comp 4 & 5

  1. Central Nervous System
    the body's primary nervous system that consists of the brain & spinal cord
  2. Peripheral Nervous System
    located outside of the brain & spinal cord, is made up of two divisions: the autonomic & the somatic
  3. Autonomic Nervous System
    also called the visceral system, innervates (acts on) smooth muscles & glands.

    its function include control and regulation of the heart, respiratory system, GI tract, bladder, eyes & glands

    involuntary nervous system over which a person has little or no control
  4. Somatic Nervous System
    voluntary system that innervates skeletal muscles over which there is control
  5. Sympathetic Nervous System (also called the Adrenergic system)
    at one time was believed that adrenaline was the neurotransmitter that innervated smooth muscle.

    the neurotransmitter however is norepinephrine
  6. Parasympathetic Nervous System (also called the Cholinergic System)
    the neurotransmitter at the end of the neuron that innervates the muscle is acetylcholine
  7. Adrenergic Blockers (symphatholytics or adrenergic antagonists)
    effects epinepherine

    drugs that block the effects of the adrenergics neurotransmitter
  8. Adrenaline Blockers
    • *block Alpha and Beta Receptor sites
    •  'directly: by occupying receptors
    •  'indirectly: by inhibiting release of eurotransmitters epinephrine and norepinephrine
  9. Adrenaline
    acute stress response system

    response to high stress or exciting situations
  10. Norepinephrine
    fight or flight response
  11. Acetylcholine
    neurotransmitter located at the ganglions and the parasympathetic terminal nerve endings

    it innervates the receptors in organs, tissues, and glands
  12. Adrenergic receptors
    *located through out body

    * Alpha1 & alpha2

    *Beta1 & beta2
  13. Alpha1 effects
    increase cardiac contractility, vasoconstriction, dilate pupils, decrease salivary gland secretion, increase bladder and prostae constraction
  14. Alpha2 effects
    • Inhibit norepinephine release, promotes vasodilation--> decrease BP
    • Decrease GI motility and tone
  15. Alpha Blocker (alpha adrenergic blockers)
    drugs that block or inhibit a respinse at the alpha adrenergic receptor site
  16. ALPHA1 Effects of adrenergic blockers @ receptors
    vasodilation, decrease, reflex tachycardia, pupil dilation, suppresses ejaculation, reduces contraction of smooth muscles in bladder adn neck
  17. (alpha blockers) Drugs that inhibit a reponse at alpha adrenergic receptor site
    • *selective
    •   'block Alpha1
    • *Nonselective
    •   'block alpha1 & alpha2
    • *Action
    •   'cause both arterial & venous dilation--> reducing peripheral vascular resistance & BP
    •   'effects receptors on prostate gland & bladder-decrease resistance to urinary outflow
  18. Alpha Blockers examples
    *Doxazosin (cardura)-used for HTN & BPH

    *Prazosin (Minipress)- used for HTN

    *Terazosin (Hytrin)- used for HTN & BPH

    *SE: 1st dose orthostatic hypotension, dizziness, syncope
  19. Beta1 effects
    *Effects HEART

    *Increase cardiac contractility & HR, increase renin secretion-->Inc BP
  20. Beta2 effects
    • *Effects LUNG
    • *Bronchiodilation
    • *increase blood flow in skeletal muscles
    • *Decrease uterine flow
    • *ALSO: decreases GI tone and motility and activates live glycogenolysis which increase blood glucose
  21. Beta Blockers (Beta adrenergic blockers)
    decreases heart rate, decrease in BP usually follows
  22. Beta 1 Blocker (beta 1 adrenergic blocker) effect at receptors 
    *Reduces cardiac contractility

    *Decreases pulse
  23. Beta 2 blocker (adrenergic blockers) effects at receptors

    *contracts uterus

    *inhibits glycogenolysis
  24. Beta Blockers--indications
    *antianginal: decreases demand for myocardial oxygen

    *cardioprotective: inhibits stimulation from circulating catecholamines

    *Class II antidysrhythmics


    *some are used to tx heart failure

    *tx of migraine headaches.

