Adrenergic Agonist/Antagonists Flashcards
autonomic nervous system
Regulates the body’s involuntary functions including heart rate, respiratory rate and digestion.
- can’t stop, automatic
sympathetic -fight or flight
- Adrenergic system Norepinephrine
- Works opposite with the parasympathetic nervous system
- increased HR
parasympathetic -rest and digest
- Cholinergic System Acetylcholine
- Works opposite the sympathetic nervous system
- calms you down , esp. after sympathetic response
somatic nervous system
- Conducts impulses from the CNS to skeletal muscles.
- Voluntary nervous system because we can consciously control skeletal muscles.
- Ex. Running or make aggressive moves with activation sympathetic nervous system.
- Calming behaviors and movement with activation of parasympathetic system
peripheral nervous system response
parasym or sym
parasympathetic
- Parasympathetic: cholinergic
- Relaxes body
- Slows heartbeat
•GABA released
•Slow switch on – short switch off
sympathetic
- Sympathetic–adrenergic
- Fight or flight
- Increases heart rate
•Increased levels of released epinephrine norepinephrine
- Liver secretes glucose
- Quick switch on – long switch off.
parasympathetic
effects on body
Parasympathetic - Juicy
- •Eye pupil constricts*
- •Lungs – constricts bronchioles and increases secretions*
•Heart = HR decreases
•Blood vessels – dilate
- GI increased peristalsis and secretions
- Bladder constricts
- •Salivary glands – increased salivation*
- •Cholinergic system - Acetylcholine*
parasym receptors
Receptors
- Nicotine – Affects Skeletal Muscle
- Muscarinic – affects smooth muscle and slows HR
sympathetic effects on body
- sym: fast & dry
- •Eye pupil dilate*
- •Lung bronchioles dilate*
- •Heart = HR increases*
- •Blood vessels constrict*
- GI relaxes
- Bladder relaxes
- Uterus relaxes
•Adrenergic System - Norepinephrine
sym receptors
•Receptors
- Alpha 1 and 2
- Beta 1 and 2
- all meds affect these
Adrenergic Agonist
Sympathomimetics = Adrenergics
Drugs that stimulate SNS because they mimic the sympathetic neurotransmitters Norepinephrine and Epinephrine
non selective
Affect many receptor sites
selective
Affect only one receptor site
alpha 1
-agonist
- Increased cardiac contractibility
- Vasoconstriction –increased BP
•Dilate pupils
- Decrease salivary gland secretion
- Increase bladder and prostate contraction
alpha 2
-antagonist
- Inhibits norepinephrine release
- Promotes vasodilation which decrease BP
- Decrease GI motility and tone
beta 1
- Increase cardiac contractibility and HR
- Increase renin secretion to increase HR
-Dopaminergic – Vasodilation
increases blood flow only dopamine can activate this receptor
Beta 2
•Beta 2
•Bronchodilation
- Increases blood flow to skeletal muscles
- Decreases uterine tone
- Decreases GI tone and motility
•Activates liver glycogenolysis which increases blood glucose
Adrenergic Agonists =Sympathomimetics = Adrenergics
3 cat of receptors
-direct acting, indirect, mixed acting
direct acting
Stimulates epinephrine and norepinephrine
indirect
stimulates the release of norepinephrine from the terminal nerve endings – Amphetamine
mixed acting
stimulate both the adrenergic receptor sites and stimulates the release of norepinephrine from the terminal nerve endings - ephedrine
-Ex: pseudoephedrine – increased HR and active glucose to the body
ANS system meds
- Adrenergic Agonists/Adrenergics/Sympathomimetics
- Stimulate the sympathetic nervous system
•Mimic the neurotransmitters of norepinephrine and epinephrine
- Act on one or more adrenergic receptor sites located in the effector cells of the muscles
- Heart
- Bronchiole walls
- GI tract
- Urinary bladder
- Ciliary muscle of the eye
- Adrenergic Receptors (3) – Alpha 1, Alpha 2, Beta 1, Beta 2, Dopaminergic
epinephrine (adrenalin)
•Action
- Vasoconstriction causing increased BP
- Increases heart rate
- promotes bronchodilation
- renal vasoconstriction = decreased urinary output
•Route
•SQ, IV, Topical, Inhalation, Intracardiac
•Uses
- Anaphylaxis, anaphylactic shock
- Bronchospasms
- Cardiac arrest
ephinephrine
contra/caution
- Contraindications and Caution
- Cardiac dysrhythmias may worsen, hypertension >160/100
- Hyperthyroidism, Pregnancy
ephinephrine
SE/AD
•Side Effects
•hypertension, tachycardia, nervousness, tremors, agitation
•Adverse Reactions
•Ventricular fibrillation and Pulmonary edema
epinephrine
drug interactions
•Drug interaction
•Beta-blockers - Decreases epinephrine action (antagonize or counteract)
•MAOI and tricyclic antidepressants can cause effects to be intensified and prolonged
•Digoxin may increased chance of dysrhythmias
epinephrine (Adrenalin) – Nursing Interventions
•Monitor BP, P, decreased urine output, urinary retention
- Report tachycardia, palpitations, tremors, dizziness, hypertension
- Avoid cold medications/diet pills if hypertensive, diabetic, CAD, or dysrhythmias
- Avoid adrenergics when nursing infants
- Avoid continuous use of adrenergic nasal sprays
- Monitor IV site for infiltration
ephinephrine antidote
•Antidote: phentolamine mesylate (Regitine)
albuterol (Proventil) and salmeterol (Serevent)
what kind of receptor?
