10.2 Nutrition and Chronic Hematologic Illness
4 min read•june 18, 2024
Neurotransmitters are chemical messengers that allow our nervous system to function. They play crucial roles in everything from muscle movement to mood regulation. Understanding how these chemicals work is key to grasping how drugs affect our bodies and minds.
Drugs can interact with our nervous system in various ways. Some mimic or block neurotransmitters, while others affect their release or reuptake. This knowledge helps us comprehend how medications treat conditions like depression, anxiety, and Parkinson's disease.
Neurotransmitters and Nervous System Pharmacology
Neurotransmitters and their functions
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- Acetylcholine (ACh)
- Serves as a neurotransmitter in both the central nervous system (CNS) and peripheral nervous system (PNS)
- Plays a crucial role in memory formation, learning processes, and muscle contraction (skeletal and smooth muscle)
- Involved in the regulation of autonomic functions such as heart rate, digestion, and secretion
- Norepinephrine (NE)
- Acts as a neurotransmitter primarily in the sympathetic nervous system
- Increases heart rate, blood pressure, and blood glucose levels during stress or
- Plays a key role in the body's "fight or flight" response to prepare for action in emergency situations
- Dopamine (DA)
- Functions as a neurotransmitter in the CNS, particularly in the brain's reward and motor control systems
- Regulates movement, emotional responses, motivation, and feelings of pleasure and reward
- Imbalances in dopamine levels are associated with neurological disorders such as Parkinson's disease and psychiatric conditions like schizophrenia
- Serotonin (5-HT)
- Serves as a neurotransmitter in the CNS and gastrointestinal tract
- Regulates mood, sleep patterns, appetite, and pain perception
- Dysregulation of serotonin is linked to various psychiatric disorders, including depression and anxiety
- Gamma-aminobutyric acid (GABA)
- Acts as the primary inhibitory neurotransmitter in the CNS
- Reduces neuronal excitability by hyperpolarizing the postsynaptic membrane
- Plays a crucial role in regulating anxiety levels and promoting relaxation
- Glutamate
- Serves as the primary excitatory neurotransmitter in the CNS
- Involved in learning, memory formation, and synaptic plasticity (the ability of synapses to strengthen or weaken over time)
- Excessive glutamate activity can lead to excitotoxicity, which is associated with neurodegenerative disorders
Drug interactions with autonomic receptors
- Cholinergic receptors
- Muscarinic receptors (M1-M5)
- Activated by ACh and targeted by drugs like atropine and scopolamine to block their effects
- Used to treat conditions such as motion sickness, overactive bladder, and chronic obstructive pulmonary disease (COPD)
- Nicotinic receptors (NM, NN)
- Activated by ACh and targeted by drugs like nicotine and varenicline to stimulate or partially activate these receptors
- Used to treat conditions such as smoking cessation and Alzheimer's disease by improving cognitive function
- Muscarinic receptors (M1-M5)
- Adrenergic receptors
- Alpha-1 receptors (α1)
- Activated by NE and targeted by drugs like prazosin and tamsulosin to block their effects
- Used to treat conditions such as hypertension and benign prostatic hyperplasia by relaxing smooth muscle
- Alpha-2 receptors (α2)
- Activated by NE and targeted by drugs like clonidine and guanfacine to stimulate these receptors
- Used to treat conditions such as hypertension and attention deficit hyperactivity disorder (ADHD) by reducing sympathetic activity
- Beta-1 receptors (β1)
- Activated by NE and targeted by drugs like atenolol and metoprolol to block their effects
- Used to treat conditions such as hypertension, angina, and heart failure by reducing heart rate and contractility
- Beta-2 receptors (β2)
- Activated by NE and targeted by drugs like albuterol and salmeterol to stimulate these receptors
- Used to treat conditions such as asthma and COPD by promoting bronchodilation
- Alpha-1 receptors (α1)
Sympathetic vs parasympathetic nervous system agents
- Sympathetic nervous system (SNS) stimulants
- Drugs that increase the activity of the SNS by mimicking or enhancing the effects of NE
- Examples include epinephrine, norepinephrine, and amphetamines
- Used to treat conditions such as anaphylaxis, cardiac arrest, and narcolepsy by increasing alertness and cardiovascular function
- Sympathetic nervous system (SNS) blockers
- Drugs that decrease the activity of the SNS by blocking the effects of NE at adrenergic receptors
