Autonomic Nervous System: Parasympathetic vs Sympathetic Activity
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Questions and Answers

What are the two opposing branches of the autonomic nervous system (ANS) that maintain the resting activity of organs?

  • Peripheral nervous system and somatic nervous system
  • Enteric nervous system and autonomic nervous system
  • Central nervous system and autonomic nervous system
  • Sympathetic nervous system and parasympathetic nervous system (correct)

    • Which neurotransmitter is associated with the parasympathetic nervous system (PNS)?

  • Norepinephrine
  • Epinephrine
  • Dopamine
  • Acetylcholine (correct)

    • How can changes in resting activity occur in organs according to the text?

  • By decreasing the activity of either the PNS or the SNS (correct)
  • By increasing the activity of both the PNS and the SNS
  • By decreasing only the activity of the sympathetic nervous system (SNS)
  • By increasing only the activity of the parasympathetic nervous system (PNS)

    • Which statement about adverse drug effects (ADRs) is accurate based on the text?

    <p>ADRs may have a therapeutic effect on target organs and an adverse effect on ancillary organs</p> Signup and view all the answers

    What is the primary focus of this chapter according to the text?

    <p>Use of drugs in primary care by advanced practice nurses to treat various conditions</p> Signup and view all the answers

    Which type of drugs target the sympathetic nervous system (SNS) by direct receptor binding or mimicking the action of norepinephrine (NE) or epinephrine?

    <p>Peripherally acting alpha-adrenergic agonists</p> Signup and view all the answers

    Which of the following is NOT a common adverse reaction in trials of methyldopa?

    <p>Insomnia</p> Signup and view all the answers

    What is the metabolic fate of approximately 50% of guanfacine's oral dose?

    <p>Converted to inactive sulfate metabolites</p> Signup and view all the answers

    In patients with renal failure, why do adverse effects of methyldopa increase?

    <p>Accumulation of methyldopa and its metabolites</p> Signup and view all the answers

    Which of the following drugs has a significant first-pass effect?

    <p>Guanfacine</p> Signup and view all the answers

    What is the primary reason for cautious use of clonidine in patients with a history of bradycardia?

    <p>Risk of mental depression</p> Signup and view all the answers

    Why should methyldopa and clonidine be used cautiously in patients with cerebrovascular disease?

    <p>They cross the blood-brain barrier</p> Signup and view all the answers

    What is the effect of stimulation of central alpha2 receptors by methyldopa's active metabolite?

    <p>Decrease in sympathetic outflow to the heart</p> Signup and view all the answers

    Which of the following receptors are primarily associated with excitation or stimulation?

    <p>Alpha1 receptors</p> Signup and view all the answers

    Where are alpha2 receptors primarily located?

    <p>Presynaptic nerve terminals of smooth muscles and islet cells of the pancreas</p> Signup and view all the answers

    What is the primary function of beta1 receptors?

    <p>Stimulation of adenylyl cyclase to increase cAMP production</p> Signup and view all the answers

    Which of the following receptors are stimulated by both norepinephrine (NE) and epinephrine?

    <p>Alpha1, alpha2, beta1, and beta2 receptors</p> Signup and view all the answers

    What is the primary use of alpha1 agonists?

    <p>Decongestants</p> Signup and view all the answers

    Which of the following is a central effect of alpha2 agonists?

    <p>Inhibition of cardioacceleration and vasoconstriction centers in the brain</p> Signup and view all the answers

    Which of the following is a potential adverse effect of centrally acting alpha2 agonists used for hypertension?

    <p>Dry mouth</p> Signup and view all the answers

    What is a potential consequence of abruptly stopping centrally acting alpha2 agonists?

    <p>Impaired homeostatic balance regulating SNS action</p> Signup and view all the answers

    Which of the following is an approved use for guanfacine?

    <p>Both A and B</p> Signup and view all the answers

    How does guanfacine reduce blood pressure?

    <p>By reducing sympathetic outflow by activating alpha2 receptors in the brain</p> Signup and view all the answers

    Which alpha1 receptor subtype is the most prevalent in the prostate?

    <p>alpha1a</p> Signup and view all the answers

    Which statement regarding the metabolism of tamsulosin is accurate?

