Pharm lecture 1 exam 2

The sympathetic system

adrenergic drugs- fight or flight

The parasympathetic system

cholinergic drugs - rest and digest

autonomic nervous system

involuntary nervous system, can be split into CNS and PNS

parasympathetic nervous system stimulating drugs include...

cholinergic

cholinergic agonist

parasympathomimetic

parasympathetic nervous system depressing drugs include...

anticholinergics

cholinergic antagonist

cholinergic blocker

parasympatholytic

sympathetic nervous system stimulating drugs include...

adrenergic

adrenergic agonist

sympathomimetic

sympathetic nervous system depressing drugs include...

anti-adrenergic

adrenergic antagonist

adrenergic blocker

effects of cholinergics on parasympathetic nervous system

(cholinergic agonist, parasympathomimetic)

constricts pupils

stimulates flow of saliva

slows heartbeat

constricts bronchi

stimulates peristalsis(movement of gi) and secretion

stimulates release of bile

contracts bladder

effects of adrenergics on sympathetic nervous systen

(adrenergic agonist, sympathomimetic)

dilates pupil

inhibits flow of saliva

accelerates heartbeat

dilates bronchi

inhibits peristalsis and secretion

conversion of glycogen to glucose

secretion of adrenaline and noradrenaline

inhibits bladder contraction

anti-adrenergic

adrenergic antagonist

adrenergic blocker

sympatholytic

all OPPOSITE effects of adrenergics

anticholinergics

cholinergic antagonist

cholinergic blocker

parasympatholytic

all OPPOSITE effects of cholinergics

Adrenergic characteristics

fight or flight response

norepinephrine and epinephrine

effects- raise hr, bronchodilation, pupils dilate, decrease digestion

adrenergic receptors

alpha and beta

cholinergic characteristics

rest and digest

acetylcholine

lowers heart rate, bronchoconstriction, pupils constrict, increase digestion

Alpha 1 receptors

pupil dilation (mydriasis)

vasoconstriction (increases BP)

bladder contraction

CNS stimulation

alpha 2 receptors

vasodilation

inhibits release of norepinephrine

decreases gastric motility and tone

Beta 1 receptors

increase HR and contractility

located primarily in the heart

increase renin secretion in kidneys

Beta 2 receptors

bronchodilation

glycogenolysis (energy release)

uterine relaxation

decreased GI motility

located in smooth muscle of the bronchioles, arterioles, and visceral organs

Dopaminergic receptors

dilates renal/mesenteric arteries

adrenergic blocking drugs stop...

all receptor site reactions

Catecholamines

natural- epinephrine, norepinephrine, dopamine

man made- isoproterenol

dubutamine

Epinephrine

adrenaline

action: nonselective (alpha 1, beta 1, beta 2)

key uses of epinephrine

Anaphylaxis, cardiac arrest, bronchospasm.

epinephrine interactions

beta blockers decrease action

TCAs/MAOIs intensify effects

alpha and beta adrenergic antagonists

alpha blockers: vasodilation (drop in BP)

beta blockers: (the lols) targets the heart, decreases hr and bp

nursing care for adrenergic drugs: recognize cues

check baseline vitals

identify history: hypertension, diabetes, CAD, asthma

screen: for cold medicines, diet pills

nursing care for adrenergic drugs: take action

iv safety: monitor dopamine sites closely

beta blocker safety: teach patient to measure apical pulse

Hold med if HR less than 60

fall prevention!

nursing care for adrenergic drugs: evaluate

vitals returned to desired range

no tissue necrosis at IV site

drug interactions with adrenergic drugs

anesthetic drugs

antidepressants

antihistamines

thyroid meds

other adrenergic meds

The "rest and digest" response

heart rate decreases

lungs: bronchoconstriction (narrow)

gi tract: increased motility and urination

"wet movement"- think fluid movement

Bethanechol chloride

primary use: urinary retention

action: contracts bladder to stimulate urination

bethanechol chloride contraindications

asthma

peptic ulcer

bradycardia

urinary obstruction

Metoclopramide

primary use: GERD, gastroparesis

action: increases gastric emptying

pilocarpine

primary use: glaucoma

action: constricts pupils to relieve pressure

cholinergic crisis

severe muscle weakness

profuse systemic secretions

respiratory and cardiac distress

cholinergic crisis nursing interventions

auscultate breath sounds

compare baseline vitals

ensure patient safety

atropine

blocks Ach receptors

increases HR, dilates pupils, dries secretions

watch for tachycardia

atropine uses...

sinus bradycardia

pre-operative (to dry secretions)

antidote for atropine

Physostigmine

nursing care for anticholinergic drugs: assessment (contraindications)

glaucoma

monitor urinary output

monitor for constipation

nursing care for anticholinergics: take action

mouth care

safety (fall risk)

eye care

heat safety (patient cannot sweat)

nursing care for anticholinergic drugs: evaluation

effective if heart rate increases or secretions decrease

Contraindications for adrenergic and cholinergic drugs

asthma/COPD risk

glaucoma risk

bradycardia- avoid cholinergics

tachycardia- avoid adrenergics

diabetes

A patient is in cardiac arrest. The nurse administered the adrenergic agonist, epinephrine. What is the primary desired action?

increase hr

Patient receives the anti-cholinergic, atropine, preoperatively. How do we know it's effective?

Their secretions dry out

The patient has urinary retention (cannot pee) and is prescribed the cholinergic agonist, bethanechol. Which condition is a contraindication?

asthma

A patient is prescribed atenolol and needs education on safe dosing. What must be assessed frequently?

blood pressure, pulse

sympathetic nervous system stimulating medications are also known as...

adrenergics

adrenergic agonists

sympathomimetic

parasympathetic blocking drugs are also known as...

anticholinergics

cholinergic antagonist

cholinergic blocker

parasympatholytic

a patient with diabetes begins to take non-selective beta blockers. What side effect will the nurse be most concerned about?

low blood sugar

Name 3 catecholamines

dopamine, norepinephrine, epinephrine