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Cholinergics/Anticholinergics, Andrenergic Agonists and antagonists
| Question | Answer |
|---|---|
| What is the therapeutic use of Bethanecol (Urecholine)? | Urinary Retention (Nonobstructive) |
| What drug class is Bethanecol? | Cholinergic |
| What can go wrong with Cholinergics (B,H,S,S,UU,D)? | bradycardia, hypotension, salivation, sweating, urinary urgency, dysrhythmias in hyperthyroid patients |
| What are the therapeutic uses for Atropine(P,B&HB,O,I,P,D)? | dry out for pre-op, Bradycardia & heart block, OAB, IBS & peptic ulcer (adjunct), Dilation for Eye procedures |
| What is the antidote for Atropine? | Physostigmine |
| What is the antidote for cholinergic (muscarinic) overdose? | Atropine |
| Give the 5 most common adverse effects of Atropine (DBTDU). | Drowsiness, Blurred Vision, Tachycardia, Dry Mouth, Urinary Hesitancy |
| What drug class is Oxybutynin (Ditropan)? | Anti-Cholinergic |
| What is the therapeutic use of Oxybutynin (Ditropan) ? | OAB |
| What are the therapeutic uses of drugs that cause alpha 1 activation (H, LA, E, M,N) ? | hemostasis, adjunct to local anesthesia, Elevate BP, Mydriasis-dilate the eye, Nasal decongestant |
| What are the side affects associated with drugs that activate alpha 1 receptors (H,B,N)? | Hypertension, bradycardia, necrosis |
| What does the activation of Alpha 2 receptors do? | Inhibits the release of norepinephrine |
| What conditions are treated by the activation of beta 1 receptors (Ca,Hf, S,A)? | Cardiac Arrest, Heart Failure, Shock, Atrioventricular heart block |
| What are the adverse effects of beta 1 activation (A,A)? | Abnormal heart rate or rhythm, angina pectoris |
| Name the 5 catecholamines. | Epinephrine, Norepinephrine, Isoproterenal, Dopamine, Dobutamine |
| Name the 3 noncatacholamines. | ephedrine, phenylephrine, terbutaline |
| What are the therapeutic uses of beta 2 activation (A,P)? | For treatment of asthma and to delay preterm labor |
| What are the adverse effects of beta 2 activation (H,T)? | hyperglycemia and tremor |
| What catacholamines might be administered in very small doses in order to stimulate kidney function? | Dopamine or Dobutamine |
| How does dopamine help stimulate kidney function? | Causes vascular dilation, increase perfusion |
| Give 8 therapeutic uses for epinephrine (B,N,D,LA,CF, A,M,A). | elevate bp, relieve nasal congestion, dilate bronchi, control superficial bleeding, delay absorption of local anesthesia, restore function/cardiac arrest, overcome AV heart block, Mydriasis, anaphylactic shock |
| Name 5 drug types that don't play well with epinephrine. | MAO inhibitors, tricyclic antidepressants, General anesthesia, Alpha blockers, Beta blockers |
| Which catecholamine is Lovaphed? | Norepinephrine |
| What is the therapeutic use for Lovaphed? | Hypotension |
| What are the adverse effects associated with Lovaphed (H, A, N, S,TU, DP, HA)? | Elevated BP, AV heart block, N&V, sweating, trouble urinating, dilated pupils, head ache |
| What baseline info do we need for Bethanechol? | I&O |
| Who should not take Bethanechol (P, O,CI,H,H,A)? | Patients with PUD, Obstruction, coronary insufficiency, hypotension, asthma, and hyperthyroidism |
| Since Bethanechol can work pretty quickly what should we ensure our patient has? | A place to go potty |
| How do we know if Bethanechol is effective? | Monitor I&O |
| What does muscarinic/cholinergic overdose look like (7)? | Excessive salivation, tearing, visual disturbance, bronchospasm, diarrhea, bradycardia, and hypotension |
| Used to treat bradycardia, biliary colic, intestinal hypertonicity, hypermotility, and muscarinic agonist poisoning | atropine |
| Which patients should not use atropine (G,U,I,T)? | Patients with glaucoma, intestinal atony, urinary tract obstruction, tachycardia |
| Give 7 adverse effects of Atropine (D,B,P,UR,C,H,T). | Dry mouth, Blurred Vision, Photophobia, Urinary Retention, Constipation, Hyperthermia, Tachycardia |
| Patients skin is hot, dry, and flushed. Their temp is up. Their mouth is dry. Light hurts their eyes and they can't see well. They are seeing things that aren't there and having kinda weird thoughts. | Atropine (anticholinergic) overdose. |
| How can we prevent the continued absorption of ingested atropine in a patient who is suffering an overdose? | Activated charcoal. |
| Which catecholamine is used for anaphylaxis and cardiac arrest? | Epinephrine |
| Which andrenergic is used for control of superficial bleeding and delay of local anesthetic absorption? | Epinephrine |
| Epinephrine must be used with great caution in patients with which six conditions (H,CD,OHD,H,A,D)? | hyperthyroidism, cardiac dysrhythmias, organic heart disease, hypertension, angina pectoris, diabetes |