- Selective
- Acts on Beta 2 adrenergic receptors
- Promotes bronchodilation
- Decreased GI tone and mobility
albuterol (Proventil) and salmeterol (Serevent)
uses/dosage
•Uses
•Treat/prevent bronchospasm, asthma, bronchitis, COPD
•Dosage
- Albuterol—PO, Inhalation, Nebulizer
- Treat bronchospasm (short acting—rescue inhaler)
- Salmeterol—Inhalation (powder or inhaler)
- Prevent bronchospasm (long acting—routine inhaler)
Albuterol (Proventil) and Salmeterol (Serevent)
SE/AD
•Side effects/adverse reactions
•Tremors, nervousness, restlessness
•Dizziness
•Reflex tachycardia with overuse HR >100
- Hallucinations
- Cardiac dysrhythmias
- High doses of albuterol may affect beta 1 receptors resulting in increased heart rate
Albuterol (Proventil) and Salmeterol (Serevent)
caution
•Severe cardiac disease, hypertension, hyperthyroidism, diabetes mellitus may increase Blood glucose, pregnancy
Albuterol (Proventil) and Salmeterol (Serevent)
Nursing Implications
- Instruct patients to avoid factors that exacerbate their respiratory condition
- Encourage fluid intake - (up to 3000 mL per day) if permitted
- Educate about proper dosing, use of equipment (MDI, spacer, nebulizer), and equipment care
Salmeterol (Serevent) is indicated for prevention of bronchospasms, not management of acute symptoms
If using another type of inhaler (corticosteroid) use the bronchodilator first—wait 5 min—then administer the corticosteroid
- •Short acting Beta 2 adrenergic agonist = Albuterol (Proventil)*
- •Long acting Beta 2 adrenergic agonist = Salmeterol (Serevent)*
Albuterol (Proventil) and Salmeterol (Serevent) Evaluation – Did the Medication Work?
- Return to normal respiratory rate <18 >10
- Improved breath sounds, fewer crackles/wheezes
- Increased air exchange = O2 Sat Above 92%
- Decreased cough
- Less dyspnea
- Improved blood gases – Increased HCT
- Increased activity tolerance
Adrenergic Agonists (Alpha 1, Beta 1 and Beta 2)
•Dopamine – used to ↑ BP -Vasopressor Stimulates beta-1
•Dobutamine – used to treat cardiac decompenstion
- Pseudoephedrine (Sudafed, Afrin)– used to treat nasal congestion
- What can happen with overuse???
- Terbutaline (Brethine)– used to treat bronchospasm
Adrenergic Blockers = Antagonists = Sympatholytics
Block the effects of adrenergic neurotransmitters
Inhibits or opposite effects
Alpha-Adrenergic Blockers
- Alpha-Adrenergic Blockers = Heart
- Selective
- Block Alpha 1 effects
- Non selective
- Block both Alpha 1 and 2
- Can cause orthostatic hypotension
- Reflex tachycardia
- Not used as much as beta adrenergic blockers due to side effects
beta-adrenergic blockers
- Beta-Adrenergic Blockers – smooth muscle
- Selective – Block beta 1
- Decrease HR and BP follows
- Non selective
- Affects both beta 1 and beta 2
receptor sites
•Caution in COPD or Asthma due to bronchoconstriction as a result of blocking beta 1
Alpha Adrenergic Blockers (Antagonists)
Drugs
•Doxazosin (Cardura)
•Used for hypertension (HTN) and Benign Prostrate Hypertrophy (BPH)
•Prazosin (Minipress)
•Used for HTN and Post Traumatic Stress Disorder (PTSD)
•Terazosin (Hytrin)
•Used for HTN & BPH
Alpha Adrenergic Blockers (Antagonists)
action
vasodilation which results in decreased BP over time pulse drops as well
Alpha Adrenergic Blockers (Antagonists)
SE
Side Effects:
- 1st dose orthostatic hypotension; dizziness, syncope
- Orthostatic hypotension
- Reflex tachycardia
- Due to these side effects this class of medication not used as much a beta blockers.
