Peripheral Nervous system/ Central Nervous system
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- Adrenergic: everything in the sympathetic (fight-or-flight) side of the brain -- A and B receptors.
- Cholinergic: everything in the parasympathetic (body glands in the body) side of the brain.
What are common cholinergic/parasympathetic Nervous Systems.
What do anticholinergic/sympathetic Nerves do?
- there is total of 7 of them.
- Slowing HR.
- Increased gastric secretion.
- Emptying the bladder.
- Emptying the bowel.
- Focusing the eye for near vision.
- Constricting the pupil (Miosis)Contracting bronchial smooth muscle.
- Anticholinergic: do the opposite. For example, Parasy slows HR, symp accelerates HR.
What are the neurotransmitters of the Peripheral Nervous System? what are cholinergic side? which ones are in the anticholinergic?
- Neurotransmitters: acetylcholine, Norepi and epi.
- Cholinergic: reponsible for all cholinergic receptors (Nicotinic-n, Nicotinic-m, Muscarinic)
- Nicotinic-m: Associated w muscle or movement, only skeletal muscles. Drugs or diseases that attack this receptors paralyzed the pt.
- Nicotinic-n: release of little epi from the adrenal medula.
- Muscarinic: Reponsible for all the other seven cholinergic effects. -- Muscurinic antagonist acts like anticholigenic drugs (e.i speed HR, retains water, etc) -- comon drug is atropine.
- Anticholinergic: epi and norepi. They are reponsible for flight -or-fight response.
Muscarinic agonist drug? TU? AE?
- TU: mainly used for Urinary retention in post op and portpartum pts.
- AE: slowing of the HR, urination, hypotension, etc.
Muscarini antagonist MOA? AKAs? Drugs?
- MOA: block the action of acetylcholine at muscarinic receptors.
- AKA: parasympathetic drugs, anticholinergic drugs, etc.
- Drugs: Dipehndrydramine (Brenadryl), Atropine , etc.
What is Atropine? PE? DI? SE?
- It is a known muscurinic antagonist.
- PE: reverse of the seven cholinergic effects. increase HR, decreases release of exocrine glands, relazes bronchi, eye mydriasis (dilatation), etc.
- DI: other anticholinergic drugs, like benedryl and Opiods.
- SE: anticholinergic effects, urinary retention, constipation, tahycardia, etc.
What is Myasthenis Gravis cause? tX?
- Autoimmune proccess in which antibodies attack nicotinic-m receptors on skeletal muscle.
- Tx: Edrophonium (tensilon) drug, if they get better then it was a Myasthenis Gravis attack.
Guillian Barre syndrome TX?
- Respiratory assistance.
- Glucocorticoids (supress immnuse system response).
What are the disesases of the PNS?
Guillian Barre, and Myasthenis Gravis.
Parkinson's Disease drugs? Levodopa DI? AE? Selegiline chs? patient teaching?
- Levodopa: promotes dopamine synthesis (re-uptake whatever is left, not the making it of it).
- Dopamine agonist: stimulate dopamine receptors directly (suck it into the receptors so that it doesn't get lost)
- Selegiline: inhibits dopamine breakdown.
- levodopa DI: Avoid CNS drugs, Food delays absorption, high-protein foods will reduce therapeutic effects.
- Levodopa AE: Nausea and vomiting (have it w food),
- Selegiline: Can supress destruction of dopamine derived from levodopa and prolong the effects of dopamine.
- PT: May take several weeks to see beneficial effects -- change position slowly -- take w food -- Do not discontinue drugs -- Avoid the use of alcohol -- AE: if the movement increases or gets worse, maybe there is something else going on.
Alzheimer's Disease drugs? SE
- Cholinesterase inhibitors: Donepezil (aricept), Galantamine (razadyne), Rivastigmine (exelon) also used in PD, Tacrine (causes liver damage).
- SE of cholinesterase inh: GI (nausea, vomiting, diarrhea), dizziness, headache, bronchoconstriction, liver injury (tacrine).
Multiple Sclerosis (MS) drugs? AE?
- drugs: Immunomodulators and immunosuppresants (short course of high-dose IV glucocorticoids) -- Natalizumab (tysabril) used in MS and Crohn's disease.
- Immunomodulators: recreate the immune system to not recognize there is an inflammatory response (interferon beta-1a (avonex, Rebif) 1b (betaseron), etc)
- AE: interferon beta could cause for flu-like rxn(give late in day -- might premedicate w tylenol).
- There are drugs to manage all the symptoms of MS.
Epilepsy drug types? MOA? drugs names, SE, and serum drug level (SDL)?
- Drugs types: Traditional antiepilectic drugs (AEDs) and newer AEDs.
- MOA: Supression of sodium influx, suppression of calcium influx, antagonism of glutamate, potentiation of GABA.
- Phenytoin (dilantin): 8 to 60 hrs of half-life -- used as a antiHTN drug -- AE: sedation, cognitive impairment, CV effects (hypotension- HR increase), gingina hyperplasia -- SDL: 10 to 20 mcg/ml
- Carbamazepine (tegreto): AE: hematologi effects (leukopenia, anemia, thrombocytopenia) -- SDL:5-12 mcg/dl
- Valproic Acid (depakene, depakote, depacon): AE: GI probs -- SDL:50-125 mcg/dl
- Ethosuximide (zarontin): drug of choice for small seizures. SE: initially may cause drowsiness, dizziness, and lethargy, but it goes away. SDL: 40-100 mcg/dl. not a big drug.
- Phenobarbital (solfoton): promotes sleep and sedation, usually not the first DOC. -- SDL: 10-30 mcg/ml.
Manage Epilepticus generally?
- Start the watch.
- Maintain ventilation, protect head, put them on the side.
- Terminate seizures w IV benzos.
- ** Need to know if the seizure is bc type I diabetes.
- get the serum levels, draw 8 hrs after last dose.
antiseizure drugs in children?
- Avoid sedation. (teachers should know how to handle seizures)
- Medic alert bracelet.
- Chewable dosage should not ve used for once -a-day admim bc of the 1st pass effect.
- should keep a journal of what happens in the seizure (family)
Antiseizure drugs in older adults?
- Liver and kidney function.
- Older adults have decreased levels of serum albumin.
Muscle spasms and spasticity drugs? AE?
- Diazepam (valium): MOA through enhancing effects of GABA.
- tizanidine (zanaflex): MOA through agonist action at presynaptic alpha2 receptors.
- AE: generalized CNS depression, physical dependence, hepatic toxicity.
Drugs for spasticity? AE?
- Baclofen (lioresal): CNS depressant, urinary retention, some anticholinergic side effects.
- Diazepam (Valium): sedation.
- Dantrolene (dantrium): MOA directly on the skeletal muscles, nicotinic-m receptors.-- AE: Diarrhea, drwosiness, muscle weakness.
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