Chapter 18 Adrenergic drugs Flashcards
Somatic nerves are part of the PNS, and refer to which type of nerves, voluntary or involuntary?
voluntary (skeletal muscle)
Adrenergic is to the Sympathetic as ___________ is to the Parasympathetic
Cholinergic
Your body has alpha receptors 1 and 2 and ____ receptors 1 and 2
beta receptors
The sympathetic and the parasympatheitc are part of what?
the ANS (autonomic nervous system)
Are the alpha receptors 1 and 2 and the beta receptors 1 and 2 found under the sympathetic or the parasympathetic?
sympathetic
What do Adrenergic drugs stimulate? (which nervous system)
SNS Sympathetic Nervous System
Give two other names for Adrenergic drugs
Adrenergic Agonists Sympathomimetics
What do Adrenergic drugs mimic the effects of?
SNS neurotransmitters
Which NT associates with the parasympathetic division?
ACh
Which NT associates with the Sympathetic division?
NE
What is the broad term for SNS Neurotransmitters?
Catecholamines
Which NT’s fit under the Catecholamine category?
Norepiephrine (NE) Epinephrine (Epi) Dopamine
Where are Adrenergic receptors located?
throughout the body (in all organs and tissues)
List the 3 types of Adrenergic receptors
Alpha-adrenergic receptors Beta-adrenergic receptors Dopaminergic receptors
How are the adrenergic receptors differentiated?
by their location on the nerve
Where are Alpha1 Receptors located?
postsynaptic effector cells of the tissue, muscle, or organ that the nerve stimulates
Where are Alpha2 Receptors located?
presynaptic nerve terminals (the nerve that stimulates the effector cells)
Which receptors, Alpha1 or Alpha2, control the release of the neurotransmitter?
Alpha2
What is the prodominant response you are going to get from an Alpha Adrenergic Agonist is ________________ and ___ stimulation
- vasoconstriction
- CNS Stimulation
Beta Adrenergic Receptors are all located where?
postsynaptic effector cells
Beta1-adrenergic receptors are located primarily where?
in the heart
(stimulate)
Catecholamines can be __________ (made from body) or synthetic
Endogenous
Beta2 adrenergic receptors are located in the smooth muscle of the
bronchioles
arterioles
visceral organ
What would the Beta Adrenergic response be?
- smooth muscle relaxation in the bronchioles, GI and uterine
- Glycogenolysis
- Cardiac Stimulation
Name the additional adrenergic receptors that are specific to dopamine
Dopaminergic Receptors
Dopamine stimulates Dopaminergic receptors and causes dilation of the blood vessels(increased blood flow), especially in which four areas?
Renal
Mesenteric
Coronary
Cerebral
Cardiovascular
which receptor(s) associate with Blood vessels and what is the response?
(remember always think fight or flight)
Location Receptor Response
Blood Vessels alpha1 contriction
Blood Vessels beta2 dilation
Which Catecholamines are endogenous?
Epinephrine, NE, and dopamine
Cardiovascular
Which receptor associates with Cardiac Muscle and what is the response?
Location Receptor Response
Cardiac Muscle Beta1 Increased contractility
Cardiovascular
Which receptor associates with AV Node and what is the response?
Location Receptor Response
AV Node Beta1 Increased Heart rate
Cardiovascular
Which receptor associates with SA Node and what is the response?
Location Receptor Response
SA Node Beta1 Increased Heart rate
Respiratory
What receptor associates with Bronchial muscles and what is the response?
Location Receptor Response
Bronchial muscles Beta2 Dilation
What are Catecholamines?
Neurotransmitters that can produce a sympathomimetic response
Name the 2 synthetic catecholamines
Dobutamine
Phenylephrine
What does a direct-acting sympathomimetic drug bind to?
binds (attaches) directly to the receptor site (tissue, organ, etc.)
What is the mechanism of action with an indirect-acting sympathomimetic drug?
They wok on the pre-synaptic site
they cause release of catecholamine from the storage vesicles in the nerve ending.
Once the Catecholamine is released, it then binds to the receptor sites on the tissues and organs and cause a physiologic response
What is the mechanism of action for the mixed-acting sympathomimetic drugs?
It is a combo of direct and indirect acting sympathomimetic drugs. They bind directly and release NT from presynaptic storage vesicles
stimulation of Alpha-adrenergic receptors on smooth muscle result in
________________ of Blood Vessels
__________ of GI smooth muscles (decreased motility)
____________ of bladder sphincter
___________ of uterus
Male ejaculation
___________ of pupillary muscles of the eye
(dilated pupils= mydriasis)
Vasocontriction of Blood Vessels
Relaxation of GI smooth muscles
Constriction of Bladder sphincter
Contraction of uterus
Male ejaculation
Contraction of pupillary muscles of the eye
(dilated pupils= mydriasis)
Stimulation of Beta1 -adrenergic receptors on the myocardium, AV Node, and SA Node results in cardiac stimulation
__________ force of contraction (positive inotropic effect)
__________ heart rate (positive chronotropic effect)
__________ conduction through AV node (positive dromotropic effect)
increased
increased
increased
stimulation of Beta2-adrenergic receptors on the airways results in
_______________ (relaxation of the bronchi)
Uterine __________
Glycogenolysis in the liver
_________ renin secretion in the kidneys
__________ of GI Smooth muscles (decreased motility)
Bronchodilation
uterine relaxation
Glycogenolysis in the liver
increased renin secretion in the kidneys
relaxation of GI Smooth muscle (decreased motility)
Catecholamine neurotransmitters are produced by the ___ and are stored in vesicles or granules located in the ends of ______
CNS
Nerves
NT wait for nerve to be stimulated, then the vesicles move to the walls of the nerve endings and release their contents into the space between the nerve ending and the effector organ. What is this space called?
synaptic cleft
Once the neurotransmitter(catecholamine) binds to the receptors, the effector organ responds.
true or false
true
Name the 2 enzymes that Catecholamines are metabolized by
(MAO)
(COMT)
MAO= monoamine oxydase
COMT= catechol orthomethyltransferase
Which enzyme breaks down catecholamines that are in the nerve ending
MAO
Which enzyme type breaks down catecholamines that are outside the nerve ending at the synaptic cleft?
