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Pharmacology
Adrenergics/Adrenergic Blockers. Cholinergic/Cholinergic blockers
| Question | Answer |
|---|---|
| Autonomic Nervous System | Maintains homeostasis & equilibrium with body. Part of peripheral nervous system. 2 components: sympathetic (adrenergic) and parasympathetic (cholinergic. |
| Sympathetic Nervous system Main neurotransmitters | Norepinepherine (derived from dopamine) and epinephrine. |
| Parasympathetic System Responsible for | "Normal" status. Secretion of GI fluids, saliva, slowing of HR, peristalsis, bladder emptying, bowel movements. |
| Equilibrium | If one system effects are decreased, other system will have major influence. If parasympathetic effects decreased/blocked-results similar to adrenergic stimulation. If sympathetic effects decreased/blocked-results similar to parasympathetic stimulation |
| Sympathetic Nervous system Receptors Classified as | Alpha1 receptors, Alpha1 receptors, Beta1 receptors, Beta2 receptors. |
| Alpha1 (adrenergic) receptors found primarily in | smooth muscles located in blood vessels and sphincters of GI and GU tracts. |
| Simulation of Alpha1 (adrenergic) receptors | Causes smooth muscle constriction: Increase BP and HR contractility, constriction of urinary bladder sphincter and GI tract. "Goosebumps" |
| Alpha1 receptors | Inhibit release of Norepinephrine- decrease vasoconstriction, decreased BP |
| Beta1 receptors located primarily in | Cardiac muscle. Stimulation increases HR and force of contraction**. |
| Beta2 receptors located primarily in | bronchial smooth muscle (lungs)**. Also in arterioles of skeletal muscles and uterine muscles. |
| Simulation of Beta 2 receptors | Relaxation of smooth muscles in lungs- bronchodilation. This is the site of action for asthma medications |
| Beta2 receptor actions | Increase blood flow to skeletal muscles, relax detrusor and uterine muscles, breakdown glycogen from liver, release glucagon from pancreas = increase blood glucose = energy to run. Decrease GI muscle tone, secretions |
| Adrenergic neurotransmitters | Norepinephrine, epinephrine, dopamine |
| Drugs that mimic the effect of norepinephrine | Sympathomimetics, adrenergic agonists |
| Drugs that block effects of norepinephrine | Sympatholytics, Adrenergic blockers/antagonists |
| Adrenergic Drugs | Affects both alpha and beta receptors. Naturally occurring catecholamine. Sympathomimetic for tx of shock: increases BP, HR. Stimulation- vessels dilate and increased blood flow |
| Dopamine | Adrenergic. Given in emergent situations when perfusion in decreased to organs. Effects are dose dependent**- low dose used to increase renal blood flow. Higher dose to control BP. In high doses, acts like epinephrine (adrenalin) |
| Epinephrine (adrenalin) | VERY potent. Stimulates all adrenergic receptors. Causes increased force of myocardium contraction. Causes blood vessels to constrict, increase BP and HR. Dilates bronchial smooth muscles. Dangerous b/c of potency, damage to organs in some cases. |
| Epinephrine in emergencies | Tx anaphylaxis, cardiac arrest, bronchospasm (acute asthma) |
| Epinephrine side effects | High doses can lead to cardiac dysrhythmias so ECG monitored. Renal vasoconstriction can decrease perfusion and lead to decreased urine output. Expected side effect: PALLOR, all blood is shunted to vital organs |
| Ephedrine | Sympathomimetic. Not as potent as epinephrine. Stimulates beta2 receptors. Useful for mild asthma. Can be used as part of local anesthesia to keep drug localized by constricting blood vessels. |
| Ephedrine OTC | used as cold/allergy med to constrict small vessels to decrease runny nose, sinus congestion = danger to people with cardiac, BP, thyroid, DM. |
| Alpha specific agonist | Drugs specific to Alpha 1 or 2 |
| Albuterol (Proventil) | Selective for beta2 receptors. Action is bronchodilation, fewer side effects for asthmatics, if dose decreased: effects on beta1 receptors- increase HR, tremors, restlessness. Treats bronchospasms- very effective for acute asthma |
| Nursing considerations for Adrenergic Agonists | Monitor HR, BP. Contraindicated/caution if hx dysrhythmias, high BP, thyroid disease**. Beta blockers decrease effect of epinephrine/norephrine. Caution pt OTC cold, allergy type meds, many contain sympathomimetic drugs***. |
