• also called sympathomimetic drug because it mimics the effects of SNS
• direct effect by occupation of the adrenergic receptor
• indirect effect by modulation of the release of neurotransmitters from the axon

• Alpha- and Beta- adrenergic agonist
• Alpha-specific adrenergic agonist
• Beta-specific adrenergic agonist

• Hypotensive states
• Shock
• bronchospasm
• some types of asthma

• Dopamine (Intropin)
• Dobutamine (Doburtrex)
• Ephedrine (Pretz-D)
• Epinephrine (Adrenalin, Sus-phrine)
• Metaraminol (Aramine)
• Norepinephrine (Levophed)

• Increased HR with increased myocardial contractility
• Bronchi dilate and increased respiration in rate and depth
• blood vessels constrict and increase BP
• intraocular pressure decreases
• glycogenolysis throughout the body
• pupils dilate
• sweating increases

• rapidly absorbed after injection or passage through mucous membranes 
• metabolized in the liver and exreted in the urine

• choice treatment for shock
• stimulates heart and BP
• causes renal & splanchinic arteriole dilation that increases blood flow to the kidney -
  • preventing diminished renal blood supply and shutdown that can occur with Epi and Norepi

• treatment of heart failure
  • increases myocardial contractitlity without change in rate
  • does not increase oxygen demand of the cardiac muscles (an advantage over other sympathomimetic drugs)

• Treatment of hypotensive episodes
• seasonal rhinitis
• stimulates the release of norepi from nerve endings and acts directly on adrenergic receptor sites (declining use because less toxic drugs are available)

• Treatment of shock when increased BP and heart contractitily are essential;
• glaucoma-ophthalmic agent
• primary treatment for bronchospasm
• produces local vasoconstriction that prolongs the effects of local anethetics

• Treatment of shock if norepi or dopamine cannot be used
• prevention of hypotension with spinal anesthesia
• increases myocardial contractility causing peripheral vasoconstriction

• treatment of shock
• used during cardiac arrest to get sympathetic activity

• Tachyarrhythmias & ventricular fibrillation
• hypovolemia
• caution should be used with those who have peripheral vasculare disease
• pheochromocytoma

• PVD (peripheral vascular disease)
  • arterosclerosis
  • raynaud disease
  • diabetic endrateritis

Sympathomimetic drugs could exacerbate the vasoconstriction

• Arrhythmias
• hypertension
• palpitations
• angina
• dyspnes
• nausea
• vomiting
• headache
• sweating

• MAOI's
• Tricyclic antidepressants

• monitor pulse & BP for excessive stimulation
• obtain ECG to evaluate possible arrhythmias
• note respiratory rate and ausculate lungs for adventitious sounds
• monitor urine output to evaluate perfusion of the kidney
• monitor lab tests
  • renal & liver function tests
  • serum and electrolyte levels

• improved
  
  • BP
  • oculare pressure
  • bronchial airflow

• CV changes
• decreased urine output
• headache
• GI upset

• Hypertension
• Constriction of topical vessels in the nose

• Well absorbed; reach peak levels in 20-45 minutes
• Widely distributed in the body
• metabolized in the liver and excreted in urine

• Phenylephrine (Neo-synephrien, Allerest, AK-dilate, and others)
• Clonidine (Catapres)
• Midodrine (ProAmatine)

What are the uses of Phenylephrine (Neo-Synephrine)?

potent vasoconstrictor and alpha 1-agonist with little or no effect on the heart or bronchi

• allergic rhinitis
• otitis media
• cold & allergy
• paterterally for:
  • shock & shock like states
  • supraventricular tachycardias
  • prolong local anesthesia
  • maintain BP during anesthesia
• Ophthalmically - dilates pupils, relieves pressure from glaucoma
  

• MAOIs
  • severe hypertension
  • headache
  • hyperpyrexia
• TCAs
  • Increased sympathomimetic effects occur

Specifically stimulates CNS alpha 2- receptors and leads to decreased sympathetic outflow from the CNS because alpha 2-receptors moderate teh release of norepinephrine from the nerve axon

• Treatment of essential hypertension
• chronic pain
• ease opiate withdrawal
• used only for adults

an oral drug used to treat orthostatic hypotension in patients who do not respond to traditional therapy.  Activate alpha 1-adrenergic receptors leading to peripheral vasoconstriction and an increase in vascular tone and blood pressure

Note: effects can cause serious supine hypertension, patients need to be monitored while standing or sitting

• allergy to drug
• severe hypertension or tachycardia
• narrow angle glaucoma
• pregnancy

• CVD and vasomotor spasm
• Thyrotoxicosis
• Diabetes

• anxiety, restlessness, depression, fatigue, and blurred vision
• ECG changes, arrhythmias, BP changes
• Nausea and vomiting
• Decreased uriniary output

• MAOIs and TCA
• Digoxin and beta-blockers

Nursing considerations for pts when using

alpha-specific adrenergic agonists?

