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35 Cards in this Set

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Uses of adrenergic drugs
• Increase the output of the heart
• Raise blood pressure
• Increase urine flow as part of the treatment of shock
• Heart stimulants
• Reverse the drop in blood pressure that is sometimes caused by general anesthesia
• Stop bleeding by causing the blood vessels to constrict
• Keep local anesthetics in a small area of the body by closing off the nearby blood vessels that would otherwise spread the anesthetic to other parts of the body
• Reducing nasal stuffiness associated with colds and allergies
• Open the bronchi (the tubes leading to the lungs) for treatment of asthma and chronic obstructive pulmonary disease (COPD)
Side effects of adrenergic drugs
• Nervousness
• Rapid heart beat
• High blood pressure
• Irregular heart beat
• Rapid heartbeat
• Chest pain
• Dizziness
• Dry mouth
• Headache
• Flushing
• Nausea
• Vomiting
• Weakness
Uses of adrenergic blockers
Alpha-beta blockers belong to a larger class of medicines called adrenergic inhibitors. They combine the effects of two types of medicines. They behave like alpha blocker medicines when they affect special receptor cells in the smooth muscles of your blood vessels. This action stops your cells from receiving chemicals called catecholamines. These chemicals narrow your arteries. This makes your blood pressure go up. When these chemicals are blocked, your blood vessels can relax. This in turn allows your blood to flow more easily, resulting in lower blood pressure. These medicines act like beta-blockers when they block these same catecholamines in your brain, heart, and blood vessels. The result is that your heart beats more slowly and with less force. Plus, your blood vessels relax and widen so that blood flows through them more easily. Both of these actions make your blood pressure go down.
Adrenergic inhibitors reduce the effects of the sympathetic nervous system (SNS), lowering the pulse and peripheral vascular resistance.
• High blood pressure
• Prostatitis
• Raynaud's disease
• Scleroderma
• Benign prostatic hyperplasia
• Pheochromocytoma (adrenal gland tumors)
Beta blockers reduce blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow.
Uses of beta blockers:
• High blood pressure
• Irregular heart rhythm (arrhythmia)
• Heart failure
• Chest pain (angina)
• Heart attacks
• Glaucoma
• Migraines
• Generalized anxiety disorder
• Hyperthyroidism
• Certain types of tremors
Side effects of adrenergic blockers
Alpha blockers may have what's called a "first-dose effect." When you first start taking an alpha blocker, you may develop pronounced low blood pressure and dizziness, which can make you suddenly faint when you rise from a sitting or lying position.
• Headache
• Pounding heartbeat
• Nausea
• Weakness
• Weight gain
• Small decreases in low-density lipoprotein cholesterol (the "bad" cholesterol)
Common side effects of beta blockers:
• Fatigue
• Cold hands
• Dizziness
• Weakness

