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Ch17Adrenergic Drugs

Adrenergic Drugs (Alpha1, Beta1, and Beta2)

Generic (Brand)Route and DosageUses and Considerations
norepinephrine bitartrate (Levarterenol, Levophed) Alpha1 and beta1 A: IV: 4 mg in 250–500 ml of D5W or NSS infused initially 8–12 mcg/min, then 4 mcg/min; monitor blood pressure For shock. Potent vasoconstrictor. Increases blood pressure and cardiac output. Blood pressure should be closely monitored every 2–5 min during infusion. IV flow titrated according to blood pressure. Pregnancy category: D; PB: UK; t½: UK
dopamine HCl (Intropin) Alpha1 and beta1 A: IV/INF: 1–5 mcg/kg/min initially; gradually increase 5–10 mcg/kg/min; max: 50 mcg/kg/minC: IV: Usually the same To correct hypotension. Does not decrease renal function in doses <5 mcg/kg/min. Pregnancy category: C; PB: UK; t½: 2 min
midodrine (ProAmatine) Alpha1 A: PO: 10 mg t.i.d. To treat symptomatic orthostatic hypotension. Blood pressure may increase by 15 to 30 mm Hg in 1 h with one 10-mg dose. Pregnancy category: C; PB: UK; t½: 3–4 h
phenylephrine HCl 12-hour spray/oxymetazoline HCl (Neo-Synephrine) Alpha Nasal decongestant:A: Instill: 2–3 sprays or gtt of 0.25%-0.5% solC: <6 y: Instill: 2–3 gtt of 0.125% solC: 6–12 y: Instill: 2–3 gtt of 0.25% solAlso available IM, IV To treat nasal congestion; acts as a decongestant. Used for clients with common cold, sinusitis, allergic rhinitis. Have client blow nose before drug is administered. Pregnancy category: C; PB: UK; t½: 2.5 h
pseudoephedrine HCl (Sudafed, Actifed, Co-Tylenol, PediaCare) Alpha and beta1 Nasal decongestant: A: PO: 60 mg q.i.d./q6h PO/SR: 120 mg q12h; max: 240 mg/dC: 2–6 y: PO: 15 mg q6h; max: 60 mg/dC: 6–12 y: PO: 30 mg q6h; max: 120 mg/d To treat nasal congestion. OTC drug. Check label for contraindications. Avoid taking with a history of hypertension, cardiac disease, diabetes mellitus. Pregnancy category: C; PB: UK; t½: 9–16 h
phenylpropanolamine HCl (Dimetapp, Dristan, Contac 12 Hour, Triaminicol, Triaminic) Nasal decongestant:A: PO: 25 mg q4h PRNPO/SR: 75 mg q12h PRNC: 2–6 y: PO: 6.25 mg q4h PRNC: 6–12 y: 12.5 mg q4h PRN To treat nasal congestion; acts as OTC drugs. FDA has required that phenylpropanolamine be withdrawn from OTC weight-control products and other OTC drugs. In some cases, pseudoephedrine has been used in place of phenylpropanolamine.
