Adrenergics And Adrenergic Blockers

Front 1

Adrenergic Recceptor Types

Back 1

Alpha receptors: agonist response is vasoconsriction and CNS stim.

Beta receptors: agonist response is broncodialation, decrease GI motility, uterine smooth muscle relax, glyconeolysis, and cardiac stimulation

Dopaminergic receptors: stimulated by dopamine (only) to dilate renal, mesentrric, coronary, and cerebral arteries

Front 2

Catecolamines

Back 2

Epinephrine, norepinephrine, and dopamine bind to adrenergic receptor sites.

Front 3

Beta adrenergic drugs mimic catecolamines and stimulate the heart in 3 ways

Back 3

1. Positive intropic: increases heart contraction force

2. Positive chronotropic: increases heart contraction speed

3. Positive dromotropic: helps reg. heart electrical activity

Front 4

Direct action

Back 4

Drug binds to receptor and causes a physiologic response

Front 5

Indirect action

Back 5

Drug causes the release of a chemical (catecolamine) from a storage site

Front 6

Mixed Acting

Back 6

Directly stimulates the receptor and causes the release of a chemical (neurotransmitter)

Front 7

Respiratory adrenergic indications

Back 7

For bronchodialation by stimulating beta 2 receptors.

Drug(s): ephedrine

Tx: "lungers", Asthma, bronchitis, etc.

Front 8

Topical Nasal Indications

Back 8

Nasal decongestant through vasoconstriction of dilated arterioles.

Reduces nasal blood flow to decrease congestion

Drugs stimulate alpha 1 receptors: phenylephrine

Front 9

Ophthalmic Indications

Back 9

Alpha stimulation of eye vasculature (areterioles) results in vasoconstriction to ease conjunctival congestion.Drugs: epinephrine and phenylephrine

Drugs: epinephrine and phenylephrine

Alpha stimulation of eye vasculature (areterioles) results in vasoconstriction to ease conjunctival congestion.

Drugs: epinephrine and phenylephrine

Adrenergics also result in pupil dilation (mydriasis) to reduce IOP from open angle glaucoma. Mydriasis also effect also used for diagnostic eye examination.

By stiming Alpha or beta 2 receptors

Front 10

Overactive bladder indications

Back 10

Beta receptor stimulation causes detrusor muscle to relax during storage phase to increase bladder storage capacity

Drug(s): mirabegron

Front 11

Cardiovascular indications

Back 11

Cardiac failure or shock (hypotension) AKA: vasoactive sympathomimetrics, vasoconstrictive drugs, vasopressive drugs, pressure, inotropes, cardiovascular sympathomimetics Stimulate alpha and beta receptors Drugs: dobutamine, dopamine, epinephrine, midodrine, norepinephrine, phenylephrineTypically have short half lives and must be given more frequently as a drip for continual blood concentrations

Cardiac failure or shock (hypotension) AKA: vasoactive sympathomimetrics, vasoconstrictive drugs, vasopressive drugs, pressure, inotropes, cardiovascular sympathomimetics Stimulate alpha and beta receptors Drugs: dobutamine, dopamine, epinephrine, midodrine, norepinephrine, phenylephrineTypically have short half lives and must be given more frequently as a drip for continual blood concentrations

Cardiac failure or shock (hypotension) AKA: vasoactive sympathomimetrics, vasoconstrictive drugs, vasopressive drugs, pressure, inotropes, cardiovascular sympathomimetics Stimulate alpha and beta receptors Drugs: dobutamine, dopamine, epinephrine, midodrine, norepinephrine, phenylephrineTypically have short half lives and must be given more frequently as a drip for continual blood concentrations

Cardiac failure or shock (hypotension) AKA: vasoactive sympathomimetrics, vasoconstrictive drugs, vasopressive drugs, pressure, inotropes, cardiovascular sympathomimetics Stimulate alpha and beta receptors Drugs: dobutamine, dopamine, epinephrine, midodrine, norepinephrine, phenylephrineTypically have short half lives and must be given more frequently as a drip for continual blood concentrations

Cardiac failure or shock (hypotension) AKA: vasoactive sympathomimetrics, vasoconstrictive drugs, vasopressive drugs, pressure, inotropes, cardiovascular sympathomimetics Stimulate alpha and beta receptors Drugs: dobutamine, dopamine, epinephrine, midodrine, norepinephrine, phenylephrineTypically have short half lives and must be given more frequently as a drip for continual blood concentrations