COMT
Neurotransmitter molecules may be taken back up into the presynaptic nerve fiber by _______ _____ within the cell membrane.
(known as active transport)
protein pumps
Fight or flight has to do with which branch of the Autonomic Nervous System?
(ANS)
Sympathetic
Rest and digest has to do with which branch of the Autonomic Nervous System?
Parasympathetic
Catecholamine drugs used therapeutically, produce the same result as __________ catecholamines
endogenous catecholamines
Name the three different ways that an adrenergic drug has to induce a response while inbetween the nerve and effector cell?
- direct-acting stimulation
- indirect-acting stimulation
- combination of the two (mixed-acting)
A direct-acting sympathomimetic, binds directly to the ________ and causes a physiologic response.
binds directly to the receptor
(Epi is an example of this kind of drug)
An indirect-acting sympathomimetic causes the release of the _____________ from the storage vesicles in the nerve ending; it then binds to the _________ and causes a physiologic response
(amphetamine and other anorexiants are examples of this type of drug)
catecholamine
receptor
How does a mixed-acting sympathomimetic work?
(Ephedrine is an example of a mixed-acting adrenergic drug)
it both directly stimulates the receptor by binding to it and indirectly stimulates the receptor by causing release of the NT stored in vesicles at the nerve endings
phetylephrine, metaproterenol, and albuterol are all exampes of ______________ adrenergic drugs
noncatecholamine adrenergic drugs
which has a longer duration of action, a noncatecholamine or a catecholamine (both endogenoud and synthetic)?
Noncatecholamine
Why are Epi and NE considered nonselective agonists?
because they have action at both alpha and beta receptors
What is a selective agonist?
An adrenergic drug that only effects one receptor subtype
(phenylephrine and clonidine are both selective agonists)
Adrenergic drugs can act at different types of adrenergic receptors depending on what?
the amount of drug administered
Adrenergic drugs work primarily at ______________ receptors peripherally
(the receptors that immediately innervate the effector organ, gland, or muscle)
but they may work more centrally in the Nervous System at the _____________ sympathetic nerve trunks (the ability to do this depends on the potency and the dose of specific drug used)
postganglionic receptors
preganglionic
Stimulation of Beta1 receptors on the myocardium, AV node and SA node, result in Cardiac stimulation.
What positive inotropic effect occurs?
What positive Chronotropic effect occurs?
What positive dromotropic effect occurs?
inotropic effect= increased force of contraction
Chronotropic effect= increased heart rate
dromotropic effect= increased conduction through AV
What specific Nursing Implications do we need to make sure we follow through with concerning patients that are going to be getting Andrenergic drugs but also have Chronic Lung Disease?
* instruct patients to avoid factors that would exacerbate their condition
* encourage fluid intake, up to 3000 mL/ day
EDUCATE YOUR PATIENT!! (so they know the side effects, the correct dose, when to contact the doctor etc.)
Alpha adrenergic adverse effects
CNS: Headache restlessness, excitement,insomnis, euphoria
Cardiovascular: Palpitations, dysrhythmia, tachcardia, vasoconstriction, hypertension
other: Loss of appetite, dry mouth, nausea, vomiting, taste changes
Beta -adrenergic adverse effects?
CNS: mild tremors, headache, nervousness, dizziness
Cardiovascular: increased HR palpitations, fluctuations in BP
other: sweating nausea, vomiting, muscle cramps
What interactions with Adrenergic drugs are there?
* Anesthetic drugs: increase risk of cardiac arrythmias
* Tricyclic anti-depressants: increased vasopressor effects, possible respiratory depression
*MAOIs: life-threatening hypertensive crisis
*Antihistamines: increased effects of adrenergic drugs
What is the most common route to administer adrenergic drugs?
IV most of the time
(only exception epi pen IM)
Nursing implications to do for a patient before giving adrenergic drugs?
Baseline/ basic history
history of hypertension or cardiac dysrhythmias
allergies
renal/hepatic function
Name three things you need to make sure to do (nursing implications) when administering adrenergic drugs IV route
- check IV site often for infiltration
- Use an infusion pump (infuse slowly)
- monitor cardiac rhythm (VS, EKG)
What drug is indicated for prevention of bronchospasms?
Salmeterol
2 adrenergic drugs together can result in severe cardiovascular effects such as ___________ and ____________
tachycardia
hypertension
When using an adrenergic crug for cardiovascular reasons, what therapeutic effects are we going to be looking for?
- improved CO
- decreased edema
- increased urinary output
- return to normal vital signs
- improved skin color and temp
- increased LOC
What therapeutic effects would we look for when given adrenergic drugs for asthma issues?
- return to normal respiratory rate
- improved breath sounds, fewer crackles
- increased air exchange
- decreased cough
- less dyspnea
- improved blood gases
- increased activity tolerance