| Nursing Diagnosis for Adrenergic Agonists | Risk for impaired tissue integrity, decreased cardiac output, injury r/t falls. |
| Alpha1 blocker | Vasodilate to decrease BP, prostate contraction, bladder contraction |
| Alpha1 blocker used to treat: | Benign Prostate Hypertrophy***, hypertension with other meds. |
| Alpha1 Blocker side effects | Cardiac dysrhythmias, flushing, hypotension, reflex tachycardia |
| Beta Adrenergic Blockers: Nonselective | Used to treat hypertension, heart rhythm, stage fright. Contraindications: Asthma& COPD, DM-interferes with signs of hypoglycemia |
| Beta Adrenergic Blockers: Selective | Beta 1 Selective. Used to treat hypertension, heart rhythm. Good for control of HR. Chronic angina |
| Common side effects/adverse reactions to Beta Adrenergic Blockers | Bradycardia, hypotension, headaches, addictive effect with other BP meds, less frequent hyperglycemia/hypoglycemia |
| Nursing Responsibilities for Beta blockers | Monitor HR, BP. Caution with IV- slow, lower dose, EKG monitoring, assess fall risk (orthostatic hypotension), caution with DM- glucagon to increase glucose, teach pt to not stop drug abruptly (rebound HTN) |
| Parasympathetic Nervous System groups of drugs | Cholinergics (parasympathomimetics) and anticholinergics (parasympatholytics) |
| PNS functions to | Promote body waste elimination (increases intestinal & bladder muscle tone, relaxes anus, increases sweating), promotes energy conservation by decreasing HR & BP, pupil constriction, promotes nutrient utilization- increases gastric motility & salivation |
| Sympathetic/adrenergic agonists drug Actions | Increase HR, dilate pupil, constrict bronchiole, decrease uterine contraction |
| Parasympathetic/cholinergic drug actions | Decrease HR, BP, constricts pupils, constricts bronchiole, increases bladder contraction, increases peristalsis |
| Parasympathetic neurotransmitter | Acetylcholine (Ach) |
| Cholinesterase | Enzyme that stops acetylcholine (parasympathetic neurotransmitter). An indirect acting drug blocks cholinesterase and allows Ach to bind to receptor. |
| Muscarinic | Parasympathetic receptor found in visceral effector organs. GI tract, bladder, heart, sweat glands, some blood vessels. Stimulation means increased motility, HR, bladder contraction, increased secretions. |
| Nicotinic | Parasympathetic receptor found in CNS, adrenal medulla, neuromuscular junction. Stimulation means increase muscle contraction, signs and symptoms of stress response, release of epinephrine and norephrine. |
| Bethanechol Chloride (Urecholine)*** | Direct-acting cholinergic drug. Acts at muscarinic receptor to increase urination, GI motility. Void in 1-2 hrs, achieve BM. Side effects**: hypotension, bradycardia, excessive salivation, increased secretion of gastric acid, bronchoconstriction |
| Indirect-Acting Cholinergic Drugs (cholinesterase inhibitors) | Allows AcH to attach to receptor to activate muscarinic, nicotinic receptors. S.E: bradycardia, asthma, peptic ulcers |
| Indirect-Acting Cholinergic Drugs Uses | promote muscle contraction in Myasthenia Graves, reverse neuromuscular blockers, delay progression of Alzheimer's dementia |
| Cholinesterase inhibitor Reversible (short-acting) Uses | Glaucoma by causing pupillary constriction*** Myasthenia Gravis to improve muscle strength** |
| Cholinesterase Inhibitor Irreversible (long-acting) Uses | Used for pupil constriction, used as insecticide war gases. |
| Anticholinergic drug uses | Smooth muscle relaxants: treat overactive bladder. Treat resp disease: bronchospasms. Antiparkinson. |
| Atropine*** | Anticholinergic drug. Preop med to reduce salivation. Stimulates HR. Antidote for nerve gas*** |
| Anticholinergic Drug Side Effects*** | Occur in many drugs** Tachycardia, dry mouth, nasal congestion, abdominal distention, palpitations, photophobia, blurred vision, flushing, urinary retention, constipation |
| Nursing Responsibilities for Anticholinergic Drugs | Teach Safety** Visual changes, inability to perspire. Monitor bowel and bladder function. Assess vital signs- HR, BP. How to decrease symptoms**: Dry mouth- hard candy Constipation-fluids, fiber, stool softeners Dry eyes-artificial tears. Take before bed |
Created by:
senmark
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