Cardiac failure or shock (hypotension) AKA: vasoactive sympathomimetrics, vasoconstrictive drugs, vasopressive drugs, pressure, inotropes, cardiovascular sympathomimetics Stimulate alpha and beta receptors Drugs: dobutamine, dopamine, epinephrine, midodrine, norepinephrine, phenylephrineTypically have short half lives and must be given more frequently as a drip for continual blood concentrations

Cardiac failure or shock (hypotension) AKA: vasoactive sympathomimetrics, vasoconstrictive drugs, vasopressive drugs, pressure, inotropes, cardiovascular sympathomimetics Stimulate alpha and beta receptors Drugs: dobutamine, dopamine, epinephrine, midodrine, norepinephrine, phenylephrineTypically have short half lives and must be given more frequently as a drip for continual blood concentrations

Cardiac failure or shock (hypotension) AKA: vasoactive sympathomimetrics, vasoconstrictive drugs, vasopressive drugs, pressure, inotropes, cardiovascular sympathomimetics Stimulate alpha and beta receptors Drugs: dobutamine, dopamine, epinephrine, midodrine, norepinephrine, phenylephrineTypically have short half lives and must be given more frequently as a drip for continual blood concentrations

Front 12

Adrenergic Typical Contraindications

Back 12

KDA and severe HTN

Front 13

Alpha Adrenergics Adverse Effects

Back 13

Alpha Adrenergics:

-CNS: HA, restlessness, excitement, insomnia, euphoria.

-Cardiovascular: chest pain, vasoconstriction, HTN, reflexive bradycardia, palpitations, and dysthymias

Bodysystems: anorexia, dry mouth, nausea, vomiting, taste changes

Front 14

Beta adrenergics adverse effects

Back 14

-CNS: mild tremors, HA, nervousness, dizziness

-Cardiovascular: increased HR, palpitations, B.P. fluctuations

-Body systems: sweating, nausea, vomiting, muscle cramps

Front 15

Toxic/O.D. management

Back 15

Symptom management and pts. support

Lower B.P. (blocking agents)

Front 16

Adrenergic Interactions

Back 16

Antagonists: anti-HTN

Increase risk of dysthymias when given with anesthesia

Antihistamines and thyroid drugs increase adrenergic effects

Front 17

Vasoactive adrenergics

Back 17

Cardioselective (beta receptors)

TX heart failure, shock, orthostatic hypotension

Potent, quick acting, short lived and injectable; should be titrated (slowly increasing dose) for desired response .

Front 18

Dopamine

Back 18

Dopamenergic, alpha, and beta receptor activity

D: dilate pupils

R: rate of heart increase

A: arterioles dilate (low doses only)

G: G.I. motility increases

Low doses (< 5mL): dilates vessels to brain, heart, kidneys, and messenteries (increases blood flow) (dopamenergic)

Higher doses ( > 5mL): improves cardiac contractility and CO. (Beta adrenergic)

Highest doses: vasoconstriction (alpha adrenergic)

Contraindications: phenochomocytoma ( catecolamine secreting tumor)

Route: injection only

Front 19

Dobutamine

Back 19

Beta selective vasoactive drugTargets: heartIncreases CO by increasing contractility (positive inotropy) which Increases SV Tx: heart failure, angina, low BP

Beta selective vasoactive drugTargets: heartIncreases CO by increasing contractility (positive inotropy) which Increases SV Tx: heart failure, angina, low BPRoute: IV only as continuous infusion

Beta selective vasoactive drugTargets: heartIncreases CO by increasing contractility (positive inotropy) which Increases SV Tx: heart failure, angina, low BPRoute: IV only as continuous infusion

Beta selective vasoactive drugTargets: heartIncreases CO by increasing contractility (positive inotropy) which Increases SV Tx: heart failure, angina, low BPRoute: IV only as continuous infusion

Beta selective vasoactive drugTargets: heartIncreases CO by increasing contractility (positive inotropy) which Increases SV Tx: heart failure, angina, low BPRoute: IV only as continuous infusion

Route: IV only as continuous infusion

Front 20

Epinephrine

Epinephrine

Back 20

Emergency onlyPrimarily vasoactive for cardiac life support

Stimulates alpha and beta receptors

Low doses: mostly beta1 to increase HR and contraction force

TX for asthma and anaphylaxis bc induces bronchodialation by beta2 stim.

