Week 5: Sympathetic Division 320 Flashcards
Sympathetic/Adrenergic Receptor
Where are Alpha 1 receptors located?
Arteries (Vascular smooth muscle)
Sympathetic/Adrenergic Receptor
Where are Alpha 2 receptors located?
Brain (SPECIAL presynaptic receptor)
vasomotor center of the brain
Eyes
Sympathetic/Adrenergic Receptor
Where are Beta 1 receptors located?
Heart
Sympathetic/Adrenergic Receptor
Where are Beta 2 receptors located?
Lungs (Bronchioles)
Adrenergic Drugs
Agonists
These drugs produce effects that mimic what?
(increase stress)
Norepinephrine (NE) or epinephrine
Vasopressors? 2
epinephrine/adrenaline
Vasopressors
Epi uses
IV?
Subcutaneous?
IM?
*****IV PUSH FOR:
ASYSTOLE
HYPOTENSION
BRADYCARDIA
SHOCK
SUBCUTANEOUS: Added to local anesthetics
◦Lidocaine w/epinephrine subcutaneously
*IM: Anaphylaxis (The Epipen®!)
◦IM injection!
Vasopressors: Epinephrine
Does it bind selectively or non selectively?
Beta 1?
Beta 2?
Alpha 1?
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)
Vasopressors: Epinephrine
adverse effects
tachycardia (increased HR) (chronotropic+)
Cardiac Dysrhythmia- EKG abnormalities, ischemia-MI
◦can lead to MI, stroke
◦Extremities- decreased BP to fingers and toes
Vasopressors: Epinephrine
nursing considerations
When giving epinephrine, regardless of route, what would YOU monitor? Why?
vitals
HR
BP
Anti-Adrenergic/Adrenergic Blocking ANTAGONISTS!
BETA BLOCKERS
Selective Beta 1 Blocker?
Non-Selective Beta Blocker?
ALPHA 1 BLOCKERS?
Selective Beta 1 Blocker: metoprolol
Non-Selective Beta Blocker
* Propranolol/carvedilol/labetalol
*The “lols”
ALPHA 1 BLOCKERS
*Tamsulosin, the “sins”
ß1 antagonists (selective ß-1 blockers)
metoprolol tartrate: “lol”.
used to treat?
other uses?
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!
ß1 antagonists (selective ß-1 blockers):
metoprolol tartrate -> suffix “lol”
block what receptor?
eyes?
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!
Blocking Beta Receptors will lower the Heart Rate. Why does this also lower the Blood Pressure?
BP depends on HR
Since beta blockers lower the heart rate, the blood pressure also falls
HYPERTENSION MEDICATION KEY CONCEPT #1
ORTHOSTATIC/POSTURAL HYPOTENSION
Commonly seen with Anti-hypertensive Medications
The underlying cause is relaxation of smooth muscle in veins
CONCERNS AND SIGNS SYMPTOMS of hypotension
dizziness/light headedness, pass out/syncope
Huge FALL RISK with geriatric patients!
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!
◦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!)
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?
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
Non-selective ß blockers:Carvedilol/Propranolol/
Labetalol/Timolol -> suffix “lol”
used to treat
Current or hx of MI (Heart attacks)
Hypertension, Angina (chest pain)
Dysrhythmias, Heart failure
Symptoms of Hyperthyroidism/Thyroid Storm/Thyrotoxicosis
Anxiety
Ways to remember the lols
CARvedilol
PROpranolol
LABetalol
TIMolol
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)
Non-selective ß blockers:
Carvedilol/Propranolol/Labetalol/Timolol
Selective or nonselective?
Block what?
May block what?
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)
TIMOLOL is an eye drop that treats?
What is glaucoma?
Glaucoma
Increased Intra-Ocular Pressure (IOP) aqueous humor in the eye
Glaucoma is a CHRONIC CONDITION, treat for life!
Non-selective ß blockers:
Carvedilol/Propranolol/Labetalol/Timolol
Contraindications
Asthma/COPD (NEED TO BE ON SELECTIVE!!)
*NEVER STOP SUDDENLY!
*BOXED WARNING FROM FDA- sudden stoppage can increase the risk for a heart attack!
α1 Antagonist’s “Blockers”:
Tamsulosin? 2 main uses?
Prazosin? main use?
common suffix “sin”
USED TO TREAT
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
α1 Antagonists “Blockers”:
Tamsulosin
Prazosin
MOA
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
HYPERTENSION MEDICATION KEY CONCEPT #2?
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)
REFLEX TACHYCARDIA TREATMENT
beta blocker (for example, propranolol)
α1 Antagonists “Blockers”:
Tamsulosin,
Prazosin
ADVERSE EFFECTS
(SIN AT NIGHTTIME, change positions slowly)
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
α1 Antagonists “Blockers”:
Tamsulosin,
Prazosin
ADVERSE EFFECTS CONTINUED
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
α1 Antagonists “Blockers”:
Tamsulosin
Prazosin
NURSING PROCESS: Assessment
Hold if?
Blood pressure before you administer
General rule for all BP Meds- Hold if <90/60
α1 Antagonists “Blockers”:
Tamsulosin
Prazosin
NURSING PROCESS: Plan/ implementation
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