Less common side effects include shortness of breath, trouble sleeping, loss of sex drive and slow heartbeat.
Beta blockers generally aren't used in people with asthma because of concerns that the medication may trigger severe asthma attacks.
Beta blockers can also affect your lipid levels, causing a slight increase in triglycerides and a modest decrease in high-density lipoprotein, the "good" cholesterol. These changes often are temporary. You should not abruptly stop taking a beta blocker because doing so could increase your risk of a heart attack or other heart problems.
Uses of cholinergic drugs
Cholinergic drugs are medications that produce the same effects as the parasympathetic nervous system. Such as:
• Slowing of the heartbeat
• Increasing normal stomach secretions including the digestive acids
• Increasing normal secretion of saliva
• Increasing normal secretion of tears
Cholinergic receptors:
Usually stimulated by acetylcholine (ACh)
• Nicotinic types are found in autonomic ganglia (both sympathetic and parasympathetic); these receptors are stimulated by nicotine
• A slightly different nicotinic type is found in neuromuscular junctions
• Muscarinic types are found on all organs with parasympathetic nerves; these receptors are stimulated by the mushroom poison, muscarine
Side effects of cholinergic drugs
• Slow heart beat, possibly leading to cardiac arrest.
• Muscle weakness, muscle cramps, and muscle pain
• Convulsions
• Weak breathing, inability to breathe
• Increased stomach acid and saliva
• Nausea and vomiting
• Dizziness, drowsiness, and headache
Uses of cholinergic blockers
• Antispasmodics. Antispasmodics are used to slow the motility of the gastrointestinal (GI) tract and reduce gastric secretions. Antispasmodics are commonly prescribed with other types of medications for patients who have ulcers or other GI disorders.
• Mydriatics/Cycloplegics. These agents are used to produce pupil dilation (mydriasis) and to paralyze the muscles of accommodation (cycloplegia). In other words, these drugs prevent the eye from focusing. Medications used for these purposes are commonly used following ocular surgery and for certain types of eye examinations.
• Antiparkinsonism Agents. These drugs are used to treat Parkinsonism, a condition characterized by excessive cholinergic activity in the brain. This condition results in an inability to perform fine motor movements.
• Cold Preparations. Many over-the-counter and legend cold preparations contain cholinergic blocking agents. These cholinergic blockers help to dry secretions (that is, help to "dry" a runny nose).
• Antidote for Nerve Gas Poisoning. Some cholinergic blocking drugs are used as antidotes for persons who have been poisoned by nerve gases (irreversible cholinesterase inhibitors). Certain cholinergic blocking agents are also used as antidotes for certain insecticides (irreversible cholinesterase inhibitors).
• Treatment of Bradycardia (Slow Heart Rate). Atropine sulfate, a cholinergic blocker, is sometimes administered to a patient following cardiac arrest to increase the heart rate. By blocking cholinergic innervation to the heart, sympathetic nerves are allowed to override and increase the rate of the heart.
• Preoperative Medication. Certain cholinergic blockers are administered to patients immediately before their undergoing a surgical procedure. In this case, the cholinergic blockers help to dry secretions in the mucous membranes.
Anticholinergic drugs
Drugs that block the action of the neurotransmitter acetylcholine. They are used to lessen muscle spasms in the intestines, lungs, bladder, and eye muscles.
Anticholinergics are a class of medications that inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. The nerve fibers of the parasympathetic system are responsible for the involuntary movements of smooth muscles present in the gastrointestinal tract, urinary tract, lungs, etc.
Side effects of cholinergic blockers
• Ataxia; loss of coordination
• Decreased mucus production in the nose and throat; consequent dry, sore throat
• Xerostomia or dry mouth
• Cessation of perspiration; consequent increased thermal dissipation through the skin leading to hot, red skin
• Increased body temperature
• Pupil dilation (mydriasis); consequent sensitivity to bright light (photophobia)
• Loss of accommodation (loss of focusing ability, blurred vision — cycloplegia)
• Double vision (diplopia)
• Increased heart rate (tachycardia)
• Urinary retention
• Diminished bowel movement, sometimes ileus
• Increased intraocular pressure, dangerous for people with narrow-angle glaucoma
Dobutamine and dopamine uses and differences
Dobutamine is used to help your heart pump better by strengthening the heart muscle. Dobutamine also improves blood flow and relieves symptoms of heart failure

Dopamine is used to treat heart conditions. The medication provides additional pumping strength by stimulating the heart muscle. In some patients it is used for improving kidney blood supply.
Inotropic Drugs
Inotropes are drugs that make your heart beat more strongly. They come in two basic flavors. The first type is called "b-adrenergic agonists". These include dobutamine and dopamine
Dobutamine
improves heart function and may lower blood pressure. It is used as a continuous IV infusion. It helps your body make more use of a substance called norepinephrine, which your body makes on its own. Norepinephrine stimulates your heart to work harder. You can become tolerant to dobutamine faster than to dopamine, and larger doses are necessary to get the same effect over time. Eventually it might stop helping you entirely. Potential side effects include irregular heart rhythm (although less than with dopamine), and increased demand for oxygen by the heart.
Dopamine
improves heart output and may raise blood pressure. It is also a continuous IV infusion. It increases the amount of norepinephrine active in your body. You become tolerant to dopamine, so larger and larger doses are necessary to get the same effect over time. Dopamine is often used to help get rid of edema because of how it affects receptors in the kidney's blood vessels. Potential side effects include irregular heart rhythm, and increased demand for oxygen by the heart
Routes of Epi and uses of Epi
When injected intravenously, epinephrine causes an immediate and pronounced elevation in blood pressure, which is due to the coincident stimulation of the action of the heart and the constriction of peripheral blood vessels. The chief metabolic changes following the injection of epinephrine are a rise in the basal metabolic rate and an increase of blood sugar. These effects of epinephrine are transitory.

