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38 Cards in this Set

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Adrenergic drugs are also called?
Sympathomimetic drugs
Indications for the use of an adrenergic drug. List 5 reasons and the effect.
1. cardiac arrest, heart block, hypotension, and shock= for tissue perfusion
2. bronchial asthma and obstructive pulmonary disease= relieves constriction and spasm.
3. decongestant
4. allergic reactions= vasodilation and relieve edema.
5. pre-term labor = relax muscle to prevent contraction
In an emergency situation, an adrenergic drug is used to treat?
respiratory and allergic disorders
When should a adrenergic not be used ?
1. arrhythmias - usually rapid
2. angina pectoris
3. hypertension
4. hyperthyroidism
5. Cerebrovascular disease
6. narrow angle glaucoma
7. allergy to drug
8.with local anesthesia of distal areas with a single blood supply=fingers, nose, ears.
List 6 drugs in the adrenergic drug class also know as sympathomimetic.
1. epinephrine
2. ephedrine
3. pseudoephedrine
4. isoproterenol
5. phenyleprine
6. phenylpropanolamine
Prototype adrenergic drug
Epinephrine = ADRENALIN
Epinephrine (Adrenalin), the major clinical use for this drug is ?
allergic reactions,
cardiac arrest
hypotension
shock
local vasoconstriction
bronchodilation
cardiac stimulation
opthalmic conditions
How do adrenergic drugs act to relieve symptoms of acute bronchospasm, anaphylaxis, cardiac arrest, hypotension, and shock, and nasal congestion?
Bronchospasm: Adrenergic drugs stimulate beta2-adrenergic receptors causing bronchodilation
Anaphylaxis: Adrenergic drugs stimulate alpha1-receptors causing vasoconstriction; beta1, increasing heart rate and force of contraction; and beta2, causing bronchodilation
Cardiac arrest, hypotension, and shock: Adrenergic drugs stimulate alpha1 receptors, causing vasoconstriction; and beta1, increasing heart rate and force of contraction
Nasal congestion: Adrenergic drugs constrict arterioles and reduce blood flow to the nasal mucosa
Which adrenergic receptors are stimulated by administration of epinephrine?
Alpha and beta receptors are stimulated by epinephrine.
Why is it important to have epinephrine and other adrenergic drugs readily available in all health care settings?
They are the drugs of choice in emergency situations of acute cardiovascular, respiratory, and allergic disorders.
Which adrenergic drug is the drug of choice to treat acute anaphylactic reactions?
Epinephrine is used because it relieves bronchospasm, laryngeal edema, and hypotension quickly. It acts as a physiologic antagonist of histamine and other bronchoconstricting and vasodilating substances released during anaphylaxis.
Why is inhaled epinephrine not a drug of choice for long-term treatment of asthma and other bronchoconstricting disorders?
Tolerance can build, decreasing bronchodilating effects
What are the major adverse effects of adrenergic drugs?
Major adverse effects are hypertension, angina, tachycardia, and agitation.
Why are clients with cardiac dysrhythmias, angina pectoris, hypertension, or diabetes mellitus especially likely to experience adverse reactions to adrenergic drugs?
. Adrenergic drugs also stimulate glyconeogenesis and gluconeogenesis. Adrenergic drugs stimulate beta1 receptors that increase heart rate and force of contraction; alpha1 receptors cause vasoconstriction
What signs and symptoms occur with an overdose of noncatecholamine adrenergic drugs?
Severe hypertension. This may lead to headache, confusion, seizures, and intracranial hemorrhage. Reflex bradycardia and atrioventricular block have also occurred with phenylephrine toxicity.
What interventions are needed to treat toxicity?
Treatment involves maintaining a patent airway, ventilation (if necessary), and activated charcoal. Hypertension is actively treated with vasodilators. Beta blockers are administered in conjunction with vasodilators. Urinary acidification may assist with the elimination of ephedrine and pseudoephedrine.
How do alpha2 agonists and alpha1 blocking agents decrease blood pressure
Alpha2 agonists use a negative feedback system to decrease the release of norepinephrine from receptor sites, decreasing sympathetic activity. Alpha1 blockers inhibit the release of norepinephrine in the brain, thereby decreasing sympathetic stimulation throughout the body.