| Name 3 drugs that do not play well with Epinephrine. | MAO inhibitors, Tricyclic antidepressants, general anesthesia |
| What kind of epinephrine is brown or pink? | Old oxidized epinephrine - Discard it. Throw it out. |
| Why is it so important to double check the solution strength of epinephrine? | Because different administrations come in different strengths. So if you give a solution meant for I.V. by I.M. injection...that would be bad. |
| What should we monitor continuously if our patient is recieving IV epinephrine? | Cardiovascular status |
| What happens to bp when alpha receptors are activated by epinephrine? | activation of alpha 1 receptors in blood vessels cause intense vasoconstriction which can lead to hypertension |
| What kind of drug is phentolamine and which adverse effect of epinephrine could it be used to counteract? | Alpha adrenergic blocker - to lower blood pressure |
| What are the adverse effects of epinephrine related to beta 1 activation (3)? | anginal pain, tachycardia, dysrhythmias |
| What kind of drug is propanolol? What adverse effects of epinephrine could be treated with this type of drug? | Beta blocker - anginal pain, tachycardia, dysrhythmias |
| What do we do if an IV line delivering epinephrine becomes extravasated? | Infiltrate the region with phentolamine to minimize injury. |
| What do we need to think about with epinephrine and diabetic patients? | Activating the sympathetic nervous system releases glucose so they may need extra insulin if hyperglycemia develops. |
| What effect do MAO inhibitors and tricyclic antidepressants have on epinephrine? | They prolong and intensify the effects of epinephrine. |
| What Andrenergic agonist is used to improve hemodynamic status in patients with shock or heart failure? | Dopamine |
| What do we get from Alpha 1 activation (2)? | Vasoconstriction and dilation of the pupil (mydriasis – open wider) |
| What do we get from Alpha 2 activation? | inhibit release of Norepinephrine – No clinical signifigance outside of the CNS. |
| What do we get from Beta 1 activation(3 heart things)? | Stronger heart contractions, Increased heart rate, enhanced impulse conduction through the A.V node |
| What do we get from Beta 2 activation(B,U)? | bronchodilation, relaxation of uterine smooth muscle |
| What are the adverse effects associated with Alpha 1 activation(H, N, B)? | Hypertension, Necrosis, Bradycardia – higher BP triggers baroreceptor reflex and slows the heart. |
| What are the adverse effects associated with Beta 1 activation? | Tachycardia, Dysrhythmias, Angina Pectoris - (Increased work needs more oxygen that clogged arteries may not be able to deliver.) |
| What are the adverse effects associated with Beta 2 activation (H,T)? | hyperglycemia and Tremor |
| How does Beta 2 activation cause hyperglycemia? | Beta 2 receptors in the liver and skeletal muscle causes the glucose stored as glycogen to be released. Normally insulin would carry the extra blood sugar to the cells. Diabetics have a problem with this step and may need more insulin. |
| What do we get from dopamine receptor activation? | dilation of the vasculature of the kidneys |
| Which catecholamine can activate alpha 1 and 2, and beta 1 and 2 receptors? | epinephrine |
| Which catecholamine activates Alpha 1, Alpha 2, and Beta 1? | Norepinephrine |
| Which catecholamine activates Beta 1 and Beta 2 receptors? | Isoproterenol |
| Which catecholamine activates Beta 1? | dobutamine |
| Which noncatecholamine activates all the alpha and beta receptors? | ephedrine |
| Which noncatecholamine activates Beta 2? | terbutaline |
| Which non catecholamine activates Alpha 1? | phenylephrine |
| What baseline data do we need to know before we give dopamine? | The patient’s cardiac, hemodynamic, and renal status |
| Name 2 conditions for which dopamine would be contraindicated (T,VF). | tachycardia, ventricular fibrillation |
| Name four situations in which dopamine would only be used with extreme caution (OHD, H, H,M). | Organic heart disease, hyperthyroidism, hypertension, MAO inhibitors |
| What do we do if IV dopamine becomes extravasated? | Infiltrate the area with phentolamine (alpha blocker). |
| How do we know if dopamine is working? | Monitor cardiovascular status and urinary output. Increased output is a sign of success. |
| If Dopamine causes adverse effects of beta 1 activation such as angina pain, tachycardia, or dysrhythmia, what would type of drug would probably be ordered? | beta blocker like propranolol |
| What catecholamine is used to improve hemodynamics in patients with heart failure? | Dobutamine |
| What baseline data do we need in order to measure the effectiveness of dobutamine? | cardiac, renal, and hemodynamic status |