They increase the rate and force of heart contractions, increasing blood output and raising blood pressure. Epinephrine also stimulates breakdown of glycogen to glucose in the liver, raising blood glucose levels, and both hormones increase the level of circulating free fatty acids. All these actions ready the body for action in times of stress or danger, times requiring increased alertness or exertion. Epinephrine is used in medical situations including cardiac arrest, asthma, and acute allergic reaction.

Heightened secretion caused perhaps by fear or anger, will result in increased heart rate and the hydrolysis of glycogen to glucose. This reaction, often called the “fight or flight” response, prepares the body for strenuous activity.
Uses of epinephrine:
• Stimulant in cardiac arrest
• Vasoconstrictor in shock
• Bronchodilator and antispasmodic in bronchial asthma
• Lower intra-ocular pressure in the treatment of glaucoma.
How Epi works
Epinephrine is used as a drug to promote peripheral vascular resistance via alpha-stimulated vasoconstriction in cardiac arrest and other cardiac dysrhythmias resulting in diminished or absent cardiac output, such that blood is shunted to the body's core. This beneficial action comes with a significant negative consequence—increased cardiac irritability—which may lead to additional complications immediately following an otherwise successful resuscitation. Alternatives to this treatment include vasopressin, a powerful antidiuretic, which also increases peripheral vascular resistance leading to blood shunting via vasoconstriction, but without the attendant increase to myocardial irritability.
Because of its suppressive effect on the immune system, epinephrine is used to treat anaphylaxis and sepsis. Allergy patients undergoing immunotherapy may receive an epinephrine rinse before the allergen extract is administered, thus reducing the immune response to the administered allergen. It is also used as a bronchodilator for asthma if specific beta2-adrenergic receptor agonists are unavailable or ineffective.
Adverse reactions to epinephrine
include palpitations, tachycardia, anxiety, headache, tremor, hypertension, and acute pulmonary edema
What to do when vasopressors infiltrate
• Cold causes vasoconstriction, localizing the extravasation and allowing time for local vascular and lymphatic systems to disperse the agent.
• Elevation
• Phentolamine (an alpha-adrenergic blocking agent relaxing smooth vascular muscles) has been used as an antidote to vasopressor extravasation. Extravasation of a vasoconstrictive agent, such as dopamine, dobutamine, epinephrine, or norepinephrine, may result in significant tissue injury. Local administration of a vasodilator may prevent ischemia in the tissues surrounding the infiltration. Phentolamine is a nonspecific alpha-adrenergic blocking agent which serves as a competitive antagonist of alpha-adrenergic agonists. It acts at both arterial and venous sites, inhibiting vasoconstriction and allowing improved blood circulation through the affected area.
Metabolic effect of adrenergics
When injected intravenously, epinephrine causes an immediate and pronounced elevation in blood pressure, which is due to the coincident stimulation of the action of the heart and the constriction of peripheral blood vessels. The chief metabolic changes following the injection of epinephrine are a rise in the basal metabolic rate and an increase of blood sugar. These effects of epinephrine are transitory.
Epinephrine
One of two hormones (the other being norepinephrine) secreted by the adrenal glands, as well as at some nerve endings, where they serve as neurotransmitters. They are similar chemically and have similar actions on the body. They increase the rate and force of heart contractions, increasing blood output and raising blood pressure. Epinephrine also stimulates breakdown of glycogen to glucose in the liver, raising blood glucose levels, and both hormones increase the level of circulating free fatty acids. All these actions ready the body for action in times of stress or danger, times requiring increased alertness or exertion. Epinephrine is used in medical situations including cardiac arrest, asthma, and acute allergic reaction.
Receptors Epi stimulates
Adrenergic receptors:
Usually stimulated by norepinephrine (NE) or epinephrine (E)
• Alpha 1 type is found in the smooth muscle of most arterioles and in sphincter muscles of the GI tract and bladder
• Alpha 2 type is found in presynaptic nerves and parts of the GI tract
• Beta 1 type is the dominant type in the heart and other locations
• Beta 2 type is found in the bronchioles of the lung, the wall muscles of the bladder and other locations
Effects of receptors. Alpha, Beta 1 and Beta 2
Alpha-1 receptors are found in the smooth muscle of arteries and veins, GI tract, endocrine glands, bronchioles and eye.
Effects of Alpha-1 drugs:
• Vasoconstriction - produce homeostasis or arrest bleeding
• Mydriasis (reflex pupillary dilation as a muscle pulls the iris outward; occurs in response to a decrease in light or certain drugs) - produce dilation for eye exams and ocular surgery

