Chapter 13 Autonomic Nervous System Drugs & 14 Antineoplastic Drugs

Front 1

Autonomic Nervous System (ANS)

Back 1

involuntary, automatic, self-governing

- sympathetic: "alert-system" can quicky ready your body to face emergencies

- parasympathetic: "resting and digesting" automatically helps to maintain the normal body functions again without your conscious effort

Front 2

Sympathetic Nervous System (SNS)

- the emergency room used to mobilize the body for quick response and action

"fright, fight, and flight"

Back 2

Catecholamines

= Chemical substances (neurotransmitters) released at the sympathetic nerve endings

(norepinephrine and dopamine)

Front 3

Neurotransmitters: chemical substances that are released at the nerve endings within these systems to transmit the nerve impulses from nerve to nerve at the synapses or from nerve to smooth muscle or glands

Back 3

Drugs that affect the function of the ANS are divided into 4 categories

1. Adrenergics

2. Adrenergic blockers

3. Cholinergics

4. Cholinergic blockers

Front 4

Adrenergics (sympathomimetics = mimic sympathetic responses)

Back 4

Adrenergic blockers (alpha- and beta-blockers = block sympathetic responses)

Front 5

Cholinergics (parasympathomimetics = mimic parasympathetic responses)

Back 5

Cholinergic blockers (anticholinergics = block parasympathetic responses)

Front 6

Adrenergics: drugs that mimic the action of the sympathetic nervous system called sympathomimetic

Back 6

Actions of Adrenergic include

- cardiac stimulation

- increased blood flow to skeletal muscles

- peripheral vasoconstriction

- bronchodilation

- dilation of the pupils (mydriatic action)

Front 7

Uses of Adrenergics include

- restoring rhythm in cardiac arrest

- elevating blood pressure in shock

- constricting capillaries

- dilation bronchioles in acute asthmatic attacks, bronchospasm or anaphylactic reaction

- ophthalmic procedures

Back 7

Side effects of the adrenergics may include

- palpitations (rapid strong irregular heartbeat due to agitation, exertion or illness)

- nervousness or tremor

- tachycardia (abnormal rapid heartbeat)

- cardiac arrhythmias (abnormal heart rhythm)

- anginal pain

- hypertension

- hyperglycemia

- tissue necrosis

- headache and insomnia

Front 8

Precautions/Contraindications with adrenergics

- angina

- coronary insufficiency

- hypertension

- cardiac arrhythmias

- angle-closure glaucoma

- organic brain syndrome (decreased mental function)

- hyperthyroidism

Back 8

Caution for Adrenergics

- give subcutaneous, IM (deltoid) or IV

- small amounts only

Front 9

Interactions of adrenergics may occur with

- CNS drugs

- propranolol (Inderal) or other beta-adrenergic blockers

- Terazosin (Hytrin) or other alpha-adrenergic blockers

Back 9

Anaphylactic shock

- severe allergic reaction that occurs suddenly and is commonly caused by food, medication, or latex allergies, severe insect bites or stings

Front 10

Adrenergic Blockers

- drugs that block the action of the sympathetic nervous system

- most commonly used: alpha-blockers and beta-blockers

Back 10

Most commonly used Adrenergic drugs

- alpha-blockers

- beta-blockers

- alpha- and beta-adrenergic blockers

Front 11

Uses of Beta-blockers include treatment of the following

- hypertension

- cardiac arrhythmias

- angina pectoris

- migraine headache

- tremor

Back 11

Side effects of beta-blockers may include

- hypotension

- bradycardia

- fatigue or lethargy

- bronchospasm

- nausea and vomiting

- hypoglycemia

- confusion

Front 12

Precautions/Contraindications apply to the use of beta-blockers with

- abrupt discontinuation (decrease over several weeks)

- congestive heart failure or atrioventricular block

- hypotension

- asthma, COPD

- diabetes (can mask signs of hypoglycemia)

Back 12

Interactions of beta-blockers may occur with

- digoxin

- insulin or oral anti-diabetic agents

- theophylline

- MAOIs and tricyclic antidepressants

- Epinephrine (causes hypertensive response)

- Phenothiazines

Front 13

The parasympathetic nerve fibers synthesize and liberate _________ as the mediator

