Exam 1 Chapter 15 Adrenergics +review of other Flashcards
Primary transmitter of sympathetic nervous system (SNS)
Norepinephrine
Receivers of the SNS
Alpha 1 and 2, Beta 1 and 2
Reconciliation of medications (online)
The process of identifying:
The most accurate list of all medications that the patient is taking.
This includes:
medication name
dosage,
frequency, and
route,
By comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider.
Reconcilation of medications
Confirming that everything on the drug list is:
1. Updated with the patient.
2. No drug or CAM is missing.
3.The doses are correct.
4. You answer any questions the patients may have about the medications.
What is first pass effect?
Involves metabolism. If there is a significant first pass effect, less medication is available.
Bisphosphonates are the most commonly prescribed drug class for what diagnosis?
Osteoporosis.
What is the important patient teaching for bisphosphonates?
Patient must take with water and stay upright for 30 minutes so it doest not create esphophageal erosion.
What is the common ending for osteoporosis drugs?
ONATE
What are contraindications for bisphosphonates?
Hypocalcemia
Inability to sit upright for 30 minutes
Reduced kidney function
Pregnancy
What other classes of medications are available to treat osteoporosis?
CERNS - but risk - hot flashes,
Contraindication: no history of DVT’s due to estrogen content.
What are long term effects of bisphosphonates?
Femur fractures and jaw necrosis.
S/S of a DVT?
Swelling in one leg (unilateral)
Leg tender
Leg pain
Leg coolness, could be warmth over clot
Leg weak
Leg pulse diminished,
This is a priority patient.
What 3 things can DVT’s lead to?
Stroke, PE, and heart attack.
What ingredient increased the risk of developing blood clots and in what type of medications are they found they found?
Estrogen:
CHC products (combined hormonal contraception)/birth control,
hormonal replacements/menopause,
CERVS/osteoporosis
What are contraindications for patients taking estrogen products?
Pregnancy,
smoking,
family or personal history of DVT,
liver disease,
breast cancer, and
breastfeeding.
What does BPH stand for?
Benign prostatic hyperplasia
What are the 3 classes of medications to treat BPH?
5-Alpha Reductase Inhibitors. (alpha1 agonist contracts prostate)
PDE (phosphodiesterase inhibitors)
alpha 1 adrenergic blockers
What are the side effects of 5-Alpha reductase inhibitors?
Erectile dysfunction
How long does it take for 5-Alpha reductase inhibitors to work?
Up to 6 months.
How long do you hold an epi pen in?
3 seconds
What class of drug is Sildenafil? Tadalafil?
Phospho-di-esterase inhibitor (PDE),
vasodilator, example -viagra
“AFIL” - What is the common ending AFIL drug class?
phosphodiesterase inhibitors (PDE)
How do PDE inhibitors work?
They block the release of PDE
increase cGMP which relaxes smooth muscle and
increases blood flow to the corpus cavernosum
Side effects of PDE inhibitors that need medical attention?
Priapism
painful urination, and
vision changes.
After administering EPI pen what do you do next?
Call 911
What does the sympathetic nervous system do?
Stimulates the fight or flight mechanism
Autonomic nervous system’s goal?
homeostasis, one system may have to dominate.
Neurotransmitters are ….
messengers
What space is between two nerve endings?
Synaptic cleft
What are the structures that receives the messages from the messengers (neurotransmitters)?
Receptors.
Three primary neurotransmitters of SNS
1.Norepinephrine (Primary) Neurotransmitters=Norepinephrine
2.Epinephrine,
3.Dopamine
Receivers of SNS adrenergic agonist receptors?
Apha 1, 2, Beta 1, 2
How do you remember what system adrenergic is from?
Adrenergic-adrenaline. SNS.
Global effect of Adrenergic agonist effects
Eyes (dilate),
Lungs (bronchodilation),
Heart (tachycardia).
Blood Vessels (vasoconstriction),
GI (gastroperistalisis relaxed),
Bladder (relaxes, no contraction to release urine),
Uterus (relaxes).
Name the four Alpha 1 Receptor locations
Blood Vessels - constrict - inc. BP, inc. heart contractility
Eyes - dilate
Bladder - relax
Prostate - constrict
Name the two Beta 1 Receptor locations
One Heart - inc. heart contraction, inc. HR
Two Kidneys - inc renin, inc angiotensin, inc. BP
Alpha 1 -
Increases BP
Beta 1 -
Increases BP and HR
Name the four Beta 2 Receptor locations
BETA 2
One Liver - inc glycogenesis - inc. glucose
Two Lungs - bronchodilation
GI -dec tone and motility
Uterus - relaxation of smooth muscle
How are neurotransmitters inactivated?
