Pharm adrenergic blocking agents ch.18
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| Adrenergic blockers **adrenergic antagonists **sympatholytics | bind to adrenergic receptors, but inhibit or block stimulation of the sympathetic nervous system (SNS)
**alpha blockers and beta blockers
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| alpha blockers | -cause both arterial & venous dilation, reducing peripheral vascular resistance & BP
-used to treat HTN
-effect on receptors on prostate gland & bladder decreased resistance to urinary outflow, thus reducing urinary obstruction & relieving effects of B
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| alpha blockers | -alpha blocker like pills are used to treat HTN b/c it dilates
-alpha is resp. for sphincter control so ppl with problems going to the bathroom take an alpha blocker (especially men over 60 w/ enlarged prostate -- BPH (benign prostate hypertrophy)
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| alpha blockers used to control & prevent HTN in patients with pheochromocytoma | pheochromocytoma: tumor in adrenal gland. ppl w/ this have malignant HTN b/c they constantly secrete things coming form adrenal cortex (NE, EPI, adrenaline)
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| alpha blockers: phentolamine -quickly reverses the potent vasoconstrictive effects of extravasated vasopressors such as norepinephrine or epinephrine **restores blood flow & prevents tissue necrosis | phentolamine: lets say I gave you too much epi in IV & it infiltrated, your blood vessels start constricting in arm so you have less blood supply to that area & that tissue can die
**you can shoot in phentolamine subq causing vasodilation to save your ar
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| alpha blockers side effects | CV: palpitations, orthostatic hypotension, tachycardia, edema, dysrythmias, chest pain
CNS: drowsiness, dizziness, headache, anxiety, depression, vertigo, weakness, numbness, fatigue
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| alpha blockers side effects | GI: nausea, vomiting, diarrhea, constipation, abdominal pain
OTHER: incontinence, nosebleed, tinnitus, dry mouth, pharyngitis, rhinitis
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| Common alpha blocker agents | -phentolamine (regitine): used to dilate if given a vasopressin
-prazosin (minipress)
-tolazoline (priscoline)
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| It is common to see the first dose faint effect when receiving alpha blocker agents | First does faint effect: ppl. will get out of bed & faint b/c they re pretty powerful BP meds (can cause orthostatic hypotension)
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| what do alpha blockers usually end in? | -zosin
**they are pretty powerful in lowering BP
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| beta blockers | -block stimulation of beta-receptors in the SNS
-compete with norepinephrine and epinephrine
-selective & non selective also called cardio selective & non specific
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| beta blockers | they are very popular; they lower BP no b/c of vasodilation (if you block beta1 the HR will slow down & so cardiac output is going to decrease which decreases the BP)
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| Cardio selective and nonspecific | cardioselective: selective b/c it only blocks beta1 in the heart
nonspecific: blocks both beta 1 and 2 and it is nonselective
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| beta 2 blocker **beta 2 receptors primarily on smooth mucles of bronchioles & blood vessels | if you block beta 2 it will constrict the bronchioles which would be a problem for asthma-- so in someone w/ asthma you would give them a cardioselective blocker so that you dont make asthma worse by constricting their bronchioles
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| non specific beta blockers **block both beta 1 and 2 | -Propranolol (inderal)
-labetalol (trandate, normodyne)
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| what do beta blockers end in? | beta blockers end in -lol
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| cardioselective beta adrenergics | -acebutolol (sectral)
-atenolol (tenormin)
-metoprolol (lopressor)
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| mechanism of action for cardioselective | -slows down conduction rate
-reduces SNS stimulation of the heart
-decreases HR
-prolongs SA node recovery
-slows conduction through AV node
-decreases myocardial contractility, thus decreasing myocardial oxygen demand
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| mechanism of action for cardioselective | -patients with angina have chest pain b/c of need for O2 in the heart so you would give a beta blocker to reduce contractility which decreases oxygen demand in the heart
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| mechanism of action for nonspecific (beta1 & beta2) | effects on heart: same as cardioselective
bronchioles: constriction, resulting in narrowing of the airways & SOB
blood vessels: vasoconstriction
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| Indications for beta blockers | antiangina: decreases demand for myocardial oxygen
cardioprotectve: inhibits stimulation from circulating catecholamines
