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Adrenergic Drugs Flashcards

1
Q

Adrenergic Drugs

also known as

A

Drugs that stimulate the sympathetic nervous system (SNS)

Also known as
Adrenergic agonists
Sympathomimetics

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2
Q

A1 receptors effects: 2

A

constrict BVs and visceral organ sphincter

dilates pupils

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3
Q

A2 receptors effects: 2

A

inhibit NE release from adrenergic terminals

inhibit insulin secretions

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4
Q

B1 receptors effects: 3

A

increase HR

increase FOC

stimulate kidneys to release renin

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5
Q

B2 receptors effects: 3

A

relaxes uterus

dilates BVs and bronchioles (relaxes SM in the airway= bronchial dilation and increased airflow)

relaxes smooth muscle walls of GI and urinary visceral organs

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6
Q

Adrenergic Drug Neurotransmitters

A

Mimic the effects of SNS neurotransmitters (catecholamines)

norepinephrine
epinephrine
dopamine

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7
Q

Autonomic Nervous System

A

The SNS is the counterpart of the parasympathetic nervous system.

Together they make up the autonomic nervous system.

They provide a checks-and-balances system for maintaining the normal homeostasis of the autonomic functions of the human body.

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8
Q

Three Adrenergic
Receptors

A

Located throughout the body

Are receptors for the sympathetic neurotransmitters
-α-Adrenergic receptors
-ß-Adrenergic receptors
-Dopaminergic receptors: respond only to dopamine

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9
Q

α-Adrenergic Receptors

A

Divided into α1- and α2-receptors

Differentiated by their location on nerves

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10
Q

α1-Adrenergic receptors location

A

Located on postsynaptic effector cells (the cell, muscle, or organ the nerve stimulates)

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11
Q

α2-Adrenergic receptors location

control the release of?

A

Located on presynaptic nerve terminals (the nerve that stimulates the effector cells)

Control the release of neurotransmitters

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12
Q

α-Adrenergic Agonist Responses

A

Vasoconstriction

Central nervous system (CNS) stimulation

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13
Q

ß-Adrenergic Receptors

Location?

ß1-Adrenergic receptors location

ß2-Adrenergic receptors three locations

A

All are located on postsynaptic effector cells.
ß1-Adrenergic receptors: located primarily in the heart
ß2-Adrenergic receptors: located in smooth muscle of the bronchioles, arterioles, and visceral organs

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14
Q

Remember: β1 for 1___; β2 for 2 _____

A

Remember: β1 for 1 heart; β2 for 2 lungs

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15
Q

ß-Adrenergic Agonist Three Responses

A

Bronchial, gastrointestinal (GI), and uterine smooth muscle relaxation

Glycogenolysis

Cardiac stimulation

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16
Q

Dopaminergic Receptors

action

which four?

A

Additional adrenergic receptors

Stimulated by dopamine

Cause dilation of the following blood vessels, resulting in increased blood flow:
-Renal
-Mesenteric
-Coronary
-Cerebral

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17
Q

Blood vessels

a1

B2

A

a1- vasoconstriction

B2-vasodilation

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18
Q

Cardiac muscle B1

A

increased contractility

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19
Q

AV node B1

A

increased HR

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20
Q

SA node B1

A

increased HR

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21
Q

GI tract muscle

a1 & B2

A

Decreased motility (relaxation of GI smooth muscle)