    • *glaucoma (topical use)
  25. Beta blockers (BBs) action
    decreases Bp & P
  26. Non selective Beta Blockers
    *Blocks Beta 1: decrease BP & P

    *Blocks Beta 2: bronchoconstriction
  27. Beta Blockers examples
    *Propanolol (Inderal)

    *Atenolol (Tenormin)

    *Metoprolol (Lopressor)

    *carvedilol (coreg)

    *Nadolol (corgard)

    *Timolol (blocadren, timoptic)- timpotic used for glaucoma
  28. Non selective (beta blocker)--Propanolol
    *Contradictions: COPD

    *SE/AE: wt gain, impotence, decreased libido, reversible alopecia

    *Drug Interactions: decr drug effects with several drugs, Heart block may occur with digoxin, calcium channel blockers
  29. Selective beta blocker (Beta Adrenergic Blocker) metoprolol (Lopressor), atenolol (tenormin) 
    • *blocks beta 1 only
    •   'Dec BP & P
    •   'fewer side effects

    • *SE/AE:
    •   'bradycardia, hypotension, dysrhythmias, CHF, dizziness, fainting, fatigue, mental depression, hypoglycemia

    * assess bp & p before give

  30. Beta Adrenergic Blockers Drug interactions
    *dec effects with NSAIDs

    *Inc effects with alpha blockers, atropine, anticholinergics

    *inc risk of hypoglycemia-insulin, sulfonylureas
  31. Adrenergic blockers (alpha & beta) NRSG implications
    • *assess for allergies & hx of COPD, hypotension, cardiac dysrhythmias, bradycardia, heart failure, or other cardiovascular problems
    • *beta blockers should never be stopped abruptly
    • *teach to change position slowly to prevent or minimize postural hypotension
    • *avoid caffeine & alcohol
  32. B Blocker drug NRSG implications
    • report to physician:
    •   *weight gain of more than 2 pounds in 1 day or 5 pounds in a week
    •   *edema of feet or ankles (fluid retention)
    •   *SOB
    •   *excessive fatique or weakness
    •   *syncope or dizziness
  33. possible drug interactions with adrenergic blocking drugs
    • antacids
    • antimuscarinics/anticholinergics
    • diuretics an cardiovascular drugs
    • neuromuscular blocking drugs
    • oral hypoglycemic drugs
  34. Classifications of Adrenergics
    *direct-acting sympathomimetic

    *Indirect-acting sympathomimetic

    *mixed-acting sympathomimetic
  35. Catecholamines
    *chemical structure of a substance that can produce a sympathomimetic response

    *Endogenous- epinepherin, norepinepherin, & dopamine

    *Synthetic- dobutamine & isoproternol
  36. Catecholamines effects
    increase HR, cause casoconstriction, brochial dilation, dilates pupils
  37. Sympatholyics
    inhibits the postganglionic functioning of the SNS
  38. Sympathomimetics
    effects transmitter substances in the SNS
  39. Cholinergic Blocking Agents (anticholinergics, parasympatholytics)
    drugs that inhibit the actions of acetylcholine by occupying the acetylcholine receptors
  40. Parasympathomimetics (cholinergic agonists)
    drugs that stimulate the parasympathic nervous system
  41. Neurotransmitter
    norepinephrine & dopamine
  42. Amphetamines
    stimulate the release of neurotransmitters from the brain and sympathetic nervous system

    ordinarily cause euphoria and alertness, nut they can also cause sleeplessness, restlessness, temors, and irritability
  43. ADHD (Attention Deficit Hyperactivity Disorder)
    problem of not being able to focus, being over active, not being able to control behavior, or a combination of these
  44. Narcolepsy
    sleep disorder that causes excessive sleepiness and frequent daytime name attacks
  45. Barbiturates
    drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia.

    They are also effective as anxiolytics, hypnotics, and anticonvulsants
  46. Benzodiazepines
    minor tranquilizer or anxiolytic sedative or hypnotic for inducing sleep
  47. Anesthetics
    general or local