• Assess for
  
  • allergies to drug
  • presence of CV
  • thyrotoxcosis or diabetes
  • chronic renal failure and/or renal and hepatic impairment
  • current pregnancy or lactation status
• monitor level of orientation, affect, reflexes, and vision
• monitor BP, pulse, peripheral perfusion, obtain ECG
• elvaluate for nausea & constipation
• monitor lab tests such as renal and liver function
  

• Improvement of condition being treated

• CV changes
• CSN changes
• GI upset

• manage and treat bronchial spasm
• asthma
• other obsructive pulmonary conditions

• increased HR, conductivity, and contractility
• bronchodilation
• increased blood flow to skeletal muscles and sphanchnic bed
• relaxation of uterus

• Albuterol (Proventil, Ventolin)
• Bitolterol (Tornalate)
• Isoetharine (generic)
• Isoproterenol (Isuprel)
• Levalbuterol (Xopenex)
• Metaproterenol (alupent)
• Pirbuterol (Maxair Autohaler)
• Ritodrine (Yutopar)
• Salmeterol (Servent Diskus)
• Terbutaline (Brethine)

• treatment & prevention of bronchospasm
• treatment of acute bronchospasm and exercise induced brochospasm (when used as an inhaler)

Beta-specific Adrenergic Agonist

• treatment of bronchial asthma and reversible bronchospasm

Beta-specific Adrenergic Agonist

treatment and prevention of bronchial asthma and reversible bronchospasm

Beta-specific Adrenergic Agonist

• Treatment of shock
• cardiac arrest
• certain ventricular arrhythmias
• heartblock in transplanted hearts
• prevention of bronchospasm during anesthesia

Beta-specific Adrenergic Agonist

treatment & prevention of bronchial asthma and reversible bronchospasm in patients greater than or equal to 4 years

Beta-specific Adrenergic Agonist

• treatment of bronchial asthma and reversible bronchospasm
• by inhalation-acute asthma attacks in children greater than or equal to 6 years

Beta-specific Adrenergic Agonist

Treatment of bronchial asthma and reversible bronchospasm

Beta-specific Adrenergic Agonist

• management of preterm labor

Beta-specific Adrenergic Agonist

• Treatment & prevention of bronchial asthma and reversible bronchospasm
• Exercise induced bronchospasm in patients great than or equal to 4

Beta-specific Adrenergic Agonist

treatment of bronchial asthma and reversible bronchospasm

Beta-specific Adrenergic Agonist

• Allergy
• Pulmonary hypertension
• Eclampsia
• uterine hemorrhage
• intrauterine death
• pregnancy and lactation

What diseases should you take caution with if using

Beta-specific Adrenergic Agonist?

• Diabetes and thyroid disease
• vasomotor problems
• heart disease
• stroke

• Restlessness, anxiety, and fear
• tachycardia, angina, MI and palpitations
• difficulty breathing, cough, and bronchospasm
• pulmonary edema
• nausea, vomiting, and anorexia

What drug to drug interactions occur with

Beta-specific Adrenergic Agonist?

• Increased reations if used with other sympathomimetic drugs
• decreased reaction with beta-adrenergic blockers

Nursing considerations for patients receiving

Beta-specific Adrenergic Agonist:

• Monitor CV status, pulse, BP
• obtain ECG to evaluate SNS stimulation
• assess respiratory status
• monitor urine output to evaluate renal function and kidney refusion
• Monitor lab tests:
  • Thyroid function
  • blood glucose levels
  • renal function

• improvement of condition being treated
• stabilized BP
• prevention of preterm labor
• cardiac stimulation

Beta-specific Adrenergic Agonist adverse effects that nurses should monitor for are:

• CNS changes
• Respiatory problems
• GI upset

Cardiac related conditions -

Essential hypertension

• lower BP
• Slower pulse rate
• increased renal perfusion with decreased renin levels

• Amiodarone (Cordarone)
• Carvedilol (Coreg)
• Labetalol (Normodyne)
• Guanadrel (Hylorel)
• Guanethidine (Ismelin)

*only used as an antiarrhythmic in life threatening situations*

alpha- and beta- adrenergic blocking agents

• hypertension
• CHF
• left ventricular dysfunction after MI

alpha- and beta- adrenergic blocking agents

• Hypertension
• hypertension associated with pheochromocytoma
• clondine withdraw

alpha- and beta- adrenergic blocking agents

Hypertension in adults not responding to thiazide diuretics

alpha- and beta- adrenergic blocking agents

• Hypertension
• Renal Hypertension

alpha- and beta- adrenergic blocking agents

What are the contraindication in

alpha- and beta- adrenergic blocking agents?

