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Adrenergics/Adrenergic Blockers. Cholinergic/Cholinergic blockers

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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