    depress the CNS, alleviate pain, and cause a loss of consciousness

    Nitro oxide (laughing gas) was the first
  48. Drugs that decrease nervousness, excitability & irritability
  49. Drugs that cause sleep
  50. Avoid use of alcohol when taking these medications
    CNS stimulants
  51. Zaleplon (Sonata), Zolpiden (Ambien) & eszoplicone (Lunesta) are examples of these drugs
    nonbenzodiazepine hypnotics
  52. Act to relive pain associated with skeletal muscle spasms
    muscle relaxants
  53. Temazepam (restoril) & triazolam (halcion) are examples of these drugs
  54. The medically approved reasons to use these drugs include ADHD, narcolepsy & weight loss
    CNS stimulants
  55. Baclofen (lioresal), cyclobenzaprine (flexeril), dantrolene (Dantrium), tizanidine (zanaflex) are examples of these drugs
    muscle relaxants
  56. Amphetamine (addrell), methylphenidate (concerta, ritalin) & sibutramine (meridia) are examples of these drugs
    CNS stimulants
  57. Seldomly used as sedatives/hypnotics today due to their side effet profile- respiratory depression, decreased REM sleep & N&V
  58. 'pam, lam, or am" drugs- used for sedative/hyonotic effect, anxiolytic effect
  59. Can occur after the prolonged use of sedatives/hypnotics
    Rebound REM
  60. What patient teaching should be included regarding administering the CNS stimulants for ADHD
    take before meals, monitor weight loss, monitor for onset tourette syndrome in children, monitor for tachycardia & palpitations, don't stop abruptly
  61. the drugs cause pupil dilation, bronchiodilation, vasoconstriction
    Adrenergic drugs
  62. the "Fight or Flight" system
    Sympathetic Nervous System
  63. Referred to as the "Rest & Digest" or "Rest & Relax" system
    Parasympathetic Nervous System
  64. Nursing implications & patient teaching for this group of drugs would include: use of sunglasses for photophobia (following dilation of eyes); elderly patients be cautious of heat stroke; report SE: urinary hesitancy and/or retention, constipation
    anticholinergic drugs
  65. The cardioselective type of the drugs will cause a decrease in HR and decreases mycardial contractility, thus reducing myocardial oxygen demand
    Beta blockers
  66. Dopamine, dobutamine and epinepherine are all examples of cardioselevtive
    adrenergic blocking drugs
  67. these drugs are used to decrease salivary excretions, treat urinary frequencym and motion sickness
    anticholinergic drugs
  68. these drugs end in "lol" or "olol"
    beta blockers
  69. Doxazosin, Prazosin, Terazosin are all examples of this type of drug
    alpha blockers
  70. The "first dose effect" of hpotension can occur with the use of this group of drugs
    alpha blockers
  71. side effects of these drugs are tachycardia, headache, nervousness, palpitations
    adrenergic drugs
  72. side/adverse effects of these drugs include hypotension, bradycardia, impotence & decreaced excercise tolerance
    alpha blockers
  73. thes drugs are also known as Cholinergic agonists
    cholinergic drugs
  74. it is important to assess for allergies and history of COPD, hypotension, cardiac dysrhythmias, bradycardia, heart failure, or other cardiovascular problems with thes drugs
    adrenergic blocking drugs
  75. "SLUDGE" is an acronym for the side effects for these drugs
    Cholinergic drugs
  76. the side effects of these drugs cause: dry mouth, constipation, urinary retention, orthostatic hypotension
    Anticholinergic Drugs
  77. These drugs cause pupil dilation constriction, slowed heart rate, bronchiole constriction, vasodilation
    adrenergic blocking drugs
  78. Adrenergic Drugs and Adrenogeneric Blocking drugs effect this system
    Sympathetic Nervous System
  79. Another name for these drugs is Sympathomimetics
    Adrenergic Drugs
  80. Cholinergic Drugs and Anticholinergenic drugs affect this system
    Parasympathetic Nervous System
  81. Ipratropium (Atrovent), Benztropine (Cogentin), and Trihexyphenidyl (Artane) are all examples of this type of of drugs
    Anticholinergic Drugs
  82. The primary effect of in creased heart rate and force of contraction occurs when these receptors are stimulated
     beta 1 Adrenergic Receptors
  83. The primary effect of bronchodilation occurs when these recepors are stimulated
    beta 2 adrenergic receptors
  84. Albuterol (Proventil/Ventolin) & Salmeterol (Serevent) are _________ that are used to treat illnesses such as ________ & ________
    * bronchiodilators

    * Asthma & COPD
  85. When administering a bronchodilator inhaler & a corticosteroid inhaler which should be administered first?
    Bronchodilator inhaler
  86. The opthlamic adrenergic drugs are u sed to trea what disease of the eye?
  87. Overuse of nasal decongestants, such as Afrin, may cause _________
    Rebound Congestion
  88. Terosin (Hytrin) & Tamsulosin (Flomax) are both used to treat _____
  89. These drugs should never be stopped abruptly
    cholinergic drugs
  90. When takine beta blockers a petient should be taught to report of weight gain of ______ _______, or edema of the feet and ankles as this may indicate ________ ________
    • *2 - 5 #
    • *fluid retention
  91. Tacrine (Cognex), Donepezil (Aricept), Memantine (Namenda) are all _______ drugs used to treat ____ _____
    * indirect active Cholinergic

