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Andrenergic Agents Flashcards

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1
Q

Adrenergic agents

A

Drugs that stimulate the sympathetic nervous system (sns)

Aka adrenergic agonists and sympathomimetics

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2
Q

Characteristics of adrenergic agents

A

Mimic the effects of the SNS transmitters norepinephrine and epinephrine

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3
Q

Adrenergic receptors

A

Located throughout the body
Are receptors for the sympathetic neurotransmitters
Alpha adrenergic
Beta adrenergic
Dopaminergic receptors: respond to dopamine

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4
Q

cardiovascular: blood vessels

A

alpha 1 receptors: constriction

beta 2 receptor: dilation

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5
Q

cardiovascular: cardiac muscle

A

beta 1: increased contractility

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6
Q

cardiovascular: atrioventricular node

A

beta 1: increased heart rate

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7
Q

cardiovascular:

sinoartial node

A

beta 1: increased heart rate

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8
Q

endocrine: pancrease

A

beta 1: decreased insulin release

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9
Q

endocrine: liver

A

beta 2: glycogenolysis

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10
Q

endocrine: kidney

A

beta 2: increased renin secretion

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11
Q

gastrointestinal: muscle

A

beta 2: decreased motility

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12
Q

gastrointestinal: sphincters

A

Alpha 1: constriction

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13
Q

genitourinary: bladder sphincter

A

alpha 1: constriction

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14
Q

genitourinary: penis

A

alpha 1: ejaculation

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15
Q

genitourinary: uterus

A

alpha 1: contraction

beta 2: relaxation

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16
Q

respiratory: bronchial muscles

A

beta 2: dilation

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17
Q

ocular: pupilary muscles of the iris

A

alpha 1: mydriasis

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18
Q

alpha- adrenergic receptors

A

divided into alpha 1 and alpha 2 receptors

differentiated by their location on nerves

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19
Q

alpha 1- adrenergic receptors

A

located on the postsynaptic effector cells (the cell, muscle or organ that the nerve stimulates)

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20
Q

alpha 2 adrenergic receptors

A

located on the presynaptic nerve terminals (the nerve that stimulates the effector cells)
controls the release of neurotransmitters
found in the CNS

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21
Q

predominant alpha- adrenergic agonist responses

A

vasocontriction and CNS stimulation

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22
Q

beta- adrenergic receptors

A

all are located on the post synaptic effector cells
beta 1 adrenergic receptors are located primarily on the heart
beta 2 adrenergic receptors- located primarily in the lungs

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23
Q

beta adrenergic agonist response

A

bronchial, GI, and uterine smooth muscle relaxation, cardiac stimulation (increased heart rate and contractility.)

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24
Q

dopaminergic receptors

A

additional adrenergic receptor
stimulated by dopamine
causes dilation of the renal vessel, the mesentaric vessels, coronary vessels, and cerebral vessel and results in INCREASED blood flow