    <p>It is extensively metabolized by CYP450 enzymes, with less than 10% eliminated unchanged.</p> Signup and view all the answers

    Which of the following statements about alfuzosin metabolism is correct?

    <p>Approximately 11% of the administered drug is eliminated unchanged in the urine.</p> Signup and view all the answers

    What is the primary reason that selective alpha1a receptor antagonists are advantageous for treating BPH?

    <p>They demonstrate fewer adverse drug reactions (ADRs)</p> Signup and view all the answers

    Which enzyme is involved in the metabolism of silodosin?

    <p>CYP3A4</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the pharmacokinetics of the alpha1 antagonist drugs?

    <p>Demonstrate low protein binding</p> Signup and view all the answers

    Which of the following alpha1 antagonist drugs has the lowest bioavailability?

    <p>Silodosin</p> Signup and view all the answers

    Based on the information provided, what is true about the active metabolite of silodosin?

    <p>It has a half-life of approximately 24 hours.</p> Signup and view all the answers

    Which alpha1 antagonist drug is known to accumulate in breast milk at a concentration 20 times that in maternal plasma?

    <p>Doxazosin</p> Signup and view all the answers

    Which of the following statements about drug interactions with alpha-blockers is accurate?

    <p>They can lead to additive hypotension, with increased risk.</p> Signup and view all the answers

    What is the primary reason that the absorption of alfuzosin is reduced when taken in a fasting state?

    <p>Alfuzosin should be administered with food</p> Signup and view all the answers

    Which statement about the metabolism and excretion of doxazosin is true?

    <p>Doxazosin exhibits biphasic plasma elimination</p> Signup and view all the answers

    What is the primary mechanism by which selective alpha1a receptor antagonists are thought to relieve lower urinary tract symptoms (LUTS) in BPH?

    <p>By a mechanism unrelated to prostate smooth-muscle relaxation</p> Signup and view all the answers

    Which alpha1 antagonist drug demonstrates the highest selectivity for the alpha1a receptor subtype?

    <p>Silodosin</p> Signup and view all the answers

    How does taking tamsulosin in a fasting state affect its pharmacokinetics?

    <p>Increases bioavailability by 30% and increases Cmax by 40-70%</p> Signup and view all the answers

    Which of the following statements about clonidine is correct?

    <p>It can cause nightmares and insomnia as an adverse reaction.</p> Signup and view all the answers

    Which drugs are well-suited for monotherapy in treating hypertension according to the text?

    <p>None of the drugs mentioned are well-suited for monotherapy</p> Signup and view all the answers

    Which of the following statements about methyldopa is true?

    <p>It is the first-line therapy for hypertension in pregnant patients.</p> Signup and view all the answers

    How can methyldopa and clonidine be used effectively for treating hypertension?

    <p>By combining them with a diuretic to address sodium and water retention</p> Signup and view all the answers

    Which of the following adverse reactions is NOT associated with centrally acting alpha2 agonists?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is the recommended approach for dosing methyldopa and clonidine in treating hypertension?

    <p>Start with the lowest recommended dose and increase gradually</p> Signup and view all the answers

    How can the sedation side effect associated with clonidine and methyldopa be minimized?

    <p>By dividing the dose with a higher dose in the evening</p> Signup and view all the answers

    Which drug interaction is mentioned in the text for centrally acting alpha2 agonists?

    <p>Beta-adrenergic blockers should not be used concurrently with them.</p> Signup and view all the answers

    Which of the following statements about the use of centrally acting alpha2 agonists in children is correct?

    <p>Methyldopa can be safely used in children, but clonidine cannot.</p> Signup and view all the answers

    Which drug in this class is approved by the FDA for the treatment of ADHD in children?

    <p>Clonidine</p> Signup and view all the answers

    For which age group is clonidine considered to work better in treating hypertension?

    <p>Adults</p> Signup and view all the answers

    Which of the following adverse reactions is specifically associated with guanabenz?

    <p>Abdominal pain and vomiting</p> Signup and view all the answers

    What should be done if a patient needs to discontinue both a centrally acting alpha2 agonist and a beta-adrenergic blocker?