High doses: Stims alpha receptors to cause vasoconstriction to increase B.P.

Route: 2 strengths for I.V. use only

Front 21

Midodrine

Back 21

TX. Symptomatic orthostatic HTN

Alpha 1 stim causes constriction of arterioles and veins

Route: P.O.

Given 2-3/day

Don't give within 4 hrs of bedtime bc supine HTN risk

Front 22

Norepinephrine

Back 22

Primarily stims alpha adrenergic receptors for vasoconstriction And some stimulation for beta1 (heart) receptorsTX. Hypotension and ShockAdmin by continuous infusion

Primarily stims alpha adrenergic receptors for vasoconstriction And some stimulation for beta1 (heart) receptorsTX. Hypotension and ShockAdmin by continuous infusionMetabolized to dopamine for continued effect.

Primarily stims alpha adrenergic receptors for vasoconstriction And some stimulation for beta1 (heart) receptorsTX. Hypotension and ShockAdmin by continuous infusionMetabolized to dopamine for continued effect.

Primarily stims alpha adrenergic receptors for vasoconstriction And some stimulation for beta1 (heart) receptorsTX. Hypotension and ShockAdmin by continuous infusionMetabolized to dopamine for continued effect.

Primarily stims alpha adrenergic receptors for vasoconstriction And some stimulation for beta1 (heart) receptorsTX. Hypotension and ShockAdmin by continuous infusionMetabolized to dopamine for continued effect.

Primarily stims alpha adrenergic receptors for vasoconstriction And some stimulation for beta1 (heart) receptorsTX. Hypotension and ShockAdmin by continuous infusionMetabolized to dopamine for continued effect.

Metabolized to dopamine for continued effect.

Front 23

Mirabergon

Back 23

Beta receptors stim Targets urothelium and detrusor smooth muscles Causes them to relax during storage phase to increase bladder capacity to TX overactive bladder. Sustained release tablet, and no ContraindicationsAdverse effects: HTN, UTI, HA, nasopharyngitis, nausea, dizziness.

Beta receptors stim Targets urothelium and detrusor smooth muscles Causes them to relax during storage phase to increase bladder capacity to TX overactive bladder. Sustained release tablet, and no ContraindicationsAdverse effects: HTN, UTI, HA, nasopharyngitis, nausea, dizziness.

Beta receptors stim Targets urothelium and detrusor smooth muscles Causes them to relax during storage phase to increase bladder capacity to TX overactive bladder. Sustained release tablet, and no ContraindicationsAdverse effects: HTN, UTI, HA, nasopharyngitis, nausea, dizziness.

Beta receptors stim Targets urothelium and detrusor smooth muscles Causes them to relax during storage phase to increase bladder capacity to TX overactive bladder. Sustained release tablet, and no ContraindicationsAdverse effects: HTN, UTI, HA, nasopharyngitis, nausea, dizziness.

Sustained release tablet, and no Contraindications

Adverse effects: HTN, UTI, HA, nasopharyngitis, nausea, dizziness.

Front 24

Phenylephrine

Back 24

Primarily TX short-term to raise B.P. for shock

Control SVT (Superventricular tachycardia

Vasoconstriction w/regional anestheia

Route: topical, ophthalmic, and nasal decongestant

Front 25

Nsg Implications

Back 25

Assess: allergies, asthma, HTN HX, dysthymias, cardiovascular problems

Assess renal, hepatic, and cardiac function

Monitor baseline vitals

Front 26

I.V. Admin gen points

Back 26

Check site often foe infiltration

Use clear solutions

Use infusion pump

Infuse slowly to avoid dangerous cardiovascular effects

Monitor cardiac rhythm

Front 27

Lung disease

Back 27

Avoid exacerbating factors

Encourage alot of fluids (3000mL/day)

Education abt proper doing and equipment

Educate abt inhaler use (rescue vs maintenance)

Front 28

OTC

Back 28

Over use of decongestants can cause rebound congestion

Gen avoid OTC and other meds incase if interactions

Front 29

2 adrenergics admin together

Back 29

Can trigger sever cardiovascular effects (tachycardia or HTN)

Front 30

Therapeutic Adrenergic cardiovascular effects

Back 30

Decreased edema

Increased urinary output

Return to normal vitals signs

Improved color and temperature

Increased LOC

Front 31

First does phenomenon

Back 31

Sudden drop in B.P. following first dose of an alpha blocker; can cause LOC

Orthostatic hypotension can occur w/any dose of an alpha blocker

Front 32

Alpha blockers

Back 32

Interrupt stim of SNS at alpha receptors through direct or indirect competition

Cause vasodialation in arterioles and venules to lower B.P.