Beta-1 receptors are found in the heart only.
Effects of Beta-1 drugs:
• Tachycardia
• Increased myocardial contractility

Beta-2 receptors are found in bronchioles and blood vessels.
Effects of Beta-2 drugs:
• Vasodilation
• Bronchodilation
• Increased muscle and liver glycogenolysis (the biochemical breakdown of glycogen to glucose)
• Increased release of glucagons
• Relax uterine smooth muscle
Neo-Synephrine - used for:
Maintaining blood pressure in certain acute low blood pressure situations. It is also used to treat blood vessel failure during shock and low blood pressure or allergic reactions caused by other medications. It may also be used to treat painful, prolonged erections (priapism).

Neo-Synephrine is a vasopressor. It works by constricting blood vessels and raising blood pressure.
Side effects of neo-synephrine:
• Excitability
• Headache
• Nausea
• Restlessness
• Vomiting
Inotropic definition
Affecting the force of muscle contraction. An inotropic heart drug is one that affects the force with which the heart muscle contracts.
Dig toxicity
Therapeutic level = 0.8-2.0 mg/mL

Digoxin is used to treat congestive heart failure and the associated symptoms of shortness of breath when lying flat, wheezing, and ankle swelling. Digoxin is also used to slow heart rate in rapid atrial rhythm disturbances such as atrial fibrillation and atrial flutter.
There is little cushion between a therapeutically beneficial level of digoxin and a toxic level of digoxin. Digoxin toxicity is common, especially in patients with kidney dysfunction. Digoxin toxicity can cause potentially life- threatening heart rhythm disturbances, ranging from very slow to rapid ventricular rhythms. In patients with existing disease of the electrical conduction of the heart, digoxin can precipitate heart block and a seriously slow heart rate.
Patients with low blood potassium levels can develop digoxin toxicity even when digoxin levels are not considered elevated. Similarly, high calcium and low magnesium blood levels can increase digoxin toxicity and produce serious heart rhythm disturbances.
SIDE EFFECTS:
The most common side effects are related to digoxin toxicity and heart rhythm disturbances. Other side effects include abdominal pain, nausea, vomiting, loss of appetite, breast enlargement, skin rash, blurred vision, and mental changes.
Epi in glaucoma what does it do?
Epinephrine compounds are eye drops that lower the intraocular pressure by increasing the rate of aqueous humor flow out of the eye.
CHF Treatment
Digoxin (Lanoxin) is often recommended to strengthen the pumping action of the heart muscle.
Beta-Blockers have recently become very beneficial in treating heart failure. Where these were once avoided in heart failure patients, they now have a great influence on helping patients stay out of the hospital, and feel better overall.
Cholinesterase inhibitors and Myasthenia Gravis
Myasthenia gravis is an autoimmune disease that affects the transmission of signals from nerves to muscles.

Drugs used include cholinesterase inhibitors. These drugs help improve nerve signals to muscles and increase muscle strength.
Cholinesterase inhibitors are drugs that block the activity of an enzyme in the brain called cholinesterase. Cholinesterase breaks apart the neurotransmitter acetylcholine, which is vital for the transmission of nerve impulses. Cholinesterase inhibitors are used to reduce the action of cholinesterase, thereby making more acetylcholine available to nerve cells in the brain
Primacor use
Primacor is used for the short term treatment of severe congestive heart failure. This is a condition where the heart fails to pump enough blood around the body. The symptoms of this condition include weakness, breathlessness, fluid build-up in the tissues and a blue discolouration of the skin.
Primacor also helps to maintain the output of blood from the heart in patients following heart surgery.
Primacor helps improve the efficiency with which your heart pumps blood around your body.
Primacor works by increasing the force by which your heart muscles work and opening up your blood vessels to allow blood to flow more freely.
Lasix ‘s effect on Dig
Lasix - Adverse effects: K+ depletion.
Low K+ level will increase the effect of Digoxin and place the patient at risk for Digoxin toxicity.