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Andrenergic Agents Flashcards

1
Q

Adrenergic agents

A

Drugs that stimulate the sympathetic nervous system (sns)

Aka adrenergic agonists and sympathomimetics

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2
Q

Characteristics of adrenergic agents

A

Mimic the effects of the SNS transmitters norepinephrine and epinephrine

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3
Q

Adrenergic receptors

A

Located throughout the body
Are receptors for the sympathetic neurotransmitters
Alpha adrenergic
Beta adrenergic
Dopaminergic receptors: respond to dopamine

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4
Q

cardiovascular: blood vessels

A

alpha 1 receptors: constriction

beta 2 receptor: dilation

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5
Q

cardiovascular: cardiac muscle

A

beta 1: increased contractility

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6
Q

cardiovascular: atrioventricular node

A

beta 1: increased heart rate

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7
Q

cardiovascular:

sinoartial node

A

beta 1: increased heart rate

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8
Q

endocrine: pancrease

A

beta 1: decreased insulin release

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9
Q

endocrine: liver

A

beta 2: glycogenolysis

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10
Q

endocrine: kidney

A

beta 2: increased renin secretion

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11
Q

gastrointestinal: muscle

A

beta 2: decreased motility

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12
Q

gastrointestinal: sphincters

A

Alpha 1: constriction

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13
Q

genitourinary: bladder sphincter

A

alpha 1: constriction

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14
Q

genitourinary: penis

A

alpha 1: ejaculation

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15
Q

genitourinary: uterus

A

alpha 1: contraction

beta 2: relaxation

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16
Q

respiratory: bronchial muscles

A

beta 2: dilation

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17
Q

ocular: pupilary muscles of the iris

A

alpha 1: mydriasis

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18
Q

alpha- adrenergic receptors

A

divided into alpha 1 and alpha 2 receptors

differentiated by their location on nerves

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19
Q

alpha 1- adrenergic receptors

A

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

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20
Q

alpha 2 adrenergic receptors

A

located on the presynaptic nerve terminals (the nerve that stimulates the effector cells)
controls the release of neurotransmitters
found in the CNS

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21
Q

predominant alpha- adrenergic agonist responses

A

vasocontriction and CNS stimulation

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22
Q

beta- adrenergic receptors

A

all are located on the post synaptic effector cells
beta 1 adrenergic receptors are located primarily on the heart
beta 2 adrenergic receptors- located primarily in the lungs

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23
Q

beta adrenergic agonist response

A

bronchial, GI, and uterine smooth muscle relaxation, cardiac stimulation (increased heart rate and contractility.)

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24
Q

dopaminergic receptors

A

additional adrenergic receptor
stimulated by dopamine
causes dilation of the renal vessel, the mesentaric vessels, coronary vessels, and cerebral vessel and results in INCREASED blood flow

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25
Q

Mechanism of action:

direct acting sympathomimetic

A

binds directly to the receptor and causes a physiologic responses
example: epinephrine

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26
Q

mechanism of action:

indirect acting sympathomimetic

A

causes release of catecholamines (neurotransmitters) from storage sites in the nerve endings
the catecholamine then binds to the receptors and causes a physiologic response
example: amphetamines

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27
Q

mechanism of action: mixed acting sympathomimetic

A

directly stimulates the receptor by binding to it and
indirectly stimulates the receptor by causing the release of stored neurotransmitters from the vesicles in the nerve endings.
example: ephedrine

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28
Q

catecholamines

A

substances that can produce a sympathomimetic response

endogenous: the body produces it (epinephrine, norepinephrine, and dopamine)
synthetic: everything else and endogenous

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29
Q

Drug effects:

stimulation of beta 1 adrenergic receptors on the myocardium, AV node, and SA node results in cardiac stimulation

A

increased force of contraction (positive inotropic effect)
increased heart rate
(positive chronotropic effect)
increased conduction through the AV node (positive dromotropic effect)

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30
Q

Beta 2 agonists- inhalers

A

mechanism of Action (MOA)

  • stimulates beta adrenergic receptors and exhibits a response.
  • indications: bronchodilator to treat asthma or COPD
    examples: albuterol, terbutaline, levalbuterol
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31
Q

albuterol (most widly used inhaler)

A

brand names: ProAir, Proventil, Ventolin
available as both an inhaler solution and inhaler
dose: 1-2 inhalations every 4-6 hours as needed for condition (wheezing, shortness of breath)
also used as an inhalation liquid for breathing machine
- 2.5mg in 3mL normal saline inhalation via breathing machine every 4-6 hours

32
Q

Levalubuterol (inhaler that isn’t as widely used)

A

advantages: less tachycardia (not widely proven)
brand names: xopenex (both inhalation liquid and inhaler)
dose: 0.63 - 1.25mg inhalation every 8 hours as needed
1-2 puffs inhalation every 4-6 hours.

33
Q

terbutaline (not used as much, mainly in childbirth if it is used at all)

A

brand name: brethine
additional use: tocolytic agent (stops contractions)
dose: asthma/ COPD 0.25mg subcutaneous, may repeat in 15-30 minutes (maximum 0.5 in 4 hour period)
tocolytic: 2.5-10mcg/minute

34
Q

Beta-Adrenergic side effects

A

CNS: Mild tremors, headache, nervousness, dizziness
Cardiovascular: increased heart rate, palpitations (dysrhythmias), fluctuations in blood pressure
other: sweating, nausea, vomiting, muscle cramps

35
Q

vasoactive sympathomimetics (pressors, inotropes)

A

also called cardioselective sympathomimetics
used to support the heart during cardiac failure or shock. various alpha and beta receptors are affected
NOTE: these agents need intensive monitoring and MUST be placed on an IV pump. Many are weight based calculated and DILUTED prior to use. know your institutions guidelines

36
Q

what does dobutamine stimulate?