1.Reuptake/Recycled by neuron
2.Enzyme transformation or degradation
What enzymes breakdown neurotransmitters
MAO monoamine oxidase
COMT Catechol-O-methyltransferase
Medications that stimulate the SNS
agonist
adrenergic agonist
sympathomimetic
Medication that inhibit the SNS
antagonist
adrenergic antagonist
sympatholytics
What type of adrenergic agonist is EPINEPHRINE?
Nonselective
What type of adrenergic agonist is EPINEPHRINE?
Nonselective
When is Epi used?
analyphalaxis
shock
bronchospasms
cardiac arrest
How long does epi pen stay in for?
3 seconds, then massage for 10 secs., then call 911
might need a 2nd injection in 30 minutes
Where is the epi pen inserted?
middle of outer glute
Beta 1 - what is the change in vitals
increased HR - one heart, 2 lungs
Beta 2 - what is the change in body
Two LUNGS decreased RR/brochodilation
One LIVER increased glucose
Alpha 1 - what is the change in the vitals
inc BP with vasoconstriction
Non-selective means there is ______ than one receptor
Non-selective means there is MORE than one receptor.
Routes for EPI
IV, Epi pen - immediate
Inhalation -1-5 min.
IM, SQ -5-10 min.
Intracardiac
What angle do you insert the epi pen
90 degrees, right angle
Name a common NON-SELECTIVE adrenergic AGONIST
EPINEPHRINE
Name a Beta 2 agonist
ALBUTEROL
Which is a Beta 2 AGONIST? Albuterol or Epinephrine?
ALBUTEROL
Is ALBUTEROL selective or non-selective?
SELECTIVE
to BETA 2.
TWO LUNGS ONE LIVER
Caution for which patients with ALBUTEROL?
Two lungs/One liver (blood sugar)
Severe Cardiac disease (crossover to Beta 1)
Hyperthyroidism
Diabetes Mellitus
Pregnancy
WHAT IS ALBUTEROL USED TO TREAT
BRONCHOSPASM
BRONCHITIS
ASTHMA
You have just administered epinephrine, what vitals would you expect to see change?
HR up
BP up
RR down
SIDE EFFECTS of ALBUTEROL
Tremors
Nervousness
Restlessness
Beta 1 cross over. ONE HEART
Cardiac dysrhythmias
DRUG interactions with ALBUTEROL
Beta blockers will decrease effectiveness
Sympathomimetics - HR and BP up more
List 3 other ADRENERGIC AGONISTS
Norepinephrine - more selective to Beta, inc. HR
Dopamine
Phenylephrine - OTC nasal spray,
ADRENERGIC AGONISTS ARE CONTRAINDICATED FOR ___
Hypertension
If you have hypertension and need OTC Adrenergic Agonist which one should you choose ?
Coricidin for patients that have hypertension, no sympathomimetics in it
sympathomimetics - will increase the BP
Adrenergic OTC nasal sprays, patient teaching
sit upright
insert so against septum
breath in
max 3-5 days, or more than twice a day or can causerebound congestion.
What aspect of glucose needs monitoring with adrenergic agonists? (epi)
Hyperglycemia
What aspect of urine output needs monitoring with adrenergic agonists? (epi)
Decreased urine output - Alpha1, relaxes bladder, so no constriction to promote urination
After auto injecting an epipen what to do next?
Call 911 can only do 2 injections w/o supervision of a HCP
Can Beta 2 adrenergic agonists also affect B1 receptors?
Yes - crossover if dose high enough
Nurse gives patient ALBUTEROL and monitors for what 3 things?
Albuterol Selective Beta 2 AGONIST
Want Bronchodilation when taking it….
Problems that could have:
Beta 1 crossover
Palpitations - crossover to Beta 1
Hypertension - crossover to Beta 1
Hyperglycemia One Liver -(glycogenesis)
Bronchospasm Two lungs (Bronchodilation)
Beta 1 receptor stimulation causes
1. ____ 2. ____
Beta 2 receptor stimulation causes
1.___2.____3.___4.___
Beta 1 receptor stimulation causes One HEART, Two Kidneys
1. inc HR, cardiac (myo) contractility
2. inc BP, release of renin, then aldosterone
Beta 2 receptor stimulation causes
1. dec RR,
2. Inc blood sugar,
3. dec uterine contraction,
4. dec Gi motility
Name 3 ADRENERGIC ANTAGONISTS
Alpha blockers
Beta blockers
Alpha/Beta blockers
“Beta-Adrenergic Blockers end in ____
“OL”. toporol
What do Beta-Adrenergic Blockers (BAB) do?