Back 13

acetylcholine

Front 14

Cholinergic drugs (parasympathomimetic)

Back 14

drugs that mimic the action of the parasympathetic nervous system

(e.g. bethanechol, neostigmine, pilocarpine and pyridostigmine)

Front 15

Actions of cholinergics include

Back 15

- increased gastrointestinal (GI) peristalsis

- increased contraction of the urinary bladder

- increased secretions (sweat, saliva and gastric juices)

- increased skeletal muscle strength

- lowered intraocular pressure

- constriction of the pupils

- slowing of the heart

Front 16

Uses of the cholinergics include treatment of

- nonobstructive urinary retention (bethanechol)

- neuromuscular blockade reversal (neostigmine)

- myastenia gravis (pyridostigmine)

- xerostomia (dry mouth) (pilocarpine-Salagen)

- open-angle glaucoma (pilocarpine)

Back 16

Side effects of the cholinergics may include

- nausea, vomiting and diarrhea

- muscle cramps and weakness

- slowing of the heart and hypotension

- sweating, excessive salivation, lacrimation (discharge of tears) and flushing

- respiratory depression and bronchospasm

Front 17

Precautions/Contraindications with cholinergics apply to those with

- benign prostatic hyperplasia (BPH)
- GI disorders (ulcer and obstruction)

- Asthma

- Cardiac disorders

- hyperthyroidism

Back 17

Interactions with cholinergics may include with

- procainamide and quinidine (have anticholinergic properties)

- local anesthetics (inhibit neuronal transmission in skeletal muscles)

Front 18

Drugs that block the action of the parasympathetic nervous system

= Cholinergic blockers or anticholinergics

aka Parasympatholytic

Back 18

Example of cholinergic blocker

- atropine

Front 19

Common use of anticholinergics is

- scopolamine transdermal patches to treat or prevent seasickness by decreasing gastric secretions and motility

Back 19

Anticholinergics most commonly used as preoperative medications include atropine and glycopyrrolate (Robinul)

- reduce secretions of the mouth, pharynx, bronchi and GI tract and reduce gastric activity

Front 20

Anticholinergics also used to

- prevent cholinergic effects during surgery

such as hypotension, or bradycardia and some cardiac arrhythmias associated with general anesthetics or vagal stimulation

Back 20

Vagus nerve is the major nerve of the parasympathetic nervous system

- can be stimulated during intubation procedures and surgery

- only atropine acts as a bronchodilator and reduce incidence of laryngospasm that can occur during general anesthesia

Front 21

Actions of anticholinergics include

- drying (all secretions decreased)

- decreased GI and genitourinary (GU) motility

- dilation of the pupils

Back 21

Uses of the anticholinergics include

- antispasmodic and antisecretory for GI or GU hypermotility

- preoperative and preanesthetic uses

- antidote for insecticide poisoning, cholinergic crisis or mushroom poisoning

- emergency treatment of bradycardia and atrioventricular heart block with hypotension

- dilation of the pupils (mydriatic)

- prevention and treatment of bronchospasm (bronchodilator, e.g. Atrovent HFA inhaler)

Front 22

Side Effects of anticholinergics may include

- fever or flushing

- blurred vision and headache

- dry mouth, constipation and urinary retention

- falls, delirium and cognitive impairment, esp in older adults

- palpitations and tachycardia (abnormally fast heartbeat)

Back 22

Interactions with potentiation of sedation and drying occur with

- antihistamines (e.g. diphenhydramine)

Front 23

Precautions/Contraindications apply to use of atropine for those with

Back 23

- asthma and other COPD atropine type inhalations of aerosols are recommended rather than oral or parenteral administration

- can reduce dry bronchial secretions and obstruct airflow- angle-closure glaucoma

- GI or GU obstruction

- Cardiac arrhythmias

- Hypertension

- Hypothyroidism and hepatic or renal disease

Front 24

Drugs that affect the function of the Autonomic Nervous System

Back 24

Adrenergics

Adrenergic blockers

Cholinergic

Cholinergic blockers

Front 25

Chapter 14

Back 25

Antineoplastic Drugs

Front 26

Tumors can be classified as

- benign (non-cancerous)

