Chapter 15: Adrenergic Agonists and Antagonists

Question 1

2 Drug groups that affect Sympathetic Nervous System

Answer 1

Adrenergic Agonists/Sympathomimetics and Adrenergic Antagonists/Sympatholytics

Question 2

It is an involuntary system of the PNS

Answer 2

Autonomic Nervous System

Question 3

Neurotransmitters of Sympathetic NS

Answer 3

Norepinephrine and Epinephrine

Question 4

Enzymes that inactivate these neurotransmitters

Answer 4

MAO and COMT

Question 5

Alpha 1 receptor sites

Answer 5

Blood vessels, eyes, bladder and prostate

Question 6

What happens when a1 receptor in blood vessels is stimulated?

Answer 6

Vasoconstriction > Increased peripheral resistance > Increased BP

Question 7

What happens when a1 receptor in eyes is stimulated?

Answer 7

Mydriasis (Pupil Dilation)

Question 8

What happens when a1 receptor in bladder is stimulated?

Answer 8

Relaxation (holds urine)

Question 9

What happens when a1 receptor in prostate is stimulated?

Answer 9

Contraction

Question 10

Alpha 2 receptor sites

Answer 10

Smooth muscles of GI and Blood vessels

Question 11

What happens when a2 receptor in blood vessels is stimulated?

Answer 11

Vasodilation > Decreased BP (reduced norepinephrine)

Question 12

What happens when a2 receptor in GI is stimulated?

Answer 12

Decrease in GI tone and motility

Question 13

Beta 1 receptor sites

Answer 13

Heart and Kidney

Question 14

What happens when b1 receptor in heart is stimulated?

Answer 14

Increased heart contraction > Increased heart rate

Question 15

What happens when b1 receptor in kidney is stimulated?

Answer 15

Increased renin secretion > Increased angiotensin > Increased BP

Question 16

Beta 2 receptor sites

Answer 16

Smooth muscles of GI, smooth muscles of lungs, liver and uterus

Question 17

What happens when b2 receptor in GI is stimulated?

Answer 17

Decreased GI tone and motility

Question 18

What happens when b2 receptor in lungs is stimulated?

Answer 18

Bronchodilation

Question 19

What happens when b2 receptor in uterus is stimulated?

Answer 19

Uterine relaxation

Question 20

What happens when b2 receptor in liver is stimulated?

Answer 20

Activation of glycogenolysis > Increased blood glucose

Question 21

Classification of sympathomimetics that stimulates release of norepinephrine in nerve terminal ending and its example drug

Answer 21

Indirect-acting sympathomimetic (Amphetamine)

Question 22

Classification of sympathomimetics that stimulates release of norepinephrine in nerve terminal ending and stimulate adrenergic receptor sites and its example drugs

Answer 22

Mixed-acting sympathomimetics (Ephedrine, Pseudoephedrine)

Question 23

Pseudoephedrine

Answer 23

Mixed-acting
Increases heart rate
Relieves nasal and sinus congestion
Contraindicated in hypertension, closed-angle glaucoma, bronchitis, emphysema and urinary retention
Use w/ caution in DM

Question 24

Albuterol Sulfate

Answer 24

B2 adrenergic agonist
Bronchodilation (prevents bronchospasm)

Question 25

Side effects of Albuterol

Answer 25

Tremors Headache Tachycardia Palpitation Dysrhythmia Nausea and vomiting, dizziness Urinary retention Nervousness

Question 26

Epinephrine (Drug class and Drug & Lab interaction)

Answer 26

DRUG CLASS: Sympathomimetic adrenergic agonist DRUG INTERACTION: Dysrhythmia may occur when taken with Digoxin LAB: Increased blood glucose and serum lactic acid

Question 27

What are the contraindications of Epinephrine?

Answer 27

Parkinsonism Closed-angle glaucoma Hypertension Hyperthyroidism Cerebrovascular, cadiac and renal diseases Labor, pregnancy and breastfeeding Renal dysfunction Hypovolemia Diabetes Mellitus

Question 28

What are the therapeutic effects of Epinephrine?

