Chapter 18 : Adrenergic Agonists

Question 1

Catecholamines (Epinephrine)

Answer 1

Drugs that produce a sympathomimetic response.

Used for: anaphylaxis & cardiac arrest

Metabolized by two enzymes:
- MOA (monoamine oxidase)
- COMT (catechol ortho methltransferase).

Examples:
epinephrine, norepinephrine, dopamine (endogenous)
Dobutamine, Phenylephrine (synthetic)

Question 2

Noncatecholamines (albuterol)

Answer 2

Used for: treatment and prevention of bronchospasm

Question 3

Adrenergic Agonists

Answer 3

Example: epinephrine & albuterol

Treats: life threatening situations such as cardiac arrest, anaphylaxis and bronchospasm.

How: they work by stimulating adrenergic receptors and trigger Fight or Flight response and causing effects such as: increase HR, BP, and bonchrodilation (opening of bronchioles to breathe better)

Side effects: restlessness, tremors, palpitations, tachycardia or nausea

Life threatening effects:
Epinephrine: pulmonary edema, ventricular Fibrillation,
Albuterol: Dysrhythmias , bronchospams

Question 4

Which assessment would be completed prior to administering an adrenergic agonist?

Answer 4

Blood pressure.

Because adrenergic agonist causes vasoconstriction, causing high blood pressure. Respiratory rate is NOT directly affected by this medication.

Question 5

Which adrenergic receptors are primarily located in the heart?

Answer 5

Beta1

Question 6

Which effect may be seen when adrenergic drugs are administered with monoamine oxidase inhibitors (MAOIs)

Answer 6

Increased risk of hypertensive crisis

Question 7

Where are beta2-adrenergic receptors located in the body?

Answer 7

Arterioles
Bronchioles
Visceral organs

Question 8

Which response is elicited by the activation of beta1 receptors located on the sinoatrial node?

Answer 8

Increased heart rate

Question 9

Which effect is a result of a beta1-adrenergic receptor stimulation?

Answer 9

Increased renin secretion

Question 10

Which are an example of endogenous catecholamines?

Answer 10

Dopamine
Epinephrine
Norepinephrine

Question 11

Which class of drugs may interact with adrenergic drugs?

Answer 11

Thyroid preparations.

Thyroid preparations can increase the effects of adrenergic drugs.

Question 12

During an emergency CPR, the nurse expects to administer which injectable, fast acting medication?

Answer 12

Epinephrine

Question 13

Which medication is classified as an alpha-adrenergic agonist?

Answer 13

Phenylephrine.

This medication is used primarily for short term treatment to raise blood pressure in patients in shock, control some dysrhythmias and provide vasoconstriction.

Question 14

Which lab test would a nurse anticipate for a patient receiving alpha-adrenergic medication?

Answer 14

Increased level of glucose

Question 15

The nurse would instruct a patient to take oral midodrine at which time?

Answer 15

0700.

Midodrine is to be given with forcing fluids before the patient gets out of bed in the morning.

Question 16

Which action would the nurse perform to help prevent infiltration of dopamine infusion site?

Answer 16

Check the site every hour for evidence of swelling

Question 17

Which assessment indicates that patient is having therapeutic effect of IV epinephrine?

Answer 17

Increased heart rate and strong pulse

Question 18

Which effect is expected in the patient with heart failure after administration of dobutamine?

Answer 18

Increased cardiac contractility.

Dobutamine increases cardiac output by increasing contractility due to stimulation of Beta1 receptors.

Question 19

A patient has been ordered a new medication in the form of inhalant. The patient tells the nurse that the inside of her mouth is irritated. Which instruction is most important for the nurse to give the patient?

Answer 19

Thoroughly rinse your mouth after using the medication

Question 20

Which assessment is the most accurate criteria for the nurse to use when determining whether a patient is appropriately responding to to use of adrenergic drug?

Answer 20

BP and Respiration rate are normal

Question 21

Which response is a priority with an older adult who is taking beta-adrenergic agonist and complaining of headache?

Answer 21

Take the patient’s BP and notify the prescribing provider.

Because beta-adrenergic agonists will affect blood pressure and pulse rate, there’s a possibility of chest pain, palpitations, headaches or seizures. Need to notify MD.

Question 22

Which medication does the nurse expect to be given to a patient with hypovolemic shock with no palpable carotid pulse and who is unresponsive?

Answer 22

Dopamine & Epinephrine

Dopamine: first choice for hypovolemic shock because it increase heart contraction

Epinephrine: first choice for cardiac arrest because it increase arterial BP and perfusion to the heart

Question 23

The teaching plan for a patient taking midodrine would include which instruction?

Answer 23

Treats low blood pressure.

Rise slowly out of bed each morning.

Midodrine treats symptomatic orthostatic hypotension. Does not affect RR.

Question 24

The best response from the nurse to the patient who says “I don’t understand why my salmeterol inhaler doesn’t help with my asthma attack”

Answer 24

Salmeterol is not designed to relive acute symptoms

Question 25

What is the proper administration of corticosteroid inhalant and a bronchodilator for asthma symptoms?

Answer 25

Use bronchodilator first.
Wait 5 minutes.
Then use corticosteroid.

Question 26

Which drug is a direct-acting sympathomimetic?

Answer 26

Epinephrine.

Question 27

How does dopamine work to help heart failure?

Answer 27

Dopamine is a dopaminergic receptor. When this receptor is stimulated by dopamine, it helps increase the strength of the heart’s concentrations, resulting in increased blood flow to the blood vessels. This increase in cardiac output helps improve blood flow towards tissues and reduce symptoms of heart failure, such as shortness or breath and edema.

Question 28

Alpha -Adrenergic Receptors

Answer 28

Are divided into alpha1, alpha2 receptors.

Alpha1:
-located on postsynaptic effector cells. (The cell, muscle, or organ that the nerve stimulates).

Alpha2:
-located on presynaptic nerve terminals (never that stimulates effector cells).
- control the release of neurotransmitters

Question 29

Alpha-Adrenergic Agonist Responses

Answer 29

• vasoconstriction
• CNS Stimulation

Question 30

Beta-Adrenergic Receptors

Answer 30

All located on postsynaptic effector cells.
- Beta1 receptor : located in heart
- Beta2 receptors: located in smooth muscle of bronchioles, arterioles and visceral organs.

Question 31

Dopaminergic Receptors

Answer 31

• stimulated by Dopamine
• causes dilation of blood vessels, resulting in increased blood flow

Question 32

Drug effects of Alpha-Adrenergic receptor results in:

Answer 32

In smooth muscle:
- vasoconstriction of blood vessels
- relaxation of GI muscles (decrease motility)
- constriction of bladder sphincter
- contraction of uterus
- male ejaculation
- dilated pupils

In myocardium:
- increased force of contraction
- increased heart rate
- increased conduction through AV node

In airway:
- bronchodilation (relaxation of bronchi)

Other effects:
- uterine relaxation
- glycogenolysis in the liver
- increased renin secretion in kidneys
- relaxation of GI muscles (decreased motility).

Question 33

Adrenergic agonists increase what?

Answer 33

Heart rate

Question 34

Antidote for Cholingerics?

Answer 34

Atropine (which is an anticholinergic)