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Pharm test 3

Pharm Adrenergic Agents ch.17

QuestionAnswer
Adrenergic Agents drugs that stimulate the SNS (sympathetic nervous system) -Adrenergic Agonists -sympathomimetics
Adrenergic SNS neurotransmitters norepinephrine (NE) epinephrine (EPI)
Adrenergic receptors -alpha-adrenergic receptors: respond to NE -Beta-adrenergic receptors: respond to EPI -dopaminergic receptors: respond to dopamine
Alpha1 adrenergic receptors located on postsynaptic effector cells (cell, muscle, or organ that the nerve stimulates)
Alpha2 adrenergic receptors located on presynaptic nerve terminals (the nerve that stimulates the effector cells) -control the release of neurotransmitters
Alpha-adrenergic agonist responses -vasoconstriction -CNS stimulation **Fight or flight: HR speeds up, BP goes up, blood to our brain, eyes dilate so we can see, blood flow to legs so we can run, digestion is not imp.
Beta-adrenergic receptors **all are located on postsynaptic effector cells Beta1: located primarily on the heart beta2: located in smooth muscle of the bronchioles, arterioles, & visceral organs
Beta-adrenergic agonist response -bronchial, GI, & uterine smooth muscle relaxation -glycogenolysis -cardiac stimulation **used for asthma or pre term labor b/c it relaxes the uterus; breaks down the stored glucose for energy
Dopaminergic receptors **stimulated by dopamine -causes dilation of the following blood vessels, resulting in increased blood flow: renal, mesenteric (GI), coronary, cerebral **dopamine works in the main places we need blood flow
Responses to stimulation: CARDIOVASCULAR: blood vessels Alpha1: constriction beta2:dilation
Responses to stimulation: CARDIOVASCULAR: cardiac muscle beta1: increased contractility
Responses to stimulation: CARDIOVASCULAR: AV node beta1: increased heart rate
Responses to stimulation: CARDIOVASCULAR: SA node beta1: increased heart rate
Responses to stimulation: GASTROINTESTINAL: muscle beta2: decreased motility
Responses to stimulation: GASTROINTESTINAL: sphincters alpha1: constriction
Responses to stimulation: GENITOURINARY: bladder, sphincter alpha1: constriction
Responses to stimulation: GENITOURINARY: penis alpha1: ejaculation
Responses to stimulation: GENITOURINARY: uterus alpha1: contraction beta2: relaxation
Responses to stimulation: RESPIRATORY: bronchial muscles beta2: dilation/relaxation
Catecholamines substances that can produce a sympathomimetic response **endogenous (make ourselves): EPI, NE, dopamine **synthetic: isoproterenol, dobutamine, phenylephrine
DRUG EFFECTS: stimulation of alpha adrenergic receptors on smooth muscles results in: -vasoconstriction of blood vessels -relaxation of GI smooth muscles -male ejaculation -decreased insulin response -contraction of the ciliary muscles of the eye (dilated pupils)
DRUG EFFECTS: stimulation of beta1 adrenergic receptors on the myocardium, AV node, & SA node results in cardiac stimulation -increased force of contraction (positive inotropic effect) -increased heart rate (positive chronotropic effect) -increased conduction through the AV node (positive dromotropic effect)
DRUG EFFECTS: stimulation of beta2 adrenergic receptors on the airways results in: -bronchodilation -uterine relaxation -glycogenolysis in the liver -increased renin secretion in the kidneys
Bronchodilators treatment of asthma and bronchitis **agents that stimulate beta2 adrenergic receptors of bronchial smooth muscles causing relaxation
Agents that affect uterine and vascular smooth muscles -albuterol -epinephrine -isoproterenol -metaproterenol -terbutaline -ephedrine -isoetharine -levalbuterol -salmeterol
epinephrine non-selective: it will constrict some things and dilate others
Albuterol given to someone with an acute asthma attack **selective: it will dilate bronchioles but not constrict other things so you will not get that jittery feeling everytime
Salmeterol prevention of future asthma attacks
what would you use for reduction of intraocular pressure & mydriasis (pupil dilation): treatment of open-angle glaucoma alpha2 or beta 2 receptors, or both **epinephrine & dipivefrin
alpha adrenergic receptors for the temporary relief of conjunctival congestion -epinephrine -phenylephrine -naphazoline -tetrahydrozoline( visine--gets the red out by vasoconstriction)
nasal decongestant -intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion **alpha1-adrenergic stimulation