    *ALzheimer's Dementia
  92. "SLUDGE" stands for ____, _____, _____, _____, ____,_____ (side effects of cholinergic drugs)
    • *salivation
    • *lacrimation
    • *urination
    • *defecation
    • *GI upset
    • *emesis
  93. Therapeutic effects of Anti- Alzheimer's drugs may occur for up to ______
    6 weeks
  94. Two ways to administer General Anesthetics
    general & local
  95. Anesthetic type that causes a certain part of body to be insensitive to pain without loss of consciousness ______
    local anesthetic
  96. This type of anethetic would be used for stitching a small laceration on the patient's arm ____
    Local anesthetic
  97. Two main types of Local Anesthetics
    esters & amides
  98. Spinal or epidural are examples of this type of anesthetic
    injectable (IV) anesthetic
  99. This type of anesthetic would be used for more serious or complicated surgeries
    general anesthetic
  100. Anesthetic type that produces unconsciousness, skeletal & smooth muscle relaxation
    general anesthetic
  101. This type of anesthetic may be used to numb a sore throat
    topical anesthetic
  102. used for diagnostic procedures such as a colonoscopy and minor surgical procedures
    moderate or conscious sedation
  103. When using this a patient can; maintain their own airway; will not recall the procedure; will have decreased anxiety & sensitivity to pain
    moderate & conscious sedation
  104. A potentially serious side effect of general anesthetics characterized by high fever and tachycardia
    malignant hyperthermia
  105. Which category of antipyschotics are MOST effective in treating both positive and negative symptoms associated with schizophrenia?
    atypical antipsychotics
  106. A person taking MAOI (antidepressant) can have what serious side effect if he or she eats aged cheeses, drinks wine or takes it concurrently with an SSRI
    hypertensive crisis
  107. Pseudoparkinsonism or Extrapyramidal Symptoms (EPS)
    Characterized by stooped posture, tremor, rigidity, pill rolling
  108. Akathisia
    Characterized by restlessness, pacing, unable to stand still, constant movement
  109. Tardive Dyskinesia
    characterized by lip smacking, tongue protrusion, involuntary bodily movements
  110. Neuroleptic Malignant Syndrome
    Characterized by high fever, rigidity, altered mental status
  111. Typical or 1st Generation Anitpsychotic Drugs
    *Chlorpromazine (Thorazine)

    *Haloperidol (Haldol)

    *Fluphenazine (Prolixen)
  112. Atypical or 2nd Generation Antipsychotic Drugs
    *Clozapine (Clozaril)

    *Risperidone (Risperidal)

    *Quetiapin (Seroquel)

    *Ziprasidone (Geodon)

    *Aripiprazole (Abilify)
  113. Which Antipsychotics requires close monitoring of the WBCs
    Clozapine (Clozaril)
  114. Which are the "pam, am, or lam" drugs
  115. which antipsychotics are used to treat anxiety

    *Buspirone (Buspar)
  116. which group of antipsychotics is used to treat bipolar disorder


  117. which antipsychotics are used to treat bipolar disorder has a narrow therapeutc index
  118. What medications are SSRIs
    *Sertraline (Zoloft)

    *Fluoxetine (Prozac)

    *Paroxetine (Paxil)
  119. which medications are TCAs
    Amitriptyline (Elavil)
  120. which group of antidepressant medications can cause a "cheese effect"
  121. Adrenergic Drugs
    *Drugs that stimulate the sympathetic nervous system (SNS)

    *"Hitting Deer"
  122. Epinephrine (Adrenaline) action
    • *vasoconstriction (alpha 1)
    • *Increase HR (Beta 1)

    *promotes bronchiodilation (beta 2)
  123. Epinephrine Routes
    SQ, IV, topical, inhalation, intracardiac
  124. Epinephrine actions
    • *anaphylaxis, anaphylactic shock
    • *Bronchospasms
    • *cardiac arrest
  125. Epinephrine Contraindications & caution
    • *cardiac dysrhythmias, hypertension
    • *hyperthyroidism, pregnancy
  126. Epinephrine Side Effects & Adverse Reactions
    *SE: N&V, hypertension, tachycardia, nervousness, tremors, agitation

    *AE: Ventricular fibrillation & pulmonary edema
  127. Epinephrine Drug Interactions
    Beta- blockers (BBs)- Decreases epinephrine action
  128. Epinephrine Nrg interventions
    • *Monitor BP, Pulse, Urine output (kidney funtioning)
    • *report SE
    • *Avoid cold medications/diet pills if hypertensive, DM, CAD, or dyrhythmias
    • *avoid adrenergics when nrg infant
    • *avoid continuous use of adrenic nasal sprays
    • * monitor IV site for infilration
    •   'antidote:phentolamine mesylate (regitine)
  129. Albuterol (provetnil) & Salmeterol (serevent)
    *Selective: acts on B2 adrenergic receptors, promotes bronchodilation

    *Uses: treat/prevent bronchospasms, asthma, bronchitis, COPD
  130. Albuterol (Proventil) Dosage/uses
    *ACUTE ATTACK- quicker