Beta Adrenergic Blockers = Beta Blockers
Action
•Action = Decreased heart rate with a decreased in BP usually follows.
- May be nonselective blocking both beta1 and beta2 receptors or selective blocking beta1 receptors.
- If nonselective use with caution in COPD or chronic respiratory disease due to increased HR with beta1 blocking but also bronchoconstriction occurs due to blocking of beta2 receptors.
Beta Adrenergic Blockers = Beta-Blockers
drugs
- propanolol (Inderal) – Also used for social phobias
- atenolol (Tenormin)
- metoprolol (Lopressor)
- carvedilol (Coreg)
- nadolol (Corgard)
- timolol (Blocadren, Timoptic) used for glaucoma – decreased eye pressure
Indications: Beta Adrenergic Blockers = Beta Blockers
- Antianginal: Decreases demand for myocardial oxygen
- Cardioprotective: Inhibits stimulation from circulating catecholamines so that the heart is not allowed to have a sympathomimetic response. The heart is protected from simulation of the fight or flight system
- Class II antidysrhythmics
- Antihypertensive
- May be used to treat heart failure
- Treatment of migraine headaches and social phobias
•
•Glaucoma (topical use)
Beta-Blockers Assessment and Planning
•propranolol (Inderal)
–•propranolol (Inderal) Nonselective Beta 1 and Beta 2 -
•Contraindications
- COPD and asthma – bronchocontriction
- Side effects/adverse reactions
- Weight gain, impotence, decreased libido, reversible alopecia, decreased pulse <60 Critical Assessment
•Drug interactions
•Decreased drug effects with several drugs
•Heart block may occur with digoxin, calcium channel blockers
metoprolol (Lopressor), atenolol (Tenormin)
assessment/planning
Selective - Blocks beta1 only
- Decrease BP and P
- Fewer side effects
- Side effects/adverse reactions – Usually dose related
- Bradycardia, hypotension, dysrhythmias, Congestive heart failure (CHF), dizziness, fainting, fatigue, mental depression, Impotence, pulmonary edema.
- hypoglycemia – blocking of beta 2 receptor that will increase blood glucose
metoprolol (Lopressor), atenolol (Tenormin)
drug interaction
Drug interactions
- Decreased effects with NSAIDs
- Increased effects with alpha blockers, atropine, anticholinergics
- Increased risk of hypoglycemia
Insulin, sulfonylureas
Nursing Implications for Adrenergic Blockers Alpha and Beta
- Assess for allergies and history of COPD, hypotension, cardiac dysrhythmias, bradycardia, heart failure, or other cardiovascular problems
- Beta Blockers should never be stopped abruptly to avoid opposite effects.
- Teach patients to change positions slowly to prevent or minimize postural hypotension
- Avoid caffeine (excessive irritability)
- Avoid alcohol ingestion and hazardous activities until blood levels become stable
- Critical Assessments: Pulse (Priority) and BP BP<100/60 Pulse <60
- Have patient report palpitations, dyspnea, nausea, vomiting constipation or the development of any urinary hesitancy or bladder distention
Drug Interactions for both Alpha and Beta Adrenergic Blockers
- Antacids (aluminum hydroxide type)
- Diuretics and cardiovascular drugs
- Antimuscarinics/anticholinergics
- Neuromuscular blocking drugs
- Oral hypoglycemic drugs
adrenergic agonist & blockers
call doc if…
Patients should report the following to their physician:
- Weight gain of more than 2 pounds in 1 day or 5 lbs within 1 week
- Edema of the feet or ankles
- Shortness of breath
- Excessive fatigue or weakness
- Syncope or dizziness
-all indications of …..
adrenergic agonists/blockers
TE
Monitor for therapeutic effects
- Decreased chest pain in patients with angina
- Return to normal BP and P - BP 100-128 and pulse 60-98 approx.
- Other specific effects, depending on the use
Cholinergic Agonists
- parasympathomimetics
- Stimulate the parasympathetic nervous system
parasym meds
Cholinergic Agonists = parasympathomimetics =
cholinomimetics = cholinergic stimulants = Agonist
Anticholinergics = parasympatholytics = cholinergic = muscarinic antagonists = Antagonist
how do cholinergic agonists stimulate the parasym?