A

Beta 1 receptors

37
Q

what does ephedrine stimulate

A

alpha 1 and beta 1 receptors

38
Q

what does phenylephrine stimulate?

A

alpha 1 receptors

39
Q

what does dopamine stimulate?

A

alpha 1, beta 1 and dopaminergic receptors

40
Q

what does epinephrine stimulate?

A

alpha 1, beta 1 and beta 2

41
Q

what does isoproterenol stimulate?

A

beta 1 beta 2

42
Q

what does norepinephrine stimulate?

A

alpha 1 and beta 1

43
Q

epinephrine

A

MOA stimulates alpha 1, beta 1 and beta 2 receptors
indications: anaphylactic reactions, cardiac arrest, bronchodilator to treat asthma or COPD
dose: anaphylaxis 0.3 mg IM, SQ every 20 mins for 3 doses
Cardiac arrest 1mg IV every 3-5 mins until return of spontaneous circulation
hypotension/shock 0.02mcg/kg/min
CONTINUOUS INFUSION MUST BE MIXED AND DILUTED

44
Q

extravasation

A

the vein breaks with the IV in it

45
Q

epinephrine monitoring

A

pulmonary function, heart rate, blood pressure, extravasation

46
Q

dopamine MOA

A

stimulates dopamine, alpha 1 and beta 1 receptors (dose dependent)

47
Q

indications for dopamine

A

shock; increase renal perfusion

48
Q

what receptors does dopamine stimulate?

A

renal receptors, alpha, beta

49
Q

dopamine doses:
low
intermediate and high

A

low: 1-3 mcg/kg/min (stimulates renal receptors)
intermediate: 3-10 mcg/kg/min
(stimulates beta receptors)
high: >10mcg/kg/min (stimulates alpha receptors)

50
Q

dopamine monitoring

A

blood pressure, ECG, heart rate, MAP (mean arterial pressure) & renal output.

51
Q

dobutamine MOA

A

stimulates beta 1 adrenergic receptors, causing increased contractility and heart rate with little effect on beta 2 receptors

52
Q

indications for dobutamine

A

short- term management of patients with cardiac decompensation

53
Q

dobutamine dose

A

2.5-20 mcg/kg/minute

54
Q

monitoring dobutamine

A

blood pressure, ECG, heart rate, MAP, urine output

55
Q

phenylephrine MOA

A

direct acting alpha 1 stimulater. must be diluted prior to administration

56
Q

indications of phenylephrine

A

treatment of hypotension, vascular failure in shock; vasoconstrictor in regional analgesia.

57
Q

phenylephrine dose:

A

0.25 mcg/kg/min

58
Q

monitoring phenylephrine

A

blood pressure; heart rate

59
Q

norepinephrine MOA

A

stimulates beta 1 and alpha 1 receptors (presser)

MUST BE DILUTED

60
Q

indications of norepinephrine

A

treatment of shock

61
Q

norepinephrine dose:

A

0.02-0.5mcg/kg/minute

62
Q

monitoring norepinephrine:

A

blood pressure and heart rate

63
Q

ephedrine MOA

A

stimulates alpha 1 and beta 1 receptors

stimulates beta adrenergic receptors and exhibits a response

64
Q

indications of ephridrine

A

treatment of nasal congestion; hypotension

65
Q

ephedrine dose

A

5-25mg slow IV push, may repeat after 5-10 mins as needed then every 3-4 hrs. DO NOT EXCEED 150mg/24hrs

66
Q

monitoring ephedrine

A

blood pressure & heart rate

67
Q

isoproterenol MOA

A

stimulates beta 1 and beta 2 receptors

MUST BE DILUTED

68
Q

indications of isoproterenol

A

heart block, cardiac arrest, bronchospasm during anesthesia

69
Q

isoproterenol dose

A

2-10mcg/minute

70
Q

monitoring isoproterenol

A

ECG, heart rate & respiratory rate

71
Q

alpha adrenergic side effects on the CNS

A

headaches, restlessness, excitement, insomnia, euphoria

72
Q

alpha adrenergic side effects on the cardiovascular system

A

palpitations, tachycardia, vasoconstriction, hypertension

73
Q

alpha adrenergic side effects (other)

A

anorexia, dry mouth, nausea, vomiting, taste changes

74
Q

beta adrenergic side effects on the CNS

A

mild tremors, headache, nervousness, dizziness

75
Q

beta adrenergic side effects on the cardiovascular system

A

increased heart rate, palpitations, fluctations in BP

76
Q

beta adrenergic side effects (other)

A

sweating, nausea, vomiting, muscle cramps

77
Q

nursing implications for intravenous administration

A
  • check IV site often for infiltration
  • use clear IV solutions
  • use infusion device/IV pump
  • infuse agent slowly to avoid dangerous cardiovascular effects
  • monitor cardiac rhythm.

Pharmacology (3 decks)

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