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Questions and Answers
What is the primary role of adrenergic agonist drugs in the autonomic nervous system?
What is the primary role of adrenergic agonist drugs in the autonomic nervous system?
Which adrenergic receptor is primarily found in the heart?
Which adrenergic receptor is primarily found in the heart?
Which of the following is NOT a common indication for adrenergic agonists?
Which of the following is NOT a common indication for adrenergic agonists?
What classification do vasoconstrictive drugs belonging to adrenergic agonists fall under?
What classification do vasoconstrictive drugs belonging to adrenergic agonists fall under?
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What is a common adverse effect of overstimulation of the sympathetic nervous system?
What is a common adverse effect of overstimulation of the sympathetic nervous system?
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Which medication would be most effective for an acute asthma attack?
Which medication would be most effective for an acute asthma attack?
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What can result from administering two adrenergic drugs simultaneously?
What can result from administering two adrenergic drugs simultaneously?
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Which of the following is a common interaction that must be considered when administering adrenergic drugs?
Which of the following is a common interaction that must be considered when administering adrenergic drugs?
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What effect does blocking the action of ACh in the PSNS primarily have on respiratory function?
What effect does blocking the action of ACh in the PSNS primarily have on respiratory function?
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Which of the following conditions is most likely to be treated with cholinergic blocking drugs?
Which of the following conditions is most likely to be treated with cholinergic blocking drugs?
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What adverse effect may result from excessive cholinergic blocking drug use?
What adverse effect may result from excessive cholinergic blocking drug use?
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Why should older adult patients using anticholinergics be monitored carefully for heatstroke?
Why should older adult patients using anticholinergics be monitored carefully for heatstroke?
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Which of the following best describes the effect of cholinergic blocking drugs on the gastrointestinal system?
Which of the following best describes the effect of cholinergic blocking drugs on the gastrointestinal system?
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What is a contraindication for the use of cholinergic blocking drugs?
What is a contraindication for the use of cholinergic blocking drugs?
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Which of the following symptoms is expected with excessive administration of cholinergic blockers?
Which of the following symptoms is expected with excessive administration of cholinergic blockers?
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What therapeutic effect should be monitored in patients with Parkinson’s disease receiving cholinergic blockers?
What therapeutic effect should be monitored in patients with Parkinson’s disease receiving cholinergic blockers?
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How do cholinergic blocking drugs affect the sympathetic nervous system?
How do cholinergic blocking drugs affect the sympathetic nervous system?
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Which of the following is a critical nursing implication when administering atropine sulfate?
Which of the following is a critical nursing implication when administering atropine sulfate?
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What is the primary effect of α1-adrenergic blockers on blood pressure?
What is the primary effect of α1-adrenergic blockers on blood pressure?
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Which of the following symptoms is associated with the first-dose phenomenon of α1-adrenergic blockers?
Which of the following symptoms is associated with the first-dose phenomenon of α1-adrenergic blockers?
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What is the primary role of short-acting ß2 agonists (SABA) in asthma management?
What is the primary role of short-acting ß2 agonists (SABA) in asthma management?
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What characteristic distinguishes a cardio-selective β1-blocker from a nonselective β-blocker?
What characteristic distinguishes a cardio-selective β1-blocker from a nonselective β-blocker?
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What might a patient experience if they abruptly discontinue a β-blocker?
What might a patient experience if they abruptly discontinue a β-blocker?
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Which of the following is an expected therapeutic effect when using β1-blockers?
Which of the following is an expected therapeutic effect when using β1-blockers?
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What is the correct response of α1-adrenergic receptors when stimulated?
What is the correct response of α1-adrenergic receptors when stimulated?
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Which adverse effect is commonly associated with both α and β blockers?
Which adverse effect is commonly associated with both α and β blockers?
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What is a normal expected effect of beta2-adrenergic receptor stimulation?
What is a normal expected effect of beta2-adrenergic receptor stimulation?
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In the context of adrenergic antagonists, what is a common nursing implication to consider?
In the context of adrenergic antagonists, what is a common nursing implication to consider?