- Cardiovascular*: decrease P and BP, vasodilation, slows conduction of AV node
- GI*: increase tone and motility, increase peristalsis, relax sphincter muscles
- GU:* contract bladder, increase ureter tone, relax sphincter muscles, stimulate urination
- Eye:* pupil constriction (miosis), increase accommodation
- Lungs*: bronchial constriction, increase secretions
- Glands:* increase salivation, perspiration, tears
- Striated muscle:* increase neuromuscular transmission
Direct-Acting Cholinergics: Activate Receptor for Response
•GI: metoclopramide (Reglan)
- Used to treat GERD
- Used to treat gastroparesis (increases gastric emptying time)
- GU: bethanechol (Urecholine)
- Used to stimulate urination (for treatment of urinary retention)
- EYES: pilocarpine
- Used for the treatment of glaucoma (reduces the intraocular pressure)
- Topical application due to poor oral absorption
Indirect-Acting Cholinergics:
Another Chemical Reaction does the Work.
- Inhibit the action of the enzyme cholinesterase thus permitting acetylcholine to persist and attach to the receptor
- Alzheimers Dementia:
- tacrine (Cognex)
- •donepezil (Aricept)*
- •memantine (Namenda)*
- Used to improve memory in AD
- Helps to slow progression of the disease
- Does not cure the disease
Cholinergic Agonist Side Effects and Nursing Assessment
- Hypotension— assess BP -PT?
- Bradycardia–assess HR
- Bronchoconstriction —assess lungs
- Excessive salivation—good oral hygiene
- Increased Gastric Acid secretion–assess GI system
- Abdominal cramps–assess GI system
- Blurred Vision–safety concerns
Cholinergic agonist
Nursing Interventions
- Assess intake and output
- Teach procedure for administering eye drops
- Medications should be taken as ordered and not abruptly stopped
- The doses should be spread evenly apart to optimize the effects of the medication
•
•Therapeutic effects of anti-Alzheimer’s drugs may not occur for up to 6 weeks
TE
•metoclopramide (Reglan)
- In postoperative patients with decreased GI peristalsis, look for:
- Increased bowel sounds, Passage of flatus, Occurrence of bowel movements
TE
bethanechol (Urecholine)
In patients with urinary retention/hypotonic bladder, urination should occur within 60 minutes of medication administration
anticholinergics
parasympatholytics
cholinergic blocking agents
Same function = different names
Inhibits the actions of acetylcholine by occupying the acetylcholine receptors
effects of anticholinergics
- Heart: large doses increase HR; small doses decrease HR
- Lungs: bronchodilation, decrease secretions
•GI: Relax smooth muscle tone, decrease motility and peristalsis, decrease secretions
•GU: Relax detrusor muscle, increase sphincter constriction
- Eye: dilate pupils (midriasis), decrease accommodation
- Glands: decrease salivation, perspiration
- CNS: decrease tremors and rigidity
Antichol. drug atropine
use
•Uses:
- Pre-op medication to decrease salivary secretions
- Antispasmodic—decreases GI peristalsis
- Increase the HR (high doses)
- Used for severe bradycardia; or for heart block
Antichol. drugs
Scopolamine and Dramamine
use
motion sickness
anticholinergic drug
hyoscyamine (Cystospaz)
uses
•Uses: Treatment of Urinary bladder spasms, Irritable Bowel Syndrome (IBS) and peptic ulcers
anticholinergic drug
tolterodine (Detrol)
•Uses: “Gotta go”: Urinary frequency, urgency & incontinence
anticholin. drug
Ipratropium (Atrovent)
uses
- Bronchodilator (inhaler) to treat COPD, Asthma, bronchospasms
- Decreases bronchial secretions
anticholin. drugs:
Benztropine (Cogentin), Trihexyphenidyl (Artane)
uses
- Treatment of Parkinsonism and drug induced parkinsonism
- Decreases muscle rigidity & muscle tremors
- Used to reduce side effects of mental health medications
Anticholinergic Side Effects
- “Dry, Dry, Dry”
- Dry mouth
•Dry eyes
- Increase Intraocular pressure (IOP)
- Visual disturbances—blurred vision from pupillary dilation
- Constipation
•Urinary retention
- Orthostatic hypotension
- Tachycardia (in high doses)
What would be your nursing interventions to minimize the side effects listed on this page?
Anticholinergic Nursing Interventions
•Monitor for confusion/drowsiness especially in the elderly
•Elderly patient: be cautious of heat stroke
•Teach: limit physical exertion; avoid high temperatures; strenuous exercise
•Must have adequate fluid intake – monitor fluid balance 2-3 liters a day
•Report SE: urinary hesitancy and/or retention, constipation, palpitations, tremors, confusion, sedation or amnesia, excessive dry mouth, or fever
anticholin. drug interactions
- Antihistamines, phenothiazines, tricyclic antidepressants, MAOIs
- When given with other anticholinergic drugs, cause additive cholinergic effects, resulting in increased effects
Anticholinergic – Evaluation of Therapeutic Effects
- For patients with Parkinson’s disease: fewer tremors and decreased salivation and drooling
- For urologic problems: improved urinary patterns, less hypermotility, increased time between voiding
