 1 adrenergic agonist

cardiac stimulation to increase HR and BP

beta 2 adrenergic agonist

bronchial relaxation, GI relaxation, uterine smooth muscle relaxation, glycogenolysis

glycogenolysis

conversion of glycogen to glucose to stimulate liver receptors for more energy

sympathetic system: cardiovascular response to stimulation

blood vessels: A1 constrict, B1 dilate
cardiac muscle: B1 increases contractility
AV/SA node: B1 increases HR

sympathetic system: GI response to stimulation

slows to focus energy on blood flow
muscle: B2, A1/2 decrease motility
sphincters: A1 constriction

sympathetic system: Genitourinary response to stimulation

bladder sphincter: A1 constriction
penis: A1 ejaculation
uterus: A1 contraction B2 relaxation

sympathetic system: Respiratory response to stimulation

bronchial muscles: B2 dilation
liver: B1/2 glycogenolysis
pupils: A1 dilation

Alpha Adrenergic ADRs

CNS: headache, restlessness excitement, insomnia, euphoria
CV: chest pain, vasoconstriction, reflex bradycardia, palpitations, dysrhythmias
other: anorexia, dry mouth, N/V, taste change

Beta Adrenergic ADRs

CNS: tremors, headache, nervousness, dizzy
CV: increased heart rate, palpitations, BP fluctuations
others: sweating, N/V, muscle cramps

albuterol class

Beta 2 agonist

albuterol MOA

smooth muscle relaxation, bronchodilation

albuterol administration

inhale, PO

albuterol ADRs

tremors, tachycardia, headache

epinephrine class

nonselective Alpha and Beta agonist

epinephrine MOA

directly acts on Alpha and Beta receptors innervated by SNS (A1: increase BP, decrease edema, B1: increase CO and BP, B2: bronchiodilation)

epinephrine administration

topical, IV (smaller dose), IM

epinephrine ADRs

all beta and alpha ADRs

epinephrine interactions

alpha and beta blockers (blocks epinephrines ability to bind to a receptor site

epinephrine fatality

increase HR/BP nothing keeps it in check so it can cause MI/stroke

epic pen auto injector doses

.3 mg=>66lb
.15 mg=33-66 lb

what to do after giving a dose of epi pen

call 911, give second dose if the first is ineffective

epic pen contraindications

sensitive to heat/ligth
severe HTN

adrenergic antagonist

bind to receptors but inhibit stimulation of SNS, opposite of adrenergic, inhibit sympathetic stimulation

alpha antagonist

material and venous dilation, reduce peripheral vascular resistance and BP, treat HTN, effect on receptors on prostate gland and bladder (decreased resistance to urinary outflow/ urinary obstruction relieve effects of BPH)

cardiovascular ADRs for alpha antagonist

palpitations, orthostatic hypotension, tachycardia, edema, chest pain

CNS ADRs for alpha antagonist

dizzy/headache, anxiety/depression, weakness, numbness, fatigue

GI ADRs for alpha antagonist

N/V/D, constipation, abdominal pain

other ADRs for alpha antagonist

incontinence, dry mouth, pharyngitis

prazosin class

alpha 1 antagonist

prazosin MOA

inhibit vasoconstrictions in peripheral vasculature

prazosin indication

HT, raynauds, BPH

prazosin ADRs

first dose orthostatic hypotension, inhibited ejaculation, nasal congestion, reflex tachycardia

beta antagonist role

blocks stimulation of beta receptors in SNS, compete with epinephrine and norepinephrine, can be selective or nonselective

beta antagonist MOA cardioselective B1

decrease SNS in heart, decrease HR, prolong SA node recovery, decrease AV node conduction, decrease contractility

beta antagonist nonselective MOA

same heart effects as B1, constrict bronchioles(narrow airways, SOB), vasoconstriction in blood vessels

beta antagonist contraindications

allergy, HF, cariogenic shock, AV block, bradycardia, pregnancy, severe pulmonary disease, raynauds

beta antagonist ADRs: blood

agranulocytosis, thrombocytopenia

beta antagonist ADRs: cardiovascular

AV block, bradycardia, HF

beta antagonist ADRs: CNS

dizzy/drowsy, depression, unusual dreams

beta antagonist ADRs: GI

N/V/D, constipation

beta antagonist ADRs: other

erectile dysfunction, alopecia, wheezing, bronchospasm, dry mouth

metoprolol class

B1 antagonist

metoprolol MOA

blocks heart receptors to decrease HR/contractility

metoprolol indications

HTN, angina, HF, MI

metoprolol administration

PO: increased dose, IV: put on a cardiac monitor to watch for decrease HR, or AV block