- Examples include alpha blockers (prazosin) and beta blockers (propranolol)
- Used to treat conditions such as hypertension, angina, and migraine by reducing peripheral resistance and heart rate
- Parasympathetic nervous system (PNS) stimulants
- Drugs that increase the activity of the PNS by mimicking or enhancing the effects of ACh
- Examples include pilocarpine and bethanechol
- Used to treat conditions such as glaucoma and urinary retention by promoting smooth muscle contraction and secretion
- Parasympathetic nervous system (PNS) blockers
- Drugs that decrease the activity of the PNS by blocking the effects of ACh at muscarinic receptors
- Examples include atropine, scopolamine, and glycopyrrolate
- Used to treat conditions such as bradycardia, overactive bladder, and COPD by reducing smooth muscle tone and secretion
Drug mechanisms and nervous system interactions
- Blood-brain barrier
- Selective permeability barrier that separates the circulating blood from the brain extracellular fluid
- Influences drug delivery to the CNS and must be considered when developing CNS-active medications
- Neurotransmitter reuptake
- Process by which neurotransmitters are removed from the synaptic cleft
- Target of many antidepressants and other psychoactive drugs to prolong neurotransmitter effects
- Synaptic transmission
- Process of signal transmission between neurons at synapses
- Affected by various drugs to modulate nervous system function
- Receptor agonists and antagonists
- Agonists: Drugs that activate specific receptors to mimic or enhance neurotransmitter effects
- Antagonists: Drugs that block specific receptors to inhibit neurotransmitter effects
- Neuroplasticity
- The brain's ability to form new neural connections and adapt in response to experiences or injury
- Influenced by certain medications and therapies to promote recovery or manage neurological conditions
Key Terms to Review (59)
Absolute iron deficiency anemia: Absolute iron deficiency anemia is a condition characterized by a lack of sufficient iron to produce hemoglobin, leading to reduced oxygen transport in the blood. It results from depleted iron stores and can cause symptoms like fatigue, weakness, and pallor.
Activities of daily living: Activities of daily living (ADLs) are routine tasks that individuals do every day without assistance, such as eating, bathing, dressing, toileting, and transferring. These activities are essential for maintaining personal health and independence.
Anemia: Anemia is a condition characterized by a reduced number or impaired function of red blood cells, leading to a decrease in the oxygen-carrying capacity of the blood. This can have significant implications for an individual's overall health and wellness, particularly in the context of nursing practice and the management of various medical conditions.
Anorexia: Anorexia is an eating disorder characterized by an intense fear of gaining weight and a distorted body image, leading to restricted food intake. It can result in severe malnutrition and serious health complications.
Anticancer therapy: Anticancer therapy involves treatments designed to stop the growth of cancer cells or eliminate them entirely. These therapies can include chemotherapy, radiation, immunotherapy, and targeted drug treatments.
Anticoagulants: Anticoagulants are medications that help prevent the formation of blood clots by interfering with the normal clotting process. They are commonly used to treat and prevent conditions like deep vein thrombosis, pulmonary embolism, and atrial fibrillation, where there is an increased risk of clot formation.
Bleeding: Bleeding is the loss of blood from the circulatory system, which can occur internally or externally. It can significantly impact nutritional status and overall hematologic health, requiring careful management in healthcare settings.
Bone Marrow Biopsy: A bone marrow biopsy is a medical procedure in which a small sample of bone marrow is extracted, typically from the hip or breastbone, for analysis. This procedure is used to diagnose and monitor various hematologic (blood-related) conditions, including cancer, anemia, and other disorders affecting the production and function of blood cells.
Cachexia: Cachexia is a complex metabolic syndrome characterized by severe weight loss, muscle wasting, and fatigue. It is often associated with chronic illnesses, such as cancer, chronic obstructive pulmonary disease (COPD), and chronic hematologic disorders, and can have a significant impact on a patient's quality of life and prognosis.