**studies have shown that if you had a heart attack & are given a beta blocker it prevents having a heart attack in the future
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| indications for beta blockers | -antihypertensive
-treatment of migraine headaches
-glaucoma (topical use)
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| side effects of beta blockers | -decreased force of contraction
-decreased cardiac output
-decreased BP
-decreased HR
-decreased automaticity of ectopic pacemakers
-slowed conduction through AV node
-less effective metabolism of glucose
-less ability to respond to stress
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| side effects of beta blockers | less ability to increase HR & cardiac output in response to exercise or activity
**watch HR and hold drug if <60bpm (take pulse)
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| common adverse effects of beta blockers | -bradycardia
-congestive heart failure (CHF)
-weakness, fatigue
-bronchoconstriction
**sometime you slow the HR so much that you get a weak heart (CHF) not pumping enough to perfuse major organs like kidney & brain so you start retaining fluid, BP
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| adrenergic-blocking agents implications | -avoid OTC meds b/c they cause vasoconstriction and they can counteract
-possible drug interactions with:
antacids, antimuscarinics/anticholinergics, diuretics & CV drugs, neuromuscular blocking agents, oral hypoglycemic agents
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| NURSING IMPLICATIONS for adrenergic-blocking agents | -teach patients to change positions slowly to prevent postural hypotension
-avoid caffeine (excessive irritability)
-avoid alcohol (can have a glass)
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| therapeutic effects for adrenergic-blocking agents | -decreased chest pain in pt. with angina
-return to normal BP and P
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| NURSING IMPLICATIONS for beta-blocking agents | -rebound HTN or chest pain may occur if this medication is stopped abruptly
-inform pt. that they may notice a decrease in tolerance for exercise; dizziness & fainting may occur with increased activity
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| you should NEVER abruptly stop a beta-blocker **if you choose not to take drug you can damage kindey or have a heart attack | -sometimes men do b/c these drugs can cause erectile dysfuntction
-the heart is pumping slowly & then you abruptly stop, this will cause the heart to start beating super fast & can cause heart attack
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| when taking beta blockers pt. should report weight gain of more than 2 pounds within a week | -if you're gaining too much weight it is water weight and this can be indicative of congestive heart failure
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| A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma." VS: BP 126/84 pulse 62 resp. 24 1.Prop. blocks wut receptor | blocks beta 1 and 2 which affects his asthma and decreases HR
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| A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma 2. could propranolol affect asthma? | yes it does
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| A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma 3. what effect could propranolol have on HR. why? | decrease HR
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| A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma 4. what are the teaching aspects that should be explained? | do not abruptly stop, teach him how to take pulse & call doc if it is less than 50.
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| A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma 5. what could happen if ct. abruptly stopped this drug? | if he abruptly stopped he can develop HTN & eventually have a heart attack
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| when a patient has experienced infiltration of a peripheral infusion of dopamine, the nurse knows that injecting the alpha-blocker phentolamine (regitine) will result in local | vasodilation
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| when administering beta-blockers, the nurse knows that which guideline for administration and monitoring is correct? | weaning off the medication is necessary to prevent rebound HTN
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| The nurse providing teaching for a pt. who has a new perscription for beta1 blockers will keep in mind that these drugs may result in which effect? | bradycardia
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| a patient who has recently had an MI has started therapy with a beta blocker. the nurse explains that the main purpose of the beta blocker is to | protect the heart from circulating catecholamines
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| before initiating therapy with a nonselective beta blocker, the nurse should assess the patient for the presence of | asthma
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| a patient is taking an alpha blocker as treatment for benign prostatic hypertrophy. the nurse monitors for which potential drug effects? | -orthostatic hypotension
-increased urine flow
-headaches
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