propranolol class

nonselective beta antagonist

propranolol MOA

B1: decreased HR/contractility, B2: inhibit smooth muscle dilation and glycogenolysis

propranolol uses

tachydysrhythmia, migraines (cross BBB), essential tremor

propranolol contraindication

asthma (albuterol is ineffective), AV block, pregnancy

anaphylactic shock

severe allergy (hypotension, bronchoconstriction, edema of glottis)

parasympathetic nervous system function

rest and digest

acetylcholine

main neurotransmitter released in the brain as part of the PSNS

cholinergic agonist function

mimic acetylcholine

direct cholinergic agonists

stimulate acetylcholine

indirect cholinergic agonist

block destruction of acetylcholine

muscarinic (cholinergic agonist) drug effects: lungs

increased secretion/constriction

muscarinic (cholinergic agonist) drug effects: CV

blood vessel dilation, decreased HR/BP, pupil constriction (myosis)

muscarinic (cholinergic agonist) drug effects: GI

increased tone, increased motility, sphincter relaxation

muscarinic (cholinergic agonist) drug effects: Genitourinary

increased tone, increased motility, sphincter relaxation, increased glandular secretion

muscarinic (cholinergic agonist) ADRs: CV

Brady/tachycardia, hypo/HTN, syncope, conduction abnormalities

muscarinic (cholinergic agonist) ADRs: CNS

headache, dizziness, convulsions, ataxia

muscarinic (cholinergic agonist) ADRs: GI

abdominal cramps, increased secretions, N/V/D

muscarinic (cholinergic agonist) ADRs: respiratory

increased bronchial secretions, bronchospasm

muscarinic (cholinergic agonist) ADRs: other

increased lacrimation/sweating/salivation/myosis

bethanechol class

direct acting muscarinic agonist

bethanechol MOA

binds reversibly to muscarinic receptors for activation

• contraction in smooth muscle of the bladder

• relaxes and opens the urethra

bethanechol use

get rid of urine

bethanechol contraindications

pregnancy C

• take with food to prevent GI upset

bethanechol ADRs

bradycardia, hypotension, increased secretions

donepezil class

indirect acting muscarinic agonist

donepezil MOA

inhibit cholinesterase which stops the destruction of acetylcholine

donepezil use

mild/moderate Alzheimers

• increases Acetylcholine which increases memory/learning (cognitive function)

donepezil ADRs

anything that is caused by excessive Acetylcholine

donepezil effect

tablet or rapidly disintegrating tablet

• may take up to 6 weeks for effect

• NOT A CURE

Nursing considerations for muscarinic (cholinergic agonist) drugs

• may take up to 6 weeks to work

• monitor BP/HR, EKG

• cholinergic crisis

• possible cardiac arrest

cholinergic crisis S/S

SLUDGE:
S: sweat/salivation
L: lacrimation
U: urination
D: diarrhea
G: GI cramps
E: emesis

Antimuscarinic (cholinergic antagonist) drug function

blocks muscarinic receptors

• inadvertently increases SNS function

Antimuscarinic (cholinergic antagonist) drug effect: salivary gland

dry mouth

Antimuscarinic (cholinergic antagonist) drug effect: CNS

confusion/sedation

Antimuscarinic (cholinergic antagonist) drug effect: heart

increased HR

Antimuscarinic (cholinergic antagonist) drug effect: lungs

bronchodilate and decrease secretion

Antimuscarinic (cholinergic antagonist) drug effect: bladder

muscle relaxation

Antimuscarinic (cholinergic antagonist) drug effect: GI

muscle relaxation

Antimuscarinic (cholinergic antagonist) drug effect: iris

pupil relaxation/dilaiton

Antimuscarinic (cholinergic antagonist) drug effect: lacrimal gland

dry eyes

anticholinergic toxicity S/S

hyperthermia, dry skin, flushed, mydriasis (pupil dilation), delirium

atropine class

muscarinic antagonist

atropine MOA

naturally occurring (from deadly nightshade plant) to decrease acetylcholine

atropine uses

bradycardia, ventricular systole (flatline), code blue, pre-op (can also be an antidote for cholinergics)

atropine contraindications

closed angle glaucoma, hepatic/renal function

atropine antidote

physostigmine

oxybutynin class

muscarinic antagonist

oxybutynin MOA

blocks receptors on detrusor muscle of the bladder

• inhibit contraction
• short half life

oxybutynin use

decrease urge to void