Cancer-associated anemia: Cancer-associated anemia is a condition where cancer or its treatment leads to a decrease in the number of red blood cells. This can result in fatigue, weakness, and other symptoms that impact a patient's quality of life.
Chelation Therapy: Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals and minerals from the body. It is primarily used to treat heavy metal poisoning, such as lead, mercury, or iron overload, and can also be applied in the management of certain chronic hematologic illnesses.
Colon cancer: Colon cancer is a type of cancer that begins in the large intestine (colon), part of the digestive tract. It typically starts as small, noncancerous clumps of cells called polyps that can develop into cancer over time.
DHA: DHA, or docosahexaenoic acid, is a long-chain omega-3 fatty acid that is essential for proper brain, eye, and nervous system development and function. It is a critical component of the phospholipids that make up cell membranes, particularly in the brain, retina, and heart.
EPA (Eicosapentaenoic Acid): EPA, or eicosapentaenoic acid, is a type of omega-3 fatty acid that is essential for human health. It is primarily found in fatty fish and fish oil supplements and plays a crucial role in various physiological processes, including the neurologic, cardiovascular, and musculoskeletal systems.
Erythrocytes: Erythrocytes, also known as red blood cells (RBCs), are the most abundant type of blood cells in the human body. They are responsible for carrying oxygen from the lungs to the body's tissues and carbon dioxide from the tissues back to the lungs, playing a crucial role in the hematological system.
Erythropoiesis: Erythropoiesis is the process by which red blood cells (erythrocytes) are produced in the bone marrow. It is regulated by erythropoietin, a hormone primarily produced by the kidneys in response to low oxygen levels in tissues.
Erythropoiesis: Erythropoiesis is the process of red blood cell (erythrocyte) production and maturation. It is a crucial component of the hematological system, responsible for maintaining adequate red blood cell levels to ensure efficient oxygen transport throughout the body.
Erythropoietin: Erythropoietin (EPO) is a glycoprotein hormone produced primarily by the kidneys that stimulates the production of red blood cells (erythrocytes) in the bone marrow. It plays a crucial role in the regulation of red blood cell production and is closely linked to the hematological system and renal function.
Fatigue: Fatigue is a state of extreme tiredness and reduced functional capacity that can be physical, mental, or a combination of both. It is often a symptom of underlying health issues and can significantly impact daily activities.
Fatigue: Fatigue is a subjective feeling of physical, emotional, or mental exhaustion that can significantly impact an individual's ability to function normally. It is a common symptom that can arise from various underlying conditions, including those related to the hematological system and chronic hematologic illnesses.
Ferritin: Ferritin is a protein that stores iron in the body. It is a key indicator of the body's iron status and plays a crucial role in the hematological system, hematologic wellness, and chronic hematologic illnesses.
Folate: Folate, also known as vitamin B9, is an essential nutrient that plays a crucial role in various physiological processes in the body, including neurological, hematological, and cardiovascular wellness. It is particularly important during periods of rapid growth and development, such as pregnancy and early childhood.
Functional iron deficiency: Functional iron deficiency occurs when there is insufficient iron available for erythropoiesis despite normal or increased total body iron stores. It is commonly seen in chronic illnesses where inflammation disrupts iron homeostasis.
Genetic hemochromatosis: Genetic hemochromatosis is an inherited disorder causing the body to absorb too much iron from the diet. Excess iron is stored in various organs, particularly the liver, heart, and pancreas, leading to potential organ damage.
Hematologic Disorders: Hematologic disorders are a group of conditions that affect the blood, blood-forming organs, and the body's ability to regulate blood components. These disorders can impact the production, function, or destruction of blood cells, leading to various health complications.
Hemochromatosis: Hemochromatosis is a genetic disorder characterized by the excessive absorption and accumulation of iron in the body's organs and tissues, leading to a range of health issues if left untreated.
Hemoglobinopathies: Hemoglobinopathies are a group of genetic disorders that affect the structure or production of hemoglobin, the oxygen-carrying protein in red blood cells. These disorders can lead to various health complications and are an important consideration in the context of nutrition and chronic hematologic illness.