Block action of neurotransmitter at beta receptor sites
Beta-Andrenergic Blockers caution
Diabetes
Asthma - bronchoconstriction
COPD - bronchoconstriction non- selective beta blockers
Can Beta Blockers be selective or non-selective?
Yes they can be either
Beta blockers and diabetics what can happen?
masks hypoglycemia may decrease blood sugar
s/s dizzy, shaky, sweating, inc HR, SNS stimulated
Name a selective Beta-Adrenergic Blocker (Beta 1) and INDICATIONS….
Atenolol
CAD,
MI,
Hypertension,
Tachycardia,
CHF
How does a Beta blocker work? (Beta 1) 1 heart 2 kidneys
Decrease
HR,
BP,
RR no change
Side Effects of Beta Blockers?
In the beginning, fatigue
HA (headache)
Depression
Impotence
Bradycardia - HR less than 6
Hypotension - Systolic less than 90
Hypoglycemia can be masked
Fight or flight - 3 organs
Lungs, Heart, Brain
Epinephrine - Side effects to kidney?
Decreased blood flow, dec urine,
Epinephrine - side effects to blood sugar?
Hyperglycemia, liver gycogenesis
Nurse giving epi - vital signs
Epi -
Beta 1. ONE HEART 2 KIDNEYS Beta 2 - 2 Lungs, 1 liver
HR inc. 60 could go up to 80-110, receptors receptors
BP inc, renin released, vaso constriction
RR dec. , Bronchodilation
If patient receives 2 sympathomimetics -
How do vital signs change
A greater increase in HR and BP
could put patient at risk
If patient is taking a beta blocker and then you give them epi what happens?
Can blunt the response of the sympathomimetic.
Cardiac arrest, epi may not work as well.
EPI can be in different concentrations? T or F
True
Drug interactions with Beta Blockers
NSAIDS as will increase BP
EPI - effects decreased
Always take vital signs before hand
Albuterol can have beta1 crossover when?
those who have a sensitivity to drug
at higher doses more in the hospital
BP will increase
Beta 2 Blocker can cause _______ in the lungs
Vasoconstriction. Not good for COPD and Asthma
Non-selective Beta blockers do not give to ____
COPD
Asthma
Due to Bronchoconstriction
There are no Beta 2 blockers cause bronchoconstriction
Already bradacardic if HR is 40 do not give them atenolol
Pregnant
Patient Education for Beta Blockers
Teach how to take their pulse, less than 60 call HCP
Avoid quick changes in positions, postural hypotensions
Review potential side effects (impotence, headache, heart attack)
Do not discontinue without directions
You have a patient with 63 year old male admitted for gallbladder surgery.
History: Hypertension, COPD, obesity
Medication:
What BP medication would be contraindicated?
Non-selective beta blocker (beta 1 and beta 2)
Beta 2 could cause bronchoconstriction for COPD patient
Non-Selective Beta blockers and Diabetes
2 things to be aware of.
Patient Education for Diabetics on beta blockers
Normal Hypoglycemia s/s
dizzy, shaking, sweating, signs need to eat
SNS stimulation.
Patients may NOT get these initial signs of HYPOGLYCEMIA.
Beta blockers - diabetics will not get the message that blood sugar is low.
suggest checking glucose more often
have candy with them at all times
Could see blood sugar decrease. Beta 2 - Liver receptors are blocked. So patient would need LESS insulin since there is LESS sugar.
Atenolol is a BETA ONE ________Blocker
Atenolol is a BETA ONE SELECTIVE Blocker
so HR, BP go down, RR stays the same.
Patient prescribed Atenolol
Take vitals before 80/50
Do give the atenolol?
NO
hypotensive is systolic below 90
need to notify HCP who prescribed it
document that you did not give the drug
sometimes BP drugs may have paramenters -
ie hold for HR less then 60 BP less than 90
MUST KNOW THE MOST COMMON SELECTIVE BETA BLOCKERS
ATENOLOL and METOPROLOL
MUST KNOW THE MOST COMMON
NON-SELECTIVE BETA BLOCKERS
CARVEDILOL,
LABETALOL,
PROPANOLOL HCL,
SOTALOL,
TIMOLOL (eye drops)
Teach patient if HR is less than ______
Do not take your BP medication
HR less than 60 do not take your BP medication.
Notify HCP.
