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34 Cards in this Set
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Adrenergic Agents |
Sympathomimetics Stimulate the alpha 1 and 2, beta 1 and 2 receptors Used primarily in emergency situations Cardiac arrest to stimulate heart Hypotension to increase Blood Pressure Bronchial asthma to open bronchioles Upper respiratory congestion to serve as decongestant Direct receptor binding - Most are peripherally acting sympathomimetics Promotes norepinephrine release (Ex. amphetamines and ephedrine) Inhibit norepinephrine reuptake by synaptic terminals resulting in more available norepinephrine (Ex. cocaine, tricyclicantidepressants) Inhibit norepinephrine inactivation (monoamine oxidase inhibitors work this way) |
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Adrenergic Agents: Allergic Reactions |
Given for vasoconstriction and decongestant effects to relieve nasal congestion |
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Adrenergic Agents: Hypoglycemia |
Given to stimulate glycogen release from the liver and skeletal muscles |
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Adrenergic Agents: Local Bleeding |
To constrict blood vessels and stop bleeding |
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Andrenergic Agents: Obstetrics |
To relax the uterus |
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Adrenergic Agents: Anesthesia |
Given with local anesthetics to prolong anesthesia |
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Adrenergic Agents Adverse Effects |
Nervousness and restlessness Angina Hypertension Tachycardia, palpitations, dysrhythmias Increased blood glucose levels |
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Aderenergic Agents Contraindications |
Cardiac dysrhthmias, angina Hypertension Narrow angle glaucoma Pregnancy Use cautiously with children |
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Catecholamines |
Contain a catechol group: epinephrine, norepinephrine, isoproterenol, dopamine, dobutamine
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Hoe Catecholamines are taken |
Cannot be taken orally (monamine oxidase & catechol-o-methyltransferase are enzymes located in liver and intestinal wall) They are very active and would quickly destroy orally administered catecholamines Have brief duration of action, therefore must be administered as a continous drip Cannot cross blood brain barrier |
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Catecholamines- Epinerphrine |
Stimulates alpha 1, 2, beta 1,2 receptors: Non-selective, DOC for anaphylaxis, found in many OTC cold/asthma preparations. Will increase HR, BP, blood flow to brain, heart, skeletal muscles Causes Vasoconstriction (necorsis if extravasation occurs- may need to use with an alpha 1 blocker phentolamine (Regitine) |
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How Epinephrine can be given |
IV, IM, SQ, inhalation, through endotracheal tube, intracardially May be used as ajunct to anesthesia: by decreasing blood flow to an area, can prolong effects of anesthesia in that area, allowing reduced dosage, reduced systemic effects Cannot be given orally because GI enzymes will destroy
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Adverse Effects of Epinephrine |
Anginal pain, tachycardia dysrhythmias, severe hypertension, hyperglycemia |
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Interactions of Epinephrine |
Monamine oxidase inhibitors and tricyclic antidepressants intensity the actions of epinephrine When combined with some general anesthetics, epinephrine can lead to dysrhythmias |
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Catecholamines: Norepinephrine (Levophed) |
Potent vasoconstrictor Used to treat hypotension Cardiac arrest Use central line, avoid giving in peripheral IV due to extravasation and necrosis
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Catecholamines: Isoproterenol (Isuprel) |
Activates beta 1 and 2 receptors Acts as a bronchodilator Used to treat some dysrhythmias, enhances cardiac performance Can worsen angina |
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Catecholamines: Dopamine (Intropin) |
Receptor activity dependent upon dose Lose dose- dopamine receptors only; renal vessels Moderate dose-activates beta 1+ dopamine receptors- increase HR, contraction, and BP High-dose-activates alpha, beta, +dopamine receptors: treats hypotension |
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Uses of Dopamine |
Often used in treatment of heart failure and/or shock to increase force of contraction + inotrope Causes tachycardia- contraindicated if patient already has high HR, or ventricular fibrillation Use with extreme caution in patients with cardiomyopathy, hyperthyroidism, hypertension, or if using MAOI's Given IV |
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Catecholamines: Dobutamine |
A synthetic catecholamine Used in heart failure to stimulate (strengthen) force of contraction With all catecholamines, monitor HR, BP, EKG, Blood glucose levels, I&O, renal function Less tachycardia than dopamine |
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Noncatecholamines: ephedrine, terbutaline, phenylephrine |
Can be given orally Have longer half life Can penetrate blood brain barrier
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Pheylephrine is selective for |
Alpha 1 receptors: nasal decongestant, allergic conjunctivitis, for ocular disorders |
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Ephedrine selective for |
Alapha 1 receptors: nasal decongestant |
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Terbutaline |
Highly selective for Beta 2 receptors so it would be used as a bronchial dilator |
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Adrenergic Antagonists: Sympatholytics |
Block sympathetic stimulation of alpha and beta receptors Cause decreased heart rate, decreased force of contraction, and/or vasodilation, lowered peripheral vascular resistance, decreased BP, decreased angina. |
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Alpha Blockers |
Reduce symptoms of begnin prostatic hyperplasia by relaxing smooth muscle (alfuzosin (Uroxatral)) Reduce Blood pressure as a result of vasodilation (prazosin (Minipress)) When giving prazosin, watch for orthostatic hypotension "first dose syncope" - have patients lie down with first dose, and sit slowly before standing. May also see reflex tachycardia, nasal congestion, inhibition of ejaculation |
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Alpha Blockers can. . . |
Reduce blood pressure as a result of vasodilation (prazosin (Minipress)) |
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Alpha-Blocker: phentolamine (Regitine) |
Blocks alpha 1 receptors Prevents necrosis of tissue following extravasation of drugs like norepinephrine Used in treatment of pheochromocytoma-adrenal medulla tumor Watch for hypotension, reflex tachycardia, vasodilation of nasal blood vessels
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Labetalol (Trandate)(Normaodyne) |
Safe during pregnancy; safe for hypertensive emergencies in patients with active CAD (mixed alpha-1 and beta) |
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Beta Blockers |
Used in treatment of angina- to decrease oxygen demand, myocardial contractility Decreases incidence of myocardial infarction (negative inotropic effect) Slows rapid rhythms (hyperthyroidism, panic attacks) Lowers blood pressure Reduces intraocular pressure Prevents migraines Controls tremeors Decreases situational anxiety Decreases symptoms of PTSD Decreases portal pressure in patients with eirrhosis and esophageal varices |
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Beta-Blockers Adverse Effects |
Bradycardia Decreased A-V conduction Heart Failure Rebound cardiac excitation with abrupt withdrawal Fatigue, Reduced tolerance to exercise, depression Hypoglycemia, s/s often masked for diabetics taking insulin Bronchospasm/bronchoconstriction
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Beta Blockers are not |
The first line therapy for essential hypertension (diuretics, ACE inhibitors, ARBs, and CCbs are better choices) |
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Propranolol- Inderal |
Nonselective Acts on both Beta 1 and Beta 2 receptors Used to treat angina, myocardial infarction, dysrhythmias ALWAYS CHECK HR AND BP BEFORE GIVING Because of Beta 2 blockade, can cause bronchoconstriction
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Contraindications of Propranolol-Inderal |
Diabetic Acute heart failure/cardiogenic shock AV heart block Asthma/bronchospasm Taking calcium channel blockers or insulin |
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Metoprolol-Lopressor |
Selective for beta 1 receptors At usual therapeutic doses, only beta 1 receptors are blocked Less risk for bronchospasm Used for hypertension, angina, MI Adverse effects are similar to those of propranolol. |