Hemoglobinopathy: Hemoglobinopathy is a group of genetic disorders characterized by abnormal structure or production of hemoglobin, the protein in red blood cells that carries oxygen. These disorders can lead to various health complications, including anemia and organ damage.
Hemolytic Anemia: Hemolytic anemia is a type of anemia caused by the premature destruction or breakdown of red blood cells (RBCs), leading to a reduced number of functional RBCs in the body. This disruption in the normal lifespan of RBCs can result in various health complications and is particularly relevant in the context of chronic hematologic illnesses.
Hemophilia: Hemophilia is a genetic disorder that affects the blood's ability to clot due to the deficiency of certain clotting factors. This condition can lead to excessive bleeding even from minor injuries.
Hyperreactive hematopoiesis: Hyperreactive hematopoiesis is an abnormal increase in the production of blood cells by the bone marrow. It can be a response to chronic inflammation, infection, or certain hematologic diseases.
Injury-induced bleeding: Injury-induced bleeding is the loss of blood occurring as a result of physical trauma or injury to blood vessels. It can range from minor cuts to severe hemorrhaging and requires appropriate nutritional support for recovery.
Iron sequestration: Iron sequestration is the process by which iron is bound and stored in a manner that makes it unavailable for pathogens. It is a defensive response by the body to limit the availability of iron, which is crucial for bacterial growth and proliferation.
Iron stores: Iron stores refer to the body's reserve of iron, primarily stored in the liver, spleen, and bone marrow. They are crucial for producing hemoglobin and maintaining overall hematologic health.
Iron Supplementation: Iron supplementation refers to the intake of additional iron beyond what is obtained through diet, typically in the form of oral iron supplements or intravenous iron infusions. This practice is employed to address iron deficiency or prevent iron-related health issues, particularly in the context of the hematological system and overall wellness.
Iron-restricted erythropoiesis: Iron-restricted erythropoiesis is a condition where the production of red blood cells is limited due to insufficient iron. This can occur despite normal or increased iron stores in the body, often due to impaired iron mobilization.
Joints: Joints are the structures that connect bones and allow for movement and flexibility. They can be affected by nutrition, impacting overall hematologic health.
Leukemia: Leukemia is a type of cancer that starts in the blood-forming tissues, such as the bone marrow, and leads to the overproduction of abnormal white blood cells. These cancerous cells crowd out healthy blood cells, impairing the body's ability to fight infection, control bleeding, and transport oxygen effectively.
Low-Iron Diet: A low-iron diet is a dietary plan that limits the intake of foods high in iron to help manage conditions related to chronic hematologic illnesses, such as anemia. This type of diet aims to control the absorption and levels of iron in the body to maintain a healthy balance.
Micronutrient deficiencies: Micronutrient deficiencies are conditions where the body lacks essential vitamins and minerals necessary for various physiological functions. They can significantly impact hematologic health, leading to problems such as anemia and compromised immune function.
Neutropenic Diet: The neutropenic diet is a specialized dietary approach used for individuals with weakened immune systems, particularly those undergoing cancer treatment or with certain chronic hematologic illnesses. This diet aims to minimize the risk of foodborne infections by restricting the consumption of foods that may harbor potentially harmful bacteria, viruses, or other pathogens.
The neutropenic diet is closely linked to the topics of 10.2 Nutrition and Chronic Hematologic Illness, as it is a crucial component in the management and support of individuals with compromised immune systems due to these conditions.
Nutritional Deficiencies: Nutritional deficiencies refer to the lack or inadequate intake of essential nutrients required for proper bodily functions, growth, and development. These deficiencies can have significant impacts on an individual's health and well-being, particularly in the contexts of interdisciplinary teams in nursing practice, chronic hematologic illnesses, and chronic musculoskeletal and integumentary illnesses.
Oxidative stress: Oxidative stress is an imbalance between free radicals and antioxidants in the body, leading to cellular damage. It plays a significant role in the pathogenesis of various chronic illnesses affecting neurological, endocrine, hematologic, and pulmonary systems.