    <p>Discontinue the beta-adrenergic blocker first.</p> Signup and view all the answers

    Which drug formulation is available for patients who have difficulty taking pills or remembering frequent doses?

    <p>Transdermal clonidine</p> Signup and view all the answers

    Which of the following is NOT a recommended monitoring parameter for patients taking methyldopa?

    <p>Liver function tests</p> Signup and view all the answers

    What should be monitored for patients taking clonidine or methyldopa, especially those with renal impairment?

    <p>Serum creatinine levels</p> Signup and view all the answers

    Which drug was traditionally considered the drug of choice for pregnant women with hypertension?

    <p>Methyldopa</p> Signup and view all the answers

    Which of the following statements about the use of centrally acting alpha2 agonists in hypertension is correct?

    <p>They are used as second-line drugs when other drugs are not effective in achieving blood pressure control.</p> Signup and view all the answers

    What is the recommended approach for monitoring blood pressure when using clonidine or methyldopa?

    <p>Take baseline blood pressure before initiating therapy and monitor with each dosage change</p> Signup and view all the answers

    Which of the following adverse reactions is specifically associated with clonidine?

    <p>Pruritic rash</p> Signup and view all the answers

    What is the primary reason for conducting liver function studies before and during methyldopa therapy?

    <p>To monitor for potential hepatotoxicity associated with methyldopa</p> Signup and view all the answers

    How should patients take methyldopa to ensure proper dosing?

    <p>Take the missed dose as soon as possible, unless it's almost time for the next dose</p> Signup and view all the answers

    What is a potential consequence of missing doses of methyldopa?

    <p>Increased risk of experiencing rebound hypertension</p> Signup and view all the answers

    What should patients be aware of regarding potential drug-herbal interactions with methyldopa?

    <p>Methyldopa may interact with certain herbal supplements, so patients should inform their prescribers about any herbal use</p> Signup and view all the answers

    How should patients apply the transdermal clonidine patch?

    <p>Apply the patch to a hairless area of intact skin on the upper arm or torso once every 7 days, using a different site from the previous application</p> Signup and view all the answers

    What is the most common adverse reaction associated with methyldopa and clonidine?

    <p>Hypotension (low blood pressure)</p> Signup and view all the answers

    What should patients do to minimize the risk of hypotension while taking methyldopa or clonidine?

    <p>Avoid alcohol and other CNS depressants, and drink an adequate amount of non-caffeinated fluids</p> Signup and view all the answers

    What should patients report to their healthcare provider while taking methyldopa?

    <p>Any weight gain of more than 2 lb (1 kg) in 1 day, which may indicate fluid retention</p> Signup and view all the answers

    What should patients be encouraged to do in addition to taking medication for hypertension management?

    <p>Adhere to lifestyle interventions such as weight loss, exercise, low-sodium diet, smoking cessation, and stress management</p> Signup and view all the answers

    What is the primary mechanism of action of adrenergic antagonists in the treatment of hypertension?

    <p>They block adrenergic receptors or decrease norepinephrine release within sympathetic nervous system terminals</p> Signup and view all the answers

    What is the main reason nonselective alpha antagonists are not used in the treatment of hypertension?

    <p>They block presynaptic alpha2 receptors resulting in reflex cardiac stimulation</p> Signup and view all the answers

    Which statement about selective alpha1 antagonists is true?

    <p>Tamsulosin, alfuzosin, and silodosin have minimal effect on blood pressure</p> Signup and view all the answers

    What is the primary pharmacodynamic effect of reversible alpha1 antagonists?

    <p>Decrease in peripheral vascular resistance</p> Signup and view all the answers

    Why are prazosin and terazosin less likely to cause reflex tachycardia compared to other alpha1 antagonists?

    <p>They are more selective for alpha1 receptors in the vasculature</p> Signup and view all the answers

    Which drug was found to have an increased risk of heart failure (HF) in comparison to chlorthalidone according to the ALLHAT trial?

    <p>Doxazosin</p> Signup and view all the answers

    What is one of the reasons tamsulosin, silodosin, and alfuzosin have not been approved for hypertension treatment?

    <p>Increased selectivity for alpha1 receptors in the prostate</p> Signup and view all the answers

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