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22
Q

GI tract sphincter a1

A

Constriction

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23
Q

GU bladder sphincter a1

A

Constriction

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24
Q

GU penis a1

A

ejaculation

25
GU uterus a1 b2
a1- Contraction B2- Relaxation
26
Respiratory Bronchial muscles B2
Dilation (relaxation of bronchial smooth muscles)
27
Endocrine: liver B2
Glycogenolysis
28
Endocrine: Kidney B1
increased renin secretion
29
Eyes Pupillary muscles of iris a1
Dilation of pupils (mydriasis)
30
Catecholamines endogenous vs synthetic
Substances that can produce a sympathomimetic response Endogenous -epinephrine, norepinephrine, dopamine Synthetic (exogenous) -dobutamine, phenylephrine hydrochloride
31
Direct-acting sympathomimetic action drug
Binds directly to the receptor and causes a physiological response Example: epinephrine
32
Indirect-acting sympathomimetic
Causes release of catecholamine from storage sites (vesicles) in nerve endings Catecholamine then binds to receptors and causes a physiological response.
33
Mixed-acting sympathomimetic
Directly stimulates the receptor by binding to it Indirectly stimulates the receptor by causing the release of stored neurotransmitters from vesicles in the nerve endings
34
Stimulation of α-adrenergic receptors on smooth muscles results in: 6
Vasoconstriction of blood vessels Relaxation of GI smooth muscles (decreased motility) Constriction of bladder sphincter Contraction of uterus Male ejaculation Contraction of pupillary muscles of the eye (dilated pupils)
35
Stimulation of ß1-adrenergic receptors on the myocardium, atrioventricular (AV) node, and sinoatrial node results in: 4
CARDIAC STIMULATION Increased force of contraction (positive inotropic effect) Increased heart rate (positive chronotropic effect) Increased conduction through AV node (positive dromotropic effect)
36
Stimulation of ß2-adrenergic receptors on the airways results in: 1
in bronchodilation (relaxation of the bronchi).
37
Other effects of ß2-adrenergic stimulation: UTERUS LIVER KIDNEYS GI SMOOTH MUSCLES
Uterine relaxation Glycogenolysis in the liver Increased renin secretion in the kidneys Relaxation of GI smooth muscles (decreased motility)
38
4 Adrenergic drugs indications
Treatment of asthma and bronchitis Treatment of nasal congestion Temporary relief of conjunctival congestion (eyes) Reduction of intraocular pressure and dilation of pupils: treatment of open-angle glaucoma
39
Treatment of asthma and bronchitis BRONCHODILATORS
Bronchodilators: drugs that stimulate ß2-adrenergic receptors of bronchial smooth muscles, causing relaxation, resulting in bronchodilation
40
Common bronchodilators that are classified as predominantly β2-selective adrenergic drugs:
formoterol fumurate dihydrate, salbutamol, salmeterol, xinafoate, and terbutaline sulphate.
41
Treatment of nasal congestion
Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion. α1-Adrenergic receptors Examples: oxymetazoline hydrochloride and phenylephrine hydrochloride
42
Temporary relief of conjunctival congestion (eyes)
α-Adrenergic receptors Examples: epinephrine, naphazoline hydrochloride, phenylephrine hydrochloride (neo-synephrine), tetrahydrozoline
43
Reduction of intraocular pressure and dilation of pupils: treatment of open-angle glaucoma
α-Adrenergic receptors Example: dipivefrin hydrochloride
44
Vasoactive Sympathomimetics **(Pressors, Inotropes)
Also called cardioselective sympathomimetics Used to support the heart during cardiac failure or shock; various α- and ß-receptors affected Examples: dobutamine dopamine midodrine epinephrine phenylephrine norepinephrine
45
*dobutamine hydrochloride which receptor does it stimulate? effects? similar to?
Selective vasoactive ß1-adrenergic drug that is structurally similar to the naturally occurring catecholamine dopamine Stimulates ß1-receptors on heart muscle (myocardium); increases cardiac output by increasing contractility (positive inotropy), which increases stroke volume, especially in patients with heart failure. Intravenous drug; given by continuous infusion
46
*dopamine hydrochloride stimulate which receptor? low dose vs high doses vs highest dose
Naturally occurring catecholamine neurotransmitter Potent dopaminergic as well as ß1- and α1-adrenergic receptor activity Low dosages: can dilate blood vessels in the brain, heart, kidneys, and mesentery, which increases blood flow to these areas (dopaminergic receptor activity) Higher infusion rates: improve cardiac contractility and output (ß1-adrenergic receptor activity) Highest doses: vasoconstriction (α1-adrenergic receptor activity)
47
*epinephrine hydrochloride (Adrenalin®)
Endogenous vasoactive catecholamine Acts directly on both the α- and ß-adrenergic receptors of tissues innervated by the SNS Prototypical nonselective adrenergic agonist Administered in emergency situations (e.g. anaphylaxis) One of the primary vasoactive drugs used in many advanced cardiac life support protocols
48
*norepinephrine betartrate (Levophed®) stimulates? causes? primarily affect the? Does not stimulate? treats ____ & ____
Stimulates α-adrenergic receptors Causes vasoconstriction Direct-stimulating ß-adrenergic effects on the heart (ß1-adrenergic receptors) No stimulation to ß2-adrenergic receptors of the lung Treatment of hypotension and shock Administered by continuous infusion
49
phenylephrine hydrochloride (Neo-Synephrine®) Works almost exclusively on the? Used primarily for short-term treatment to raise _______ in patients who are in shock Control of _________ ____________ in regional anaesthesia Topical _______ drug Other uses
Works almost exclusively on the α-adrenergic receptors Used primarily for short-term treatment to raise blood pressure in patients who are in shock Control of supraventricular tachycardias Vasoconstriction in regional anaesthesia Topical ophthalmic drug Nasal decongestant
50
α-Adrenergic Adverse Effects
CNS -Headache, restlessness, excitement, insomnia, euphoria Cardiovascular -Palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension Other -Loss of appetite, dry mouth, nausea, vomiting, taste changes (rare)
51
ß-Adrenergic Adverse Effects
CNS Mild tremors, headache, nervousness, dizziness, insomnia, euphoria Cardiovascular Chest pain, increased heart rate, palpitations (dysrhythmias), hypertension, vasoconstriction Other Sweating, nausea, vomiting, muscle cramps
52
Adrenergic drugs intercations
Anaesthetic drugs (trigger cardiac dysrhythmias) Digoxin Tricyclic antidepressants (hypertensive crisis) Monoamine oxidase inhibitors (MAOIs) (hypertensive crisis) Antihistamines (increased adrenergic effects) Thyroid preparations
53
Nursing Implications
Complete a comprehensive health history. Assess for allergies and asthma; take history of hypertension, cardiac dysrhythmias, and other cardiovascular disease. Assess renal, hepatic, and cardiac function before treatment. Perform baseline assessment of vital signs, peripheral pulses, skin colour, temperature, and capillary refill; include postural blood pressure and pulse. Follow administration guidelines carefully. Avoid over-the-counter and other medications because of possible interactions.
54
Intravenous (IV) administration
Check IV site often for infiltration. Use clear IV solutions. Use an infusion pump. Infuse drug slowly to avoid dangerous cardiovascular effects. Monitor cardiac rhythm.
55
With chronic lung disease:
Instruct patients to avoid factors that exacerbate their condition. Encourage fluid intake (up to 3 000 mL/day) if permitted. Educate patients about proper dosing, use of equipment (metered-dose inhaler, spacer, nebulizer), and equipment care.
56
____ is indicated for the prevention of bronchospasms, not management of acute symptoms.
Salmeterol xinafoate
57
Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as ____ or ______.
such as tachycardia or hypertension.
58
Monitor for therapeutic effects (cardiovascular uses)
Decreased edema Increased urinary output Return to normal vital signs Improved skin colour and temperature Pedal pulse intact and strong to palpation
59
Monitor for therapeutic effects (asthma)
Return to normal respiratory rate Improved breath sounds, fewer crackles Increased air exchange Decreased cough Less dyspnea Improved blood gases Increased activity tolerance

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