• Bradycardia (less than 55 BPM)
• 2nd and 3rd heart block
• Shock
• Decompensated CHF

• Bronchospasm or asthma
• Diabetes (sign & symptoms of hypo/hyperglycemia my be masked)
• pregnancy

• Dizziness
• insomnia
• fatigue
• nausea and vomiting
• arrhythmias
• hypotension
• CHF exacerbatioin
• pulmonary edema
• bronchospasms

• Enflurane, halothane, and isoflurane anesthetics
• diabetic agents
• calcium channel blockers

What are some nursing considerations in patients taking

alpha- and beta- adrenergic blocking agents?

• monitor vital signs
  • CV status
  • pulse, RR
  • Cardiac output
• lab test for renal and liver functions
• electrolyte levels and blood glucose

• CV changes
• headache
• GI upset
• bronchospasm
• liver failure

Note: blocking all of the receptor sites within the SNS results in lowering BP

• Actions:
  • blocks postsynaptic alpha 1 receptors decreasing sympathetic tone in the vasculature and causing vasodialation
• Phamacokinetics
  • absorbed after injection and excreted in urine

• prevents cell death and tissue sloughing after extravasation of intravenous norepinephrine or dopamine
• Severe hypertension  reactions caused by manipulation of the pheochromocytoma before and during surgery
• Diagnosis of pheochromocytoma

• Contraindications:
  • allergy
  • CAD and MI
• Cautions
  • pregnancy
• Adverse effects
  • Hypotension & orthostatic hyptension
  • Angina
  • MI
  • CVA
  • Arrhythmias
  • Wekness and dizziness
    

• Ephedrine
• Epinephrine
• Alochol

What are the nursing consideration for pts receiving

Phentolamine (Reitine) or Nonselective Alpha-adrenergic blocking agents?

• assess for presence of CV
• pregnancy and lactation status
• monitor for
  • CNS changes
  • CV status, pulse, BP, peripheral perfusion, cardiac output
  • urine output

What are the improvements and adverse effects nursing need to look for in pts receiving

Phentolamine (Reitine)?

• Improvements in
  
  • signs & symptoms of pheochromocytoma
  • tissue condition after extravasation
• Adverse effects
  • Orthostatic hypotension
  • Arrhythmias
  • CNS effects: heache and dizziness

• Alfuzosin (Uroxatral)
• Doxazosin (Cardura)
• Prazosin (Minipress)
• Tamsulosin (Flomax)
• Terazosin (Hytrin)

• block the postsynaptic alpha1-receptor sites
  • decrease vascular tone and vasodilation
  • leads to fall in BP
• Block smooth muscle receptors in:
  • prostate and prostatic capsule
  • prostatic urethra
  • urinary bladder neck
  • results in relaxation of the bladder and prostate and improved urine flow in males

• Indications:
  • BPH
  • Hypertension
• Pharmacokinetics:
  • well absorbed
  • undergo extensive hepatic metabolism
  • excreted in the urine

BPH

Alpha 1-selective adrenergic blocking agents

hypertension & BPH

Alpha 1-selective adrenergic blocking agents

hypertension alone or in combo with other drugs

Alpha 1-selective adrenergic blocking agents

BPH

Alpha 1-selective adrenergic blocking agents

Hypertension

BPH

Alpha 1-selective adrenergic blocking agents

• Contraindications
  • Allergy
  • lactions
• Cautions
  • CHF
  • Renal failure
• Adverse reactions:
  • dizziness, weakness, fatigue
  • nausea, vomiting, abdominal pain, and diarrhea
  • arrhythmias, hypotension, edema, CHF, angina

• vasodilators
• antihypertensive drugs

• Assess for
  • HF or renal failure
  • hepatic dysfunction
  • pregnancy or lactation
• monitor orientation, affect, and reflexes (CNS changes)
• vital signs
• renal function and urinary output
• monitor renal & hepatic function tests

• competitive blocking of the beta-receptors in the SNS
• Blocking of beta receptors in the heart and the justaglomerular apparatus of the nephron
  • decreased heart rate, contractility, and excitability and membrane stabilizing effect
  • Juxtaglomerular cells are not stimulated to release renin which further decreaes BP

What are the

Nonselective Beta-adrenergic blocking agents?

