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Pharm week 5, 6, 7, 8, old stuff > Week 5: Sympathetic Division 320 > Flashcards

Week 5: Sympathetic Division 320 Flashcards

1
Q

Sympathetic/Adrenergic Receptor

Where are Alpha 1 receptors located?

A

Arteries (Vascular smooth muscle)

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2
Q

Sympathetic/Adrenergic Receptor

Where are Alpha 2 receptors located?

A

Brain (SPECIAL presynaptic receptor)
vasomotor center of the brain

Eyes

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3
Q

Sympathetic/Adrenergic Receptor

Where are Beta 1 receptors located?

A

Heart

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4
Q

Sympathetic/Adrenergic Receptor

Where are Beta 2 receptors located?

A

Lungs (Bronchioles)

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5
Q

Adrenergic Drugs
Agonists

These drugs produce effects that mimic what?

A

(increase stress)

Norepinephrine (NE) or epinephrine

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6
Q

Vasopressors? 2

A

epinephrine/adrenaline

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7
Q

Vasopressors

Epi uses

IV?
Subcutaneous?
IM?

A

*****IV PUSH FOR:
ASYSTOLE
HYPOTENSION
BRADYCARDIA
SHOCK

SUBCUTANEOUS: Added to local anesthetics
◦Lidocaine w/epinephrine subcutaneously

*IM: Anaphylaxis (The Epipen®!)
◦IM injection!

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8
Q

Vasopressors: Epinephrine

Does it bind selectively or non selectively?

Beta 1?
Beta 2?
Alpha 1?

A

Epinephrine binds non-selectively to alpha and beta receptors

Exogenous Adrenaline

Beta 1 activation-HEART
◦ +Chronotropic (fast) (HR) and + Inotropic (CO)

Beta 2 activation- LUNGS
◦Bronchodilation

Alpha 1 activation- Vascular Smooth Muscle
◦ Vasoconstriction (Increased BP)

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9
Q

Vasopressors: Epinephrine
adverse effects

A

tachycardia (increased HR) (chronotropic+)

Cardiac Dysrhythmia- EKG abnormalities, ischemia-MI

◦can lead to MI, stroke

◦Extremities- decreased BP to fingers and toes

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10
Q

Vasopressors: Epinephrine
nursing considerations

When giving epinephrine, regardless of route, what would YOU monitor? Why?

A

vitals
HR
BP

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11
Q

Anti-Adrenergic/Adrenergic Blocking ANTAGONISTS!

BETA BLOCKERS

Selective Beta 1 Blocker?
Non-Selective Beta Blocker?
ALPHA 1 BLOCKERS?

A

Selective Beta 1 Blocker: metoprolol

Non-Selective Beta Blocker
* Propranolol/carvedilol/labetalol
*The “lols”

ALPHA 1 BLOCKERS
*Tamsulosin, the “sins”

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12
Q

ß1 antagonists (selective ß-1 blockers)
metoprolol tartrate: “lol”.

used to treat?
other uses?

A

HEART RELATED
◦Current or hx of MI (Heart attacks)
◦Hypertension
◦Angina (chest pain)
◦Dysrhythmias
◦Heart failure
◦Thyroid Storm/Thyrotoxicosis (excessive thyroid hormone=Hyperthyroidism)

OTHER USES:
Eye drops specifically- for glaucoma!

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13
Q

ß1 antagonists (selective ß-1 blockers):

metoprolol tartrate -> suffix “lol”

block what receptor?
eyes?

A

Block Beta 1 receptors located on heart

note these are also found on the kidney- but we tend to forget about this

Eyes (eye-drops)= miosis, lower IOP!

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14
Q

Blocking Beta Receptors will lower the Heart Rate. Why does this also lower the Blood Pressure?

A

BP depends on HR

Since beta blockers lower the heart rate, the blood pressure also falls

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15
Q

HYPERTENSION MEDICATION KEY CONCEPT #1

A

ORTHOSTATIC/POSTURAL HYPOTENSION

Commonly seen with Anti-hypertensive Medications

The underlying cause is relaxation of smooth muscle in veins

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16
Q

CONCERNS AND SIGNS SYMPTOMS of hypotension

A

dizziness/light headedness, pass out/syncope

Huge FALL RISK with geriatric patients!

17
Q

ß1 antagonists (Selective ß blockers):

Metoprolol tartrate

adverse effects?
dont give if?

NEVER STOP SUDDENLY!

BOXED WARNING FROM FDA- sudden stoppage can increase the risk for a heart attack!

A

◦Orthostatic Hypotension
◦Bradycardia leading to decreased CO

DONT GIVE IF HR LESS THAN 60

◦Mask s/s of hypoglycemia (Diabetes)
◦When your blood glucose is too low, Fight or Flight kicks in!
-Adrenaline= ^HR, anxiety/jittery, sweaty!
-Beta-Blockers mask the HR, anxiety (NOT THE SWEATING!)

18
Q

metoprolol tartrate

Can cross what? and may affect what?

Can also decrease what? do not give if BP is less than what?

Also causes what dysfunction?