What are the safety factors in administering and monitoring the effects of alpha2 agonists and alpha1 blocking agents?
Monitor blood pressure closely. Use cautiously in patients with renal and hepatic failure. Start slowly and taper dose slowly.
Why should a client be cautioned against stopping alpha2 agonists and alpha1 blocking agents abruptly?
Rebound hypertension and tachycardia can occur with rapid withdrawal.
What are the main mechanisms by which beta blockers relieve angina pectoris?
Beta blockers inhibit beta1 stimulation, thereby decreasing heart rate, force of contraction, and the workload of the heart.
How are beta blockers thought to be “cardioprotective” in preventing repeat myocardial infarctions?
Beta blockers prevent or decrease catecholamine-induced dysrhythmias.
What are some noncardiovascular indications for the use of propranolol?
Propranolol is used to treat symptoms of hyperthyroidism, prophylaxis of migraine headaches, stage fright, and decrease esophageal varices in cirrhosis of the liver.
What are the main differences between cardioselective and nonselective beta blockers?
Cardioselective beta blockers act only on beta1 receptors in the heart. Nonselective beta blockers affect both beta1 and beta2 receptors. There are more adverse effects in terms of bronchoconstriction, peripheral vasoconstriction, and interference with glycogenolysis with nonselective agents. Cardioselectivity is lost at higher doses because most organs have both beta1 and beta2 receptors.
Why are cardioselective beta blockers preferred for clients with asthma or diabetes mellitus?
Cardioselective beta blockers cause less risk of bronchospasm or impaired glucose metabolism. These drugs also blunt symptoms of hypoglycemia.
List at least five adverse effects of beta blockers.
Bradycardia
Hypotension
Decreased cardiac output
Dysrhythmias
Bronchoconstriction
Decreased glycogenolysis
Explain the drug effects that contribute to each adverse reaction.
Bradycardia: negative chronotropy
Hypotension: decreased renin secretion in kidney
Decreased cardiac output: negative chronotropy and inotropy
Dysrhythmias: slowed conduction through AV node (negative dromotropy)
Bronchoconstriction: beta2 blockade
Decreased glycogenolysis: decreased glucose metabolism
What signs, symptoms, or behaviors would lead you to suspect adverse drug effects?
The following would be considered adverse drug effects: hypotension, edema, irregular heart rate, difficulty breathing, and low blood sugar
Do the same adverse effects occur with beta blocker eye drops that occur with systemic drugs? If so, how may they be prevented or minimized?
There is less risk for systemic effects with eye drops than with oral or parenteral administration of beta blockers. To decrease the risk of systemic effects, the eye drops should be administered as ordered and the lacrimal duct may be occluded with pressure by the fingertip to prevent systemic absorption.
What is the risk of abruptly stopping a beta blocker drug rather than tapering the dose and gradually discontinuing, as recommended?
Abrupt discontinuance of beta-blocking drugs increases the receptor’s sensitivity to epinephrine and norepinephrine. There is a risk of hypertension, angina, dysrhythmias, and myocardial infarction from the increase in excessive SNS stimulation. Tapering the drug allows beta adrenergic receptors to return to predrug density and sensitivity.
How can beta blockers be both therapeutic and nontherapeutic for heart failure?
Beta blockers may worsen heart failure by blocking sympathetic stimulation that maintains cardiac output. In select clients who are able to tolerate beta blockers, they may decrease the risk of sudden cardiac death and may reduce ventricular remodeling that occurs in congestive heart failure.
Epinephrine is also known as
adrenalin
Epinephrine stimulates what receptors
alpha and beta1 receptors
How can Epinephrine can be administered?
SQ=acute asthma
IM
IV=for code
Nasal=Asthma
Where is Ephinephrine is metabolized and excreted ?
metabolized in the liver by MAO and COMT enzymes.

excreted in the urine and brest milk
What effect is produced by drugs on the alpha2 receptor on the pre-synaptic nerve fibers?
produce parasympathetic effects.
What OTC drugs contain epinephrine?
Asthma-Nefrin
Primatene Mist
Bronkamist
Why is epinephrine not given orally?
because enzymes in the GI tract and liver will destroy it.
How is ephedrine administered?
PO =effects w.in 1 hour
Parenterally=acts w.in 20 min.