Dexatrim, Dietac, Control Alpha and beta1 Appetite suppressant:A: PO/SR: 75 mg daily (before breakfast); PO: 25 mg t.i.d. a.c. OTC drug used to control weight gain. Client should check with health care provider before taking an appetite suppressant. Pregnancy category: C; PB: UK; t½: 3–4 h
metaproterenol sulfate (Alupent, Metaprel) Beta1 (some) and beta2 A & C: >9 y: PO: 10–20 mg t.i.d./q.i.d.C: <6 y: PO: 1-2.6 mg/kg/d in 3–4 divided dosesC: 6–9 y: PO: 10 mg t.i.d./q.i.d.A & C: >12 yr: Inhal: 2–3 puffs q3-4h; max: 12 puffs/d Treatment for bronchospasm, acute heart block (only used in atropine-refractory bradycardia). By stimulating beta1-receptors, heart rate is increased but not as strongly as with isoproterenol HCl. Dilates bronchial tubes. Pregnancy category: C;
dobutamine HCl (Dobutrex) Beta1 A & C: IV: 2.5-10 mcg/kg/min initially; increase dose gradually; max: 40 mcg/kg/min To treat cardiac decompensation by enhancing myocardial contractility, stroke volume, and cardiac output which may result from cardiogenic shock or cardiac surgery. Pregnancy category: C; PB: UK; t½: 2 min
isoetharine HCl (Bronkosol) Beta2 A: IPPB: 0.5-1.0 ml of 0.5% sol OR 0.5 ml of 1% sol diluted in 3 ml of NSSA: Inhal: 1–2 puffs To control asthma and chronic obstructive pulmonary disease by dilating bronchial tubes. Pregnancy category: C; PB: UK; t½: UK
terbutaline sulfate (Brethine, Brethaire, Bricanyl) Beta2 Bronchodilator:A: PO: 2.5-5 mg t.i.d. OR q8h; SC: 0.25 mg initially; no more than 0.5 mg in 4 h Inhal: 2 puffs q4-6hC: >12 y: PO: 2.5 mg t.i.d. OR q8hPremature labor:A: PO: 2.5 mg q4-6h; IV: 10 mcg/min, gradually increase; max: 80 mcg/min Primary use is to correct bronchospasm. Unofficial use during premature labor to prevent premature birth. Pregnancy category: B; PB: 25%; t½: 3–11 h
ritodrine HCl (Yutopar) Beta2 and some beta1 A: PO: Initially 10 mg q2h for first 24 h; maint: 10–20 mg q4-6h; max: 120 mg/d IV: 50–100 mcg/min; dose may gradually increase to 300 mcg/min; Pregnancy category: C; PB: UK; t½: 1.6- 2.6 h Used to decrease and/or stop uterine contraction. To be effective, heart rate must be more than 100 beats per minute. Because there are many side effects, drug is not used as frequently to control premature labor as it once was.
albuterol (Proventil, Ventolin) Beta2 A: PO: 2–4 mg, t.i.d., q.i.d.; max: 32 mg/d in 4 divided dosesSR: 4–8 mg, q12hInhal: 1–2 puffs q4-6h PRNNebulizer: 0.5 ml of 0.5% sol in 3 ml of 0.9% NaCl in 5–15 minC 2–6 y: PO: 0.1 mg/kg/t.i.d.6-12 y: PO: 2 mg, t.i.d., q.i.d. To relieve bronchospasm caused by acute and chronic obstructive airway disease (e.g., asthma, bronchitis, emphysema). Stimulates beta2-receptors of bronchi. Promotes bronchodilation. Pregnancy category: C; PB: UK; t½: 2.5-5 h
epinephrine (Adrenalin Chloride) Alpha1, beta1, and beta2 A: subQ: 0.1-0.5 ml of 1:1000 PRN;IV: 0.1-0.25 ml of 1:1000 with additional dilution;IV: 1-2.5 ml of 1:10,000 infused over 5–10 min;C: subQ: 0.01 ml/kg of 1:1000;IV: 0.01 ml/kg of 1:1000 with additional dilution;IV: 0.1 mg or 10 ml of 1:100,000 To treat allergic reaction, anaphylaxis, bronchospasm, cardiac arrest; Action on one or more adrenergic sites; promotion of CNS and cardiac stimulation and bronchodilation;
ephedrine HCl, ephedrine sulfate (Ephedsol, Ectasule) Alpha1, beta1, and beta2 A: PO: 25–50 mg t.i.d./q.i.d. subQ/IM: 12.5-50 mg; IV: 10–25 mg PRN; max: 150 mg/24 hC: >2 y: PO: 2–3 mg/kg/d in 4–6 divided doses; max: 75 mg/24 h To treat hypotensive states, bronchospasm, nasal congestion, orthostatic hypotension. Effective for relief of symptoms of hay fever, sinusitis, allergic rhinitis. Also may be used to treat mild cases of asthma. Pregnancy category: C; PB: UK; t½: 3–6 h
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