    • *PO, inhalation, nebulizer
    • *treat bronchospams (short-acting/ rescue inhaler)
  131. Salmeterol (Serevent)
    *inhalation (powder or inhaler)

    *prevent bronchospasms (long acting-routine inhaler)
  132. Albuterol (proventil) & Salmeterol (servent) SE/AE/Caution
    *SE/AE: tremors, nervousness, restlessness, dizziness, reflex tachycardia, hallucinations, cardiac dysrhythmias

    *Caution: severe cardiac disease, HTN, Hyperthyroidis, DM, pregnancy
  133. Albuterol (proventil) & Salmeterol (Serevent)
    NRSG implications
    *Instruct to avoid factors that exacerbate condition

    *encourage fluid intake (up to 3000ml per day) if permitted

    *educate about proper dosing, use of equiment & care

    *salameterol (serevent) is indicated for prevention of bronchospasms, not managemtn of acute sx.

    *if using another type of inhaler use bronchiodilator first- wait 5 min- than administer the corticosteriod.

    *ALWAYS rinse mouth after corticosteriod -->kills normal bacteria in mouth
  134. albuterol & salmeterol therapeutic effects
    • *Return to normal resp rate
    • *improve breathsounds, fewer crackles/wheezes
    • *increase air exchange- check pox (normal >95%
    • *decrease cough
    • *less dyspnea
    • *improve blood gases
    • *increase activity tolerance
  135. other Adrenergic Drugs
    • *Dopamine- used to inc BP- mostly used in ICU
    • *dobutamine- used to treat cardiac decompenstion- ICU
    • *pseudoepinephrine (sudafed, Afrin (use 1 week @ most)- usd to treat nasal congestion
    • over use can cause rebound congestion
    • *terbutaline (brethine) used to tx bronchospasms
    • *phenylpropanolamine (dimetapp, dristan) taken off market d/t inc cardiac events
  136. Cholinergic drugs
  137. cholinergic drugs
    *drugs that stimulate the PNS

    *mimic the effects of the PNS neurotransmitter: acetylcholine
  138. Cholinergic Receptors
    *muscarinic receptors: affect smooth muscles

    *Nicotinic receptor: affect skeletal muscles
  139. effects of Cholinergics
    • *cardiovascular: dec BP & P, vasodilation, slows conduction of av node
    • *GI: inc tone & motility, inc peristalsis, relax sphincter muscles
    • *GU: contract bladder, inc ureter tone, relax sphincter muscle, stimulate urination
    • *EYE: inc pupil contriction, inc accomodation
    • *lungs: bronchial constriction, inc secretions
    • *glands: inc salivation, perspirations, tears
    • *striated muscle: inc neuromuscular transmission
  140. Direct acting cholinergics
    • *GI: Metoclopramide (reglan)-used to tx GERD & to tx gastroparesis (inc gastric emptying)
    • *GU: Bethanechol (Urecholine)-used to stimulate urination (for tx of urinary retention)
    • *EYES: Pilicarpine- used to tx glaucoma, topical application due to poor oral absorption
  141. Indirect acting cholinergics
    *MYASTHENIA GRAVIS: physostigmine, Pyridostigmine, Neostigmine-improves muscle strength

    • *ALZHEIMER'S DEMENTIA: tacrine (cognex), Donepzil (Aricept), Memantine (Namenda)-used to improve memory in AD. (helps to slow progression of the disease
  142. Chloinergics Drug SE/NRSG implications
    • *hypotension
    • *bradycardia
    • *bronchoconstriction
    • *excessive salivation
    • *inc Gastric acid secretion
    • *abd cramps
    • *blurred vision
  143. cholinergics nrsg implications
    • *assess I & O
    • *teach procedure for administering eye gtts
    • *medications should be taken as ordered and not abruptly stopped
    • *doses should be spread evenly apart to optimize the effects of med
    • *therapeutic effects of anti alzheimers drugs may not occur for up to 6 weeks
  144. Cholinergics -Monitor theraperutic effects:
    • *alleviated s/sx of myasthenia gravis
    • *in pts with urinary retention/hypnotic bladder, urination should occur within 60 minutes of bethanechol adminstration
    • *Metoclopramide: inpostoperative pts with dec GI peristalsis, look for: Inc bowel sounds, passage of flatus, occurrence of  bowel movements 
  145. cholinergic interactions
    • *anticholinergics, anti histamines, sympathomimetics-antagonize cholinergics drugs, results in decrease responses
    • *other cholinergic drugs-additive effects
Card Set
comp 4 & 5