Parenteral Nutrition: Parenteral nutrition refers to the intravenous administration of nutrients, including carbohydrates, proteins, lipids, vitamins, and minerals, to individuals who are unable to meet their nutritional needs through oral or enteral (tube) feeding. This method of nutrition delivery bypasses the gastrointestinal tract, providing essential nutrients directly into the bloodstream to support various aspects of health, including hematologic, pulmonary, and gastrointestinal wellness.
Phlebotomy: Phlebotomy is the practice of drawing blood from a patient's vein for medical testing, transfusion, or research purposes. It is a crucial skill in the healthcare field, allowing for the collection of blood samples that provide vital information about a patient's health and condition.
Physical activity: Physical activity is any movement produced by skeletal muscles that requires energy expenditure. It includes activities such as walking, running, and structured exercise routines.
Phytates: Phytates, also known as phytic acid, are naturally occurring compounds found in plant-based foods, particularly grains, legumes, nuts, and seeds. They are considered antinutrients due to their ability to bind to and reduce the bioavailability of essential minerals, such as iron, zinc, and calcium, in the human body.
Platelets: Platelets, also known as thrombocytes, are small, colorless cell fragments found in the blood that play a crucial role in blood clotting and hemostasis. They are essential for maintaining the body's overall hematological wellness and are closely linked to the management of chronic hematologic illnesses.
Polyphenols: Polyphenols are a diverse group of plant-based compounds known for their antioxidant properties. They are found in a wide variety of fruits, vegetables, grains, and beverages, and have been associated with various health benefits, including neurological and hematological wellness across the lifespan.
Red blood cell transfusions: Red blood cell transfusions involve the administration of red blood cells to a patient in order to treat anemia or significant blood loss. They are critical for maintaining adequate oxygen delivery to tissues and organs when endogenous production is insufficient.
Sickle Cell Disease: Sickle cell disease is an inherited blood disorder characterized by abnormal hemoglobin, which can cause the red blood cells to become sickle or crescent-shaped. This shape change can lead to various complications and health issues across the lifespan, requiring specialized nutritional considerations.
Sickle cell disease (SCD): Sickle cell disease (SCD) is a genetic blood disorder characterized by the production of abnormal hemoglobin, leading to distorted, sickle-shaped red blood cells. These misshapen cells can obstruct blood flow and lead to various complications, including pain and organ damage.
Thalassemia: Thalassemia is a genetic blood disorder characterized by less hemoglobin and fewer red blood cells than normal. This can lead to anemia, fatigue, and other complications.
Thalassemia: Thalassemia is a group of inherited blood disorders characterized by the body's reduced or absent production of hemoglobin, the oxygen-carrying protein in red blood cells. This leads to anemia, which can have significant impacts on an individual's health and wellbeing across the lifespan.
Vaso-occlusive crises: Vaso-occlusive crises are painful episodes that occur when blood flow is obstructed by sickled red blood cells, leading to ischemia and tissue damage. These crises are common in individuals with sickle cell disease and require immediate medical attention.
Vaso-Occlusive Crises: Vaso-occlusive crises are painful episodes that occur in individuals with sickle cell disease, a chronic hematologic illness characterized by abnormal hemoglobin. These crises are caused by the blockage of small blood vessels, leading to reduced oxygen supply and tissue damage.
Vitamin B12: Vitamin B12, also known as cobalamin, is an essential nutrient that plays a crucial role in various bodily functions, including the proper functioning of the nervous system, the formation of red blood cells, and the maintenance of DNA. It is a water-soluble vitamin that must be obtained from dietary sources or supplements.
Vitamin D: Vitamin D is a fat-soluble vitamin that plays a crucial role in maintaining overall health and wellness. It is often referred to as the 'sunshine vitamin' because the body can synthesize it when the skin is exposed to sunlight. Vitamin D is essential for the regulation of calcium and phosphorus levels in the body, supporting strong bones and teeth, and it also has important functions in various other physiological processes.
Vitamin D replacement: Vitamin D replacement is the administration of vitamin D to individuals who are deficient or insufficient in this nutrient. It is crucial for maintaining bone health, immune function, and other physiological processes.