- malignant (cancerous)

Back 26

Antineoplastic (against new tissue formation)

- agents that counteract the development, growth, or spread of malignant cells

- can treat various types of cancers

Front 27

Chemotherapy

- drugs and drug combinations used for palliative effects (alleviation of symptoms) or for long-term or complete remissions in early treatment of cancer

Back 27

Antineoplastic drugs cytotoxic (destructive to cells) especially to cells that are proliferating

- many possess immunosuppressive properties

(by decreasing production of white blood cells and antibodies and reduce inflammatory reaction)

= increased susceptibility to infection

Front 28

Antineoplastic agent groups are

- Antimetabolites

- Alkylating agents

- Mitotic inhibitors

- Antitumor antibiotics

- Hormones and hormone modifiers

- Biological therapies

- Targeted cancer therapies

- Vaccines

- Radioactive isotopes

Back 28

Antineoplastic drugs are frequently administered in high doses on an intermittent schedule

Front 29

Antimetabolites work by

Back 29

interfering with DNA synthesis, repair, and cellular replication and are used in treatment of various malignancies, especially involving rapid proliferating neoplasms (new growth)

Front 30

Examples of injectable Antimetabolites:

Back 30

methotrexate and fluoruracil

Front 31

Side effects of antimetabolites can include

Back 31

anorexia, nausea, vomiting, diarrhea,

ulceration and bleeding or oral mucosa and GIT tract

bone marrow suppression

rash, itching, photosensitivity and scaling

Front 32

Precautions/Contraindications with antimetabolites apply to

Back 32

renal and hepatic disorders

pregnancy

GI ulcers

Front 33

Alkylating agents

Back 33

used in treatment of a wide range of cancers

- include cisplatin and cyclophosphamide

= prevent cell growth by damaging DNA needed for reproduction

Front 34

Side effects of Alkylating agents can include

Back 34

nausea, vomiting, diarrhea

mucosal ulceration bone marrow suppression

neurotoxicity (headache, vertigo, seizures)

hemorrhagic cystitis with cyclophosphamide

rash and alopecia

pulmonary fibrosis

Front 35

Precautions and Contraindications with alkylating agents apply to

Back 35

debilitated patients

pregnancy

renal disease

Front 36

Plant Alkaloids (Mitotic inhibitors)

Back 36

are often plant alkaloids and other compounds derived from natural products that block mitosis

treat many different types of cancer

- used in combination with other chemotherapeutic agents in treatment of various malignancies

Plant alkaloid examples: vinblastine, vincristine, and paclitaxel

Front 37

Side Effects of plant alkaloids can include

Back 37

neurotoxicity

severe constipation or diarrhea, nausea, vomiting

oral or GI ulceration

rash, phototoxicity, alopecia

Leukopenia

Necrosis of tissue if intravenous

Front 38

Precautions/Contraindications with plant alkaloids apply to

Back 38

pregnancy

hepatic dysfunction

infection

geriatric patients

Front 39

Taxanes

Back 39

structurally different from other antineoplastic agents

- used as second-line or subsequent therapy in patients with metastatic breast or ovarian carcinoma refractory to conventional chemotherapy

Front 40

Paclitaxel (example of taxane) is adminstered only by IV under constant supervision of an oncologist with frequent monitoring of vital signs

Back 40

due to its severe adverse reactions

Front 41

Antitumor antibiotics

Back 41

can treat a wide variety of malignancies

Ex: doxorubicin, daunorubicin, bleomycin, daunorubicin, mitomycin, and others

(frequently used in combination of other drugs)

Front 42

Side effects of antitumor antibiotics can include

Back 42

anorexia, nausea, vomiting and diarrhea

bone marrow suppression

cardiotoxicity

pneumonitis and dyspnea;

ulceration of the mouth or coon

alopecia, rash, scaling

Front 43

Precautions/contraindications with antitumor antibiotics apply to

Back 43

pregnancy

liver disorders

cardiac disease

Front 44

Hormone used to treat cancer

Back 44

Example:

Corticosteroids - used primarily for their suppressant effect on lymphocytes in Leukemias and Lymphomas (such as prednisone)

Front 45

Side effects with prolonged use of corticosteroids

Back 45

fluid retention, edema

Cushingoid features (moon face)