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Cholinergic drugs are intended to stimulate which part of the nervous system?
Cholinergic drugs are intended to stimulate which part of the nervous system?
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Which of the following is a common indication for the use of β-blockers?
Which of the following is a common indication for the use of β-blockers?
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What level of fluid intake is often encouraged for patients if permitted?
What level of fluid intake is often encouraged for patients if permitted?
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What effect might β2-blockers have on bronchial function if used non-selectively?
What effect might β2-blockers have on bronchial function if used non-selectively?
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What therapeutic effect should a nurse expect when monitoring a patient treated with adrenergic blockers?
What therapeutic effect should a nurse expect when monitoring a patient treated with adrenergic blockers?
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What is the primary neurotransmitter for the parasympathetic nervous system?
What is the primary neurotransmitter for the parasympathetic nervous system?
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What effect do cholinergic drugs have on heart rate?
What effect do cholinergic drugs have on heart rate?
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Which of the following is a direct-acting cholinergic agonist?
Which of the following is a direct-acting cholinergic agonist?
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What mechanism do indirect-acting cholinergic agonists use?
What mechanism do indirect-acting cholinergic agonists use?
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Which of the following is a symptom of cholinergic crisis?
Which of the following is a symptom of cholinergic crisis?
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What is a contraindication for cholinergic drugs?
What is a contraindication for cholinergic drugs?
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Which cholinergic drug is used for the treatment of mild to moderate Alzheimer’s disease?
Which cholinergic drug is used for the treatment of mild to moderate Alzheimer’s disease?
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What cardiovascular effect is associated with the use of cholinergic drugs?
What cardiovascular effect is associated with the use of cholinergic drugs?
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Which of the following indicates a therapeutic effect of bethanechol?
Which of the following indicates a therapeutic effect of bethanechol?
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Which symptom is NOT a sign of overstimulation of the parasympathetic nervous system?
Which symptom is NOT a sign of overstimulation of the parasympathetic nervous system?
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What role does atropine play in relation to cholinergic drugs?
What role does atropine play in relation to cholinergic drugs?
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Which of the following drugs can cause bronchoconstriction?
Which of the following drugs can cause bronchoconstriction?
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What effect do anticholinergic drugs have on the respiratory system?
What effect do anticholinergic drugs have on the respiratory system?
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What common adverse effect may occur with cholinergic drugs?
What common adverse effect may occur with cholinergic drugs?
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Study Notes
Adrenergic Agonist Drugs (SNS)
- Mimic the "fight-or-flight" response
- Also called sympathomimetics
- Mimic catecholamines (norepinephrine, epinephrine, dopamine)
- Act on adrenergic receptors throughout the body
-
α-adrenergic receptors: Found at nerve endings of blood vessels
- Involved in vasoconstriction
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β-adrenergic receptors: Primarily in the heart (β1) and bronchial smooth muscle/blood vessels (β2)
- Regulate heart rate, bronchodilation, vessel dilation
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Respiratory Indications: Bronchodilators
- Stimulate β2-receptors in bronchial smooth muscle, leading to relaxation and bronchodilation
- Used for conditions like asthma and bronchitis
- Examples: Salbutamol (SABA), Salmeterol (LABA)
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Cardiovascular Indications: Vasoactive sympathomimetics
- Used to support the heart in failure or shock
- Affect both α- and β-receptors
- Examples: Epinephrine, Norepinephrine, Dopamine, Dobutamine, Phenylephrine, Midodrine
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Adverse Effects: Overstimulation of the SNS
- CNS: Headache, restlessness, tremors, insomnia, euphoria
- Cardiovascular: Palpitations, tachycardia, hypertension
- Other: Sweating, muscle cramps, nausea, vomiting
- Interactions: With certain drugs (e.g., anesthetics, digoxin, antidepressants, antihistamines, thyroid preparations)
- Nursing Implications: Vital signs (BP, pulse) are crucial; avoid combining adrenergic drugs; educate patients about proper inhaler use and to avoid exacerbating factors (e.g., smoking); and monitor for therapeutic effects (e.g., improved respiratory function, stable vital signs).