A

Can cross BBB- may affect mood (depression, sleep, sexual desire, etc.)

Can also decrease blood pressure
◦ASSESS: blood pressure (do not give if <90/60)

◦Sexual dysfunction (erectile dysfunction, vaginal dryness)

◦Decreased libido/impotence

19
Q

Non-selective ß blockers:Carvedilol/Propranolol/
Labetalol/Timolol -> suffix “lol”

used to treat

A

Current or hx of MI (Heart attacks)
Hypertension, Angina (chest pain)
Dysrhythmias, Heart failure

Symptoms of Hyperthyroidism/Thyroid Storm/Thyrotoxicosis

Anxiety

20
Q

Ways to remember the lols

CARvedilol
PROpranolol
LABetalol
TIMolol

A

TIMolol: Glaucoma Eye Drops (Tim has glaucoma)

CARvedilol: Mainly used in Cardiac Conditions

PROpanolol: Commonly used in Professionals

LABetalol: Commonly use in Labor and Delivery (HTN management in pregnant patients)

21
Q

Non-selective ß blockers:

Carvedilol/Propranolol/Labetalol/Timolol

Selective or nonselective?
Block what?
May block what?

A

NON-SELECTIVE:

Block Beta 1 receptors located on heart

May Block Beta 2 receptors in lungs, skeletal muscle, liver

May Block alpha 1 receptors- relax vascular smooth muscle (arteries)

22
Q

TIMOLOL is an eye drop that treats?

What is glaucoma?

A

Glaucoma

Increased Intra-Ocular Pressure (IOP) aqueous humor in the eye

Glaucoma is a CHRONIC CONDITION, treat for life!

23
Q

Non-selective ß blockers:

Carvedilol/Propranolol/Labetalol/Timolol

Contraindications

A

Asthma/COPD (NEED TO BE ON SELECTIVE!!)

*NEVER STOP SUDDENLY! ​
*BOXED WARNING FROM FDA- sudden stoppage can increase the risk for a heart attack!

24
Q

α1 Antagonist’s “Blockers”:

Tamsulosin? 2 main uses?
Prazosin? main use?
common suffix “sin”

USED TO TREAT

A

TAMSULOSIN
1. MAIN USE #1: Benign prostatic hyperplasia (BPH)
2. MAIN USE # 2: Bladder Outlet Obstruction (kidney stones!)

PRAZOSIN
1. Main use Hypertension
2. Note: Guidelines no longer recommend these as 1st line

25
Q

α1 Antagonists “Blockers”:

Tamsulosin
Prazosin

MOA

A

prevents activation of a-1 receptors (antagonist)

There are subtype a-1 receptors
-Some are found in peripheral vascular smooth muscle (arteries)
-Some are found in Bladder/Urethra/Prostate

Some a-1 blockers are selective for or non-selective
-This means that a drug that targets the Bladder may also lower someone’s blood pressure!

Blocks Sympathetic “Fight or Flight”
Rest and Digest takes control
= Lower BP + can urinate better

26
Q

HYPERTENSION MEDICATION KEY CONCEPT #2?

A

REFLEX TACHYCARDIA:
Commonly seen with Anti-hypertensive drugs that DON’T WORK DIRECTLY ON THE HEART

◦Caused by dilation of arteries/veins (sudden drop in BP)

27
Q

REFLEX TACHYCARDIA TREATMENT

A

beta blocker (for example, propranolol)

28
Q

α1 Antagonists “Blockers”:

Tamsulosin,
Prazosin

ADVERSE EFFECTS

(SIN AT NIGHTTIME, change positions slowly)

A

COMMON:
First dose Orthostatic/postural hypotension

-Almost always happens with the first dose

-Medical textbooks call this, “First Dose Phenomenon”

IMPORTANT COUNSELLING POINT
-We don’t want our patient to fall!
-Sometimes patients take at night to reduce the risk

29
Q

α1 Antagonists “Blockers”:
Tamsulosin,
Prazosin

ADVERSE EFFECTS CONTINUED

A

Sexual dysfunction may occur in patients with all anti-hypertensive medications

This drug class is noted to cause retrograde or inhibited ejaculation

Rebound hypertension can occur if any anti-hypertensive is stopped suddenly (never stop a blood pressure medication suddenly!)

◦hink of the Beta-Blocker Boxed Warning

30
Q

α1 Antagonists “Blockers”:

Tamsulosin
Prazosin

NURSING PROCESS: Assessment

Hold if?

A

Blood pressure before you administer

General rule for all BP Meds- Hold if <90/60

31
Q

α1 Antagonists “Blockers”:
Tamsulosin
Prazosin

NURSING PROCESS: Plan/ implementation

A

We always start patients on low doses of cardiac/hypertension medications and titrate up

Instruct clients to avoid activities requiring mental alertness for the first 12 to 24 hr

Instruct clients to change positions slowly and to lie down if feeling dizzy, lightheaded, or faint.

Always educate about “FIRST DOSE PHENOMENON”

Never stop suddenly

Educate about sexual dysfunction potential

Pharm week 5, 6, 7, 8, old stuff (14 decks)

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