Reduce smooth muscle contraction of bladder and prostate to decrease resistance to urinary flow (reduce bph effects)

TX extravasation of vasopressors

Control and TX of HTN in pts with phenochromocytoma

TX of raynauds disease, acrocyanosis and frostbite

Phentolamine

Front 33

Alpha blocker adverse effects

Back 33

Cardiovascular: palpitations, orthostatic HTN, tachycardia, edema, chest pain

CNS: dizzy, HA, anxiety, depression, weakness, numbness, fatigue

G.I.: Nausea, vomiting, diarrhea, constipation, abdominal pain

Gen.: incontinence, dry mouth, pharyngitis

Front 34

Toxicity and O.D. for Alpha blockers

Back 34

Symptomatic and supportive measures include: b.p. support, fluids, vol. Expanders, and vasopressors

Front 35

Phentolamine

Back 35

A blocker to reduce peripheral vascular resistance and TX HTN

Diagnosis of catecolamine secreting tumor

TX extravation of vasoconstricters by causing vasodialation

Contraindications: hypersensitivity, MI, CAD

Adverse effects: same for other A blockers

Front 36

Tamsulosin

Back 36

A blocker for BPH TX, exclusively male pts.

TX kidney stones and urinary retention in females

Similar drug: Alfuzosin

Contraindications: allergies or E.D. meds (additive hypotension)

Adverse effects: HA, abnormal ejaculation, rhinitis, and others

Front 37

Beta blockers

Back 37

Block stim beta receptors SNS

Selective or non-selective

B2 receptors mainly in bronicoles and blood vessels

Front 38

Beta blocker indicatons

Back 38

Angina- lowers O2 demand of heart

Cardioprotective - for HTN, MI, and heart failure. Inhibit stim. from catecolamines

Dysthymias - class 2 antidysrhythmic

Migraine HA - lipophilicity allows entry into CNS ie crossing blood brain barrier

Glaucoma (topical)

Front 39

Beta blockers adverse effects

Back 39

Blood: agranulocytosis, thrombocytopenia

Cardiovascular: AV block, bradycardia, heart failure, rebound HTN

CNS: dizziness, depression, weird dreams, drowsiness

G.I.: nausea and vomiting, constipation, diarrhea

Other: impotence, alopecia, wheezing, bronchospasm, and dry mouth

Nonselective can interfere w/normal hypoglycemic response

Front 40

Atenolol

Back 40

Cardiselective B blocker

Used to prevent future MI w/ pts who've had one

TX: HTN and angina and excess thyroid activity

Front 41

Carvedilol

Back 41

Nonselective B blocker

TX heart failure, HTN, and angina

-decrease freq. of hospitalization w/ mild to moderate heart failure

Front 42

Labetalol

Back 42

Nonselective B blocker

TX: severe HTN and HTN emergencies to quickly lower B.P.

Oral or injectable

Front 43

Metoprolol

Back 43

Cardioselective (B1) B blocker

Most commonly used

Increases survival of pts after MI

Oral on injectable

Front 44

Propranolol

Back 44

Nonselective B blocker

TX: indications for metoprolol, tachydysrhythmias, hypertrophic subaortic stenosis, migrane,

Contraindications of typ beta blocker + asthma pts

Front 45

Sotalol

Back 45

Nonselective B blocker

Potent antidysrhythmic (typ. Ventricular dussrhythmias) , lowers HR

Typ. Adverse effects (hypotension)

Oral use

Front 46

Adrenergic blockers assessment

Back 46

Assess: allergies, COPD/Lung disease hx, hypotension, cardiac dysthymias, bradycardia, heart failure, and other cardiovascular probs.

Front 47

Adrenergic blockers implications

Back 47

Avoid OTC meds bc poss interactions

Encourage pts to take as prescribed

Have pts report constipation, urinary hesitancy, or bladder distention

Ed pts to change position slowly to minimize postural hypotension

Ed pts to avoid caffeine bc antagonistic

Monitor for therapeutic and adverse effects

Rebound HTN or chest pain can occur if suddenly stopped