• Carteolol (Cartrol)
• Nevivolol (Bystolic)
• Nadolol (Corgard)
• Penbutolol (levator)
• Pindolol (Visken)
• Propranolol (Inderal)
• Soltalol (Betapace, betapace AF)
• Timolol (Blocadren, Timoptic)

Treating

• cardiovascular problems
• hypertension
• angina
• migraine headaches
• preventing reinfaction after MI

Hypertension in adults, alone or as part of combo therapy

Nonselective Beta-adrenergic blocking agents

Hypertension in adults alone or in combo therapy

Nonselective Beta-adrenergic blocking agents

Hypertension, chronic angina (drug of choice for angina pts who are also hypertensive)

Nonselective Beta-adrenergic blocking agents

Hypertension in adults

Nonselective Beta-adrenergic blocking agents

• Hypertension
• angina
• migraine
• essential tremor
• revention of reinfarction after MI
• prevention of stage freight

Nonselective Beta-adrenergic blocking agents

• Betaface is used in prevention of life-threatening ventricular arrhythmias
• Betaface AF is maintenance of normal sinus rhythm in patients with atrial fibrillation/flutter

• Hypertension
• prevention of reinfarction after MI
• migraine prophylaxis, reduces intraocular pressure in open angle glaucoma

Nonselective Beta-adrenergic blocking agents

• allergy
• bradycardia
• 2nd and 3rd degree heart block
• shock
• decompensated CHF
• Use caution in COPD and Asthma

• Allergic reation
• bradycardia
• HF, cardiac arrhythmias, CVA
• pulmonary edema
• Gastric pain
• Flatulence
• impotence
• decreased exercise tolerance
• brochospasm

• Assess for
  • heart block, bradycardia, shock, HF, bronchospasms, COPD, acute asthma
  • diabetes or hypoglycemia
  • thyrotoxicosis
  • renal and hepatic disfunction
  • pregnancy or lactation
• Monitor
  • sensory function & orientation
  • cardiopulmonary status
  • abdomen
  • electrolyte levels
  • adrenal & hepatic function
    

because they do not block beta 2 receptor sites, they do not block the sympathetic bronchodilation that is so improtant for patients with lung diseases or allergic rhinitis

*preferred for pts who smoke, have asthma, or other obstructive pulmonary diseases or seasonal rhinitis

• Acebutolol (Secral)
• Atenolol (Tenormin)
• Betaxolol (Kerlone, Betoptic)
• Bisoprolol (Zebeta)
• Esmolol (Brevivloc)
• Metoprolol (Lopressor, toprol XL)

• Hypertension
• Angina
• Some cardiac arrhythmias

• Heart
  • increased chronotropy and inotropy
  • increase AV node conduction and velocity
• Renal juxtaglomerular cells
  • increaed renin release

Hypertension and premature ventricular contractions in adults

Beta 1-adrenergic blocking agents

• MI
• chronic angina
• Hypertension

Beta 1-adrenergic blocking agents

• Hypertension in adults
• ophthalmic agent for treatment of ocular hypertesnion
• open-angle glaucoma

Beta 1-adrenergic blocking agents

• Hypertension in adults alone or as part of combo therapy

• supraventricular tachycardias (afib/aflutter) in adults
• nocompensatory tachycardia when the HR must be slowed

Beta 1-adrenergic blocking agents

Metoprolol (Lopresor, Toprol XL) treats:

• hypertension
• prevention of reinfarction after MI
• early acute MI treatment
• tx of stable and symptomatic HF

Beta 1-adrenergic blocking agents

• Contraindications
  • allergy
  • bardycardia
  • 2nd and 3rd degree heart block
  • shock
  • decompensated CHF
• Cautions:
  • COPD
  • Diabetes
  • Thyroid disease

Beta 1-adrenergic blocking agents adverse reactions:

• fatigue, dizziness, sleep disturbances
• bradycardia, heart block, CHF, hypotension
• symptoms in respiratory tract range from rhinitis to bronchospasms
• nausea, vomiting, diarrhea
• decreased libido and impotence

• NSAIDs
• IV lidocaine

• Assess for
  • bradycardia, heart blocks, shock, HF
  • Diabetes, thyroid diseae
  • COPD
  • pregnancy and lactation
• monitor
  • neurological status, level of orientation & sensation
  • cardiac status
  • pulmonary status
  • examine abdomine for GI effects