Answer 28

Nasal congestion Allergic reaction Anaphylaxis Asthma exacerbation, status asthmaticus Bronchospasm Angioedema Cardiac arrest and resuscitation

Question 29

Mechanism of Action of Epinephrine

Answer 29

Acts on alpha and beta receptors Promotes bronchodilation Reverse anaphylactic reactions Reduces mucosal congestion by inhibiting histamine release Increased cardiac rate and output

Question 30

Side effects of Epinephrine

Answer 30

Nausea, vomiting and dizziness Tremor, paresthesia and weakness Hypo/hyperglycemia Oliguria Pallor

Question 31

Adverse Effects of Epinephrine

Answer 31

Palpitations Tachycardia Hypertension Dyspnea (SOB) Renal insufficiency Injection site reaction LT: Dysrhythmia, pulmonary edema

Question 32

How is epinephrine excreted?

Answer 32

Breastmilk and urine

Question 33

Why can't epinephrine be administered orally?

Answer 33

rapidly metabolized in GI and liver > unstable serum levels

Question 34

How is epinephrine administered?

Answer 34

IM, IV and endotracheal

Question 35

What happens when epinephrine and digoxin are administered together?

Answer 35

Cardiac dysrhythmia

Question 36

Clonidine

Answer 36

Selective a2 adrenergic agonist Used primarily for hypertension

Question 37

Effects of Clonidine

Answer 37

Bradycardia Hypotension Sedation Dry mouth (very low doses)

Question 38

An alpha adrenergic agonist that acts within the CNS, causes activation of A2 receptors (vasodilation > decreased BP) It is not usually used anymore due to several side effects

Answer 38

Methyldopa

Question 39

Adverse effects of central-acting alpha-adrenergic agonists (Clonidine & Methyldopa)

Answer 39

Headache, nightmares and drowsiness Nasal congestion Constipation Edema Ejaculation dysfunction Elevated hepatic enzymes

Question 40

What is Perfusion?

Answer 40

Passage of blood flow through capillaries and arteries, which delivers oxygen and nutrients to body cells

Question 41

Drugs that block the effects of adrenergic neurotransmitter

Answer 41

Adrenergic antagonists Adrenergic blocker Sympatholytic

Question 42

Drugs that block or inhibit a response at the alpha-adrenergic site

Answer 42

Alpha-adrenergic antagonists Alpha blockers

Question 43

Selective alpha blockers

Answer 43

Block Alpha 1

Question 44

Nonselective alpha blockers

Answer 44

Blocks Alpha 1 and 2

Question 45

Drugs that inhibit a response at beta-adrenergic site

Answer 45

Beta-adrenergic antagonist Beta blockers

Question 45

Alpha antagonists promotes vasodilation....

Answer 45

Decreased BP > Orthostatic Hypertension

Question 46

Propranolol Hydrochloride

Answer 46

First beta blocker for treatment of angina, cardiac dysrhythmia, hypertension and heart failure

Question 46

Drug Interaction of Atenolol

Answer 46

- Increased absorption with atropine and other anticholinergics - Decreased effects with NSAIDs - Increased risk of hypoglycemia with insulin and sulfonylureas - Increased hypotension with prazosin and terazosin - Increased lidocaine and verapamil levels with toxicity

Question 46

What beta blocker is prescribed for decreasing pulse rate and bp

Answer 46

Atenolol or Metoprolol

Question 46

Atenolol drug class and ROA

Answer 46

Beta1-adrenergic blocker PO and IV

Question 47

Atenolol Contraindications

Answer 47

Hypersensitivity Bradycardia Heart block greater that first degree Cardiogenic shock Uncompensated cardiac failure Caution: RENAL DYSFUNCTION DM BRONCHOSPASM MYASTHENIA GRAVIS PULMONARY EDEMA ACUTE BRONCHOSPASM PREGNANCY LACTATION

Question 47

TRUE OR FALSE: Beta blockers should be suddenly discontinued.

Answer 47

FALSE. Should be gradually discontinued in smaller dosages.

Question 48

How is Atenolol excreted?

Answer 48

Urination

Question 49

Half life of Atenolol

Answer 49

6-7 hours