Adrenergic Blocker Drugs (SNS)
- Block SNS stimulation
- Also called adrenergic antagonists or sympatholytics
- Classification: Based on receptor blocked (α1, β1,β2)
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α1-Blockers:
- Block α1-receptors, causing vasodilation and lowering blood pressure
- Also used for benign prostatic hyperplasia (BPH) to relax bladder and prostate muscles, thus improving urinary output.
- Potential side effect: First-dose phenomenon (sudden drop in BP) and orthostatic hypotension.
- Example: Prazosin hydrochloride (Minipress®)
-
β-Blockers:
- Block β1-receptors primarily (cardio-selective) or both β1 and β2 (non-selective).
- Cardio-selective block only β1- receptors primarily affecting HR and contractility. Non cardio-selective block both β1 & β2.
- Reduced heart rate and contractility - helpful for angina, myocardial infarction, hypertension, and dysrhythmias, as it lowers myocardial oxygen demand
- Inhibit sympathetic stimulation – cardioprotective
- Possible side effect: Bronchoconstriction (non-selective β-blockers)
- Example: "olol" drugs
- Nursing Implications: Assess allergies, cardiac function, and other relevant medical history; monitor for potential hypotension (α-blockers) or bradycardia/heart block (β-blockers); emphasize that medications should not be stopped abruptly; and teach patients to change positions slowly. monitor for orthostatic hypotension initially until tolerance is developed.
Cholinergic Drugs (PSNS)
- Stimulate the "rest-and-digest" response
- Mimic acetylcholine (ACh)
- Mechanism of Action: Directly bind to cholinergic receptors or indirectly stimulate ACh release or inhibit its breakdown
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Drug Effects:
- Cardiovascular: Decreased heart rate, vasodilation (lowering blood pressure)
- Respiratory: Bronchial constriction
- Gastrointestinal/Genitourinary: Increased secretions, motility, and urination
- Eye: Pupil constriction (miosis) and reduced intraocular pressure
-
Indications:
- Glaucoma and intraocular surgery
- Postoperative bladder and GI atony (bethanechol)
-
Adverse Effects: Overstimulation of PSNS: Bradycardia, hypotension, abdominal cramps, increased secretions, nausea, vomiting, diarrhea, bronchospasm, and miosis
- Cholinergic Crisis: SLUDGE (Salivation, Lacrimation, Urinary incontinence, Diarrhea, Gastrointestinal cramps, and Emesis). Antidote: atropine
- Nursing Implications: Assess allergies, GI/GU obstructions, and vital signs; monitor frequently for potential adverse effects (SLUDGE) or indications of cholinergic crisis; educate patients about medications and potential toxicity
Cholinergic Blocking Drugs (PSNS)
- Block the action of acetylcholine (ACh)
- Also called anticholinergics or parasympatholytics
- Mechanism of Action: Competitive antagonists – compete with ACh for receptor sites
- Examples: Glycopyrrolate, oxybutynin (Ditropan®)
- Drug Effects: Inverse effects of PSNS stimulation, “things go up” – increased heart rate, bronchodilation, decreased secretions and motility in GI/GU tract, increased intraocular pressure
- Indications: Bradycardia, asthma, COPD, GI/GU hypermotility, Parkinson’s Disease, drug-induced EPS reactions
- Adverse Effects: Tachycardia, dysrhythmias, dryness of mucous membranes, blurred vision (d/t pupil dilation), urinary retention, constipation, excitation, disorientation, delirium.
- Nursing Implications: Assess allergies; monitor fluid balance (hydration); instruct patients not to stop the drug abruptly. Monitor for complications, such as heatstroke in older adults and monitor for fluid/electrolyte balance.
Autonomic Nervous System Summary
- Drugs affect the autonomic nervous system (ANS) influence the balance between sympathetic (SNS) and parasympathetic (PSNS) branches.
- Drugs that stimulate SNS shift the balance toward "fight-or-flight"
- Drugs that block SNS shift the balance toward "rest-and-digest"
- Cholinergics are opposite of anticholinergics.
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