Vasoactive sympathomimetics (pressors, inotropes) -also called cardioselective sympathomimetics -used to support the heart during cardiac failure or shock. various alpha and beta receptors affected
vasoactive sympathomimetics (pressors, inotropes) -dobutamine -ephedrine -fenoldopam -methoxamine -phenylephrine -dopamine -epinephrine -isoproterenol -norepinephrine **pressors: constricts to raise BP **inotropes: contractility of heart
Alpha adrenergic side effects CNS: headache, restlessness, excitement, insomnia, euphoria CV: palpitations (dysrythmias), tachycardia, vasoconsrtiction, hypertension OTHER: anorexia, dry mouth, nausea, vomiting, taste changes (rare)
beta adrenergic side effects CNS: mild tremors, headache, nervousness, dizziness CV: increased HR, palpitations (dysrythmias), fluctuations in BP OTHER: sweating, nausea, vomiting, muscle cramps
which medication is indicated for prevention of bronchospasms and NOT management of of acute symptoms? Salmeterol
what can overuse of nasal decongestants cause? rebound nasal congestion or ulcerations
If you administer 2 adrenergic agents together what may happen? it may precipitate severe CV effects such as tachycardia or hypertension
what should you inform patients taking inhaled isoporoterenol? that their sputum or saliva may turn pink
Therapeutic effects of Adrenergic Agents (CV uses) -decreased edema -increased urinary output -return to normal VS -improved skin color & temp -increased LOC
Therapeutic effects of Adrenergic agents (asthma) -return to normal RR -improved breath sounds, fewer rales -increased air exchange -decreased cough -less dyspnea -improved blood gases -increased activity tolerance
Ms. Sniffles suffers from acute asthma attacks when stressed or exposed to certain pollen. She appears at the clinic as an anxious young woman with audible wheezing and complaining of difficulty breathing. 1. What would you administer and by what route? Albuterol with an inhaler; if there is no albuterol you would give epinephine (subq)
Ms. Sniffles suffers from acute asthma attacks when stressed or exposed to certain pollen. She appears at the clinic as an anxious young woman with audible wheezing and complaining of difficulty breathing. 2. How does this drug work (receptor affected?) Beta 2
Ms. Sniffles suffers from acute asthma attacks when stressed or exposed to certain pollen. She appears at the clinic as an anxious young woman with audible wheezing and complaining of difficulty breathing. 3. is it selective or nonselective? albuterol is selective; epinephrine is nonselective
Ms. Sniffles suffers from acute asthma attacks when stressed or exposed to certain pollen. She appears at the clinic as an anxious young woman with audible wheezing and complaining of difficulty breathing. 4. what assessments would you perform and why? RR, BP, capillary refill, listen to breath sounds
Ms. Sniffles suffers from acute asthma attacks when stressed or exposed to certain pollen. She appears at the clinic as an anxious young woman with audible wheezing and complaining of difficulty breathing. 5. identify the S/E of this medication High BP, increase HR, dry mouth, jittery
Ms. Sniffles returns to the clinic 2 mos. later with upper respiratory infection. Her HCP is most likely to order an adrenergic agent like Sudefed. 1. how will this work to relieve her nasal congestion? vasoconstriction (alpha1)
Ms. Sniffles also suggests she use Murine or Visine to releive her red eyes since she has a modeling contract the next day. 2. What kind of drug is this and how does it work to relieve red eyes? tetrahydrozoline; vasoconstriction
1. The nurse caring for a patient who is receiving beta1 agonist drug therapy needs to be aware that these drugs cause increased cardiac contractility
2. During a teaching session for a patient who is receiving inhaled salmeterol, the nurse emphasizes that the drug is indicated for prevention of bronchospasm
3. For a patient receiving vasoactive drug such as IV dopamine, which action by the nurse is most appropriate? assess the IV site hourly to rule out infiltration
4. A patient is receiving dobutamine for shock and is complaining of feeling more "skipping beats" than yesterday. The nurse's next action should be to assess the patient's VS and cardiac rhythm
5. when a drug is characterized as having a negative chronotropic effect, the nurse knows to expect decreased heart rate
6. The nurse is monitoring a patient who is receiving an infusion of a beta-adrenergic agonist. which adverse effects may occur with this infusion? -mild tremors -tachycardia -palpitations -nervousness
Created by: lissy11