| What conditions make it dangerous to give dobutamine to a patient (OHD, H, H, Td, AP, M, T)? | Organic Heart Disease, hyperthyroidism, tachydysrhythmias, hypertension, MAO inhibitors, Tricyclic antidepressants, angina pectoris |
| What is the difference between Organic Heart Disease and Degenerative Heart Disease? | Organic means that the organ was damaged by a specific event. So, organic heart disease is acute whereas Degenerative heart disease is a slow process/chronic. |
| Name 3 drugs that don’t play well with Dobutamine. | MAO inhibitors, Tricyclic antidepressants, General Anesthetics |
| What could happen if a patient taking MAO inhibitors also takes dobutamine? | Severe cardiovascular toxicity |
| How much should Dobutamine dosage be reduced for a patient on MAO inhibitors? | By 90% |
| What is the danger involved in mixing dobutamine and general anesthesia? | Cardiac Dysrhythmias |
| What drug type might help if our patient begins to suffer cardiac dysrhythmias because of an interaction of dobutamine and general anesthesia? | A Beta Blocker may help. |
| What are the therapeutic uses of Alpha blockers? | hypertension, BPH, Reverse Alpha 1 activation that goes awry (tissue necrosis or hypertension), Pheochromocytoma, Raynaud’s disease |
| What is pheochromocytoma? | Tumor cells in the adrenal medulla are overactive producing too much epinephrine and norepinephrine. This leads to hypertension. Surgical removal is best, but alpha blockers can help. |
| What is Raynaud’s disease? | Inappropriate vasoconstriction in the fingers and toes which makes them cold and painful. |
| What baseline data do we need to know if beta blockers are working? | Heart rate; BP (hypertension); Angina- frequency, severity, circumstances; baseline ECG (cardiac dysrhythmia) |
| Beta blockers are contraindicated for which two conditions (B, A)? | Bradycardia or AV heart block |
| Which condition requires GREAT caution when using beta blockers? | HF |
| Which patients should only be administered beta blockers with caution (especially non selective agents-A,B,C,D,D,H)? | Asthma,Bronchospasm,calcium channel blockers,depression, diabetes, history of severe allergic reactions, |
| How do we know if beta blockers are working for hypertension? | monitor BP |
| How do we know if beta blockers are working for angina? | Ask patients to record incidence, circumstances, and severity of attacks and look for improvement from baseline. |
| How do we know if beta blockers are working for dysrhythmias? | ECG compared to baseline |
| What do we do if a patient experiences bradycardia as a result of taking a beta blocker? | Withhold medication, notify prescriber. The patient may need atropine or isoproterenol to restore heart rate. |
| Suppression of myocardial contractility with beta blockers can cause heart failure. What signs should our patient be aware of and report to the prescriber? | SOB, night coughs, swelling of the extremities |
| Why do we tell our patients not to suddenly stop taking beta blockers? | Because abrupt withdrawal can cause tachycardia and dysrhythmias –rebound cardiac excitation |
| Why do we advise our patients to make sure they have an adequate supply of beta blockers when traveling? | Because abrupt withdrawal can cause tachycardia and dysrhythmias – rebound cardiac excitation |
| Why must we be cautious with beta blockers if our patient has asthma? | Because Beta 2 blockade can cause substantial airway constriction |
| How can beta 1 blockade mess up diabetic patients? | One of the signs of hypoglycemia is a rapid heartbeat. Beta 1 blockade prevents that, so we need to instruct our patients not to rely on that sign |
| What are the signs of hypoglycemia? | Tachycardia, sweating, hunger, fatigue, poor concentration |
| How can beta 2 blockade mess up diabetic patients? | It prevents glycogenolysis. They may need to reduce their insulin dose. |
| What is glycogenolysis? | The catabolism of glycogen to glucose. |
| What process counteracts insulin induced hypoglycemia? | Glycogenolysis |
| Name a catecholamine that promotes glycogenolysis. | epinephrine |
| What if our patient has CNS side effects like depression, nightmares, and insomnia with beta blockers? | Beta blockers with low lipid solubility will be less likely to cause CNS side effects. |
| What happens if we combine beta blockers with calcium channel blockers like verapamil and diltiazem? | Intensifies cardiosuppression |
| What drugs don’t play well with beta blockers? | Insulin and Calcium Channel Blockers |
| What kind of drugs are Inderal, Lopressor, and Toprol? | Beta Blockers propanolol (Inderal), Metropolol ( Lopressor, Toprol) |
| What class of drug are Minipress, Cardura, and Flomax? | Alpha Blockers - prazosin (Minipress), Doxazosin (Cardura), Tamsulosin (Flomax) |
Created by:
Perseverandovercome
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