Nausea/vomiting, gastritis and GI bleeding

Osteoporosis with fractures

Front 46

Hormone modifier include

Back 46

antiestrogen - hormonal therapy for metastatic estrogen receptor–positive breast cancer and palliative treatment

antiandrogen agents - hormonal therapy in the treatment of endometriosis and metastatic prostate cancer

Front 47

Antiestrogen

Back 47

nonsteroidal agent belonging to a class of drugs called selective estrogen-receptor modifiers (SERMs)

-

Front 48

Example of Antiestrogen

Back 48

Tamoxifen: binds to estrogen receptors in various tissues

- also stimulates estrogen receptors in bones and may help prevent osteoporosis

Front 49

Antiandrogen drugs include

Back 49

leuprolide acetate, - suppresses testosterone production in the testes and usually administered IM or SC on monthly regiments for prostate cancer

Front 50

Side effects of antiandrogens can include

Back 50

impotence

hot flashes, generalized pain, infection, constipation and nausea

- continue drug even when signs or symptoms of disease improve

Front 51

Biological therapies (immunotherapy, biotherapy or biological response modifier therapy)

Back 51

designed to repair, stimulate or enhance cancer patients' natural immune systems to more effectively recognize and attack cancer cells

Front 52

Types of immunotherapy (biological therapy)

Back 52

active or direct type (such as interferons)

- stimulates the body's own immune system to fight the disease

passive or indirect type (such as monoclonal antibodies)

- uses immune system components created outside the body

Front 53

Interferons Alfa (Intron A)

Back 53

the type most widely used in cancer treatments

- a complex combination of many proteins that boost immune system response

- treats certain leukemias, melonoma, Kaposi's sarcoma and non-Hodgkin's lymphoma.

- also used to treat hepatitis B and C, multiple sclerosis and other conditions

Front 54

Adverse side effects of interferons (most common side effects)

Back 54

flulike syndrome

GI symptoms

Nervous system effects

hematological effects

dyspnea

alopecia

Front 55

Colony-stimulating factors (CSFs)

Back 55

usually do not directly affect tumor cells

(such as erythropoietin

- encourage bone marrow stem cells to divide and develop into red and white blood cells and platelets

Front 56

Monoclonal Antibodies (MABs)

Back 56

are exogenous (outside of body) antibodies genetically engineered in the lab

- designed to target only cancer cells, sparing normal tissues

- reduces host toxicity while simultaneously increasing toxicity to cancer cells

Front 57

Side effects of MABs can include

Back 57

fever and chills, headache and dizziness

nausea, vomiting

itching, rash, and generalized pain

Front 58

Targeted cancer therapies

Back 58

drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression

- focus on molecular and cellular changes that are specific to cancer

Front 59

Signal Transduction Inhibitors (STIs)

Back 59

one of the newer and largest grouping of targeted therapy drugs block specific enzymes and growth factor receptors that signal cancer cell proliferation

Front 60

Vaccines

Back 60

medicines that boost the immune system's natural ability to protect the body against "foreign invaders" mainly infectious agents that may cause disease

Front 61

two types of cancer vaccines

Back 61

preventive (prophylactic) - intended to prevent cancer from developing in healthy people

treatment (therapeutic) intended to treat an existing cancer by strengthening the body's natural defenses against cancer

Front 62

Radioactive Isotopes

Back 62

used in treatment of certain types of cancer

- sometimes radioactive material is injected into the affected site or implanted in body in the form of capsule, needles or seeds

-

Front 63

Cautions and Responsibilities for Antineoplastic Drugs

Back 63

Medications should be given on time and exactly as prescribed Intravenous sites must be checked with great care Intravenous fluids containing antineoplastic agents should not be allowed to get on the skin or into the eyes of the patient or administrator

Front 64

What medication is useful in minimizing side effects nausea and vomiting from treating lymphoma from chemotherapy>

Back 64

Tositumomab (Bexxar) with iodine 131

Front 65

what medication is a prototype for antihypertensive that works via the ANS?

Back 65

propranolol

Front 66

what medication type is used for hypertension?

Back 66

Beta-blocker

(adrenergic blocker)