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25
Mechanism of action: | direct acting sympathomimetic
binds directly to the receptor and causes a physiologic responses example: epinephrine
26
mechanism of action: | indirect acting sympathomimetic
causes release of catecholamines (neurotransmitters) from storage sites in the nerve endings the catecholamine then binds to the receptors and causes a physiologic response example: amphetamines
27
mechanism of action: mixed acting sympathomimetic
directly stimulates the receptor by binding to it and indirectly stimulates the receptor by causing the release of stored neurotransmitters from the vesicles in the nerve endings. example: ephedrine
28
catecholamines
substances that can produce a sympathomimetic response endogenous: the body produces it (epinephrine, norepinephrine, and dopamine) synthetic: everything else and endogenous
29
Drug effects: | stimulation of beta 1 adrenergic receptors on the myocardium, AV node, and SA node results in cardiac stimulation
increased force of contraction (positive inotropic effect) increased heart rate (positive chronotropic effect) increased conduction through the AV node (positive dromotropic effect)
30
Beta 2 agonists- inhalers
mechanism of Action (MOA) - stimulates beta adrenergic receptors and exhibits a response. - indications: bronchodilator to treat asthma or COPD examples: albuterol, terbutaline, levalbuterol
31
albuterol (most widly used inhaler)
brand names: ProAir, Proventil, Ventolin available as both an inhaler solution and inhaler dose: 1-2 inhalations every 4-6 hours as needed for condition (wheezing, shortness of breath) also used as an inhalation liquid for breathing machine - 2.5mg in 3mL normal saline inhalation via breathing machine every 4-6 hours
32
Levalubuterol (inhaler that isn't as widely used)
advantages: less tachycardia (not widely proven) brand names: xopenex (both inhalation liquid and inhaler) dose: 0.63 - 1.25mg inhalation every 8 hours as needed 1-2 puffs inhalation every 4-6 hours.
33
terbutaline (not used as much, mainly in childbirth if it is used at all)
brand name: brethine additional use: tocolytic agent (stops contractions) dose: asthma/ COPD 0.25mg subcutaneous, may repeat in 15-30 minutes (maximum 0.5 in 4 hour period) tocolytic: 2.5-10mcg/minute
34
Beta-Adrenergic side effects
CNS: Mild tremors, headache, nervousness, dizziness Cardiovascular: increased heart rate, palpitations (dysrhythmias), fluctuations in blood pressure other: sweating, nausea, vomiting, muscle cramps
35
vasoactive sympathomimetics (pressors, inotropes)
also called cardioselective sympathomimetics used to support the heart during cardiac failure or shock. various alpha and beta receptors are affected NOTE: these agents need intensive monitoring and MUST be placed on an IV pump. Many are weight based calculated and DILUTED prior to use. know your institutions guidelines
36
what does dobutamine stimulate?
Beta 1 receptors
37
what does ephedrine stimulate
alpha 1 and beta 1 receptors
38
what does phenylephrine stimulate?
alpha 1 receptors
39
what does dopamine stimulate?
alpha 1, beta 1 and dopaminergic receptors
40
what does epinephrine stimulate?
alpha 1, beta 1 and beta 2
41
what does isoproterenol stimulate?
beta 1 beta 2
42
what does norepinephrine stimulate?
alpha 1 and beta 1
43
epinephrine
MOA stimulates alpha 1, beta 1 and beta 2 receptors indications: anaphylactic reactions, cardiac arrest, bronchodilator to treat asthma or COPD dose: anaphylaxis 0.3 mg IM, SQ every 20 mins for 3 doses Cardiac arrest 1mg IV every 3-5 mins until return of spontaneous circulation hypotension/shock 0.02mcg/kg/min CONTINUOUS INFUSION MUST BE MIXED AND DILUTED
44
extravasation
the vein breaks with the IV in it
45
epinephrine monitoring
pulmonary function, heart rate, blood pressure, extravasation
46
dopamine MOA
stimulates dopamine, alpha 1 and beta 1 receptors (dose dependent)
47
indications for dopamine
shock; increase renal perfusion
48
what receptors does dopamine stimulate?
renal receptors, alpha, beta
49
dopamine doses: low intermediate and high
low: 1-3 mcg/kg/min (stimulates renal receptors) intermediate: 3-10 mcg/kg/min (stimulates beta receptors) high: >10mcg/kg/min (stimulates alpha receptors)
50
dopamine monitoring
blood pressure, ECG, heart rate, MAP (mean arterial pressure) & renal output.
51
dobutamine MOA
stimulates beta 1 adrenergic receptors, causing increased contractility and heart rate with little effect on beta 2 receptors
52
indications for dobutamine
short- term management of patients with cardiac decompensation
53
dobutamine dose
2.5-20 mcg/kg/minute
54
monitoring dobutamine
blood pressure, ECG, heart rate, MAP, urine output
55
phenylephrine MOA
direct acting alpha 1 stimulater. must be diluted prior to administration
56
indications of phenylephrine
treatment of hypotension, vascular failure in shock; vasoconstrictor in regional analgesia.
57
phenylephrine dose:
0.25 mcg/kg/min
58
monitoring phenylephrine
blood pressure; heart rate
59
norepinephrine MOA
stimulates beta 1 and alpha 1 receptors (presser) | MUST BE DILUTED
60
indications of norepinephrine
treatment of shock
61
norepinephrine dose:
0.02-0.5mcg/kg/minute
62
monitoring norepinephrine:
blood pressure and heart rate
63
ephedrine MOA
stimulates alpha 1 and beta 1 receptors | stimulates beta adrenergic receptors and exhibits a response
64
indications of ephridrine
treatment of nasal congestion; hypotension
65
ephedrine dose
5-25mg slow IV push, may repeat after 5-10 mins as needed then every 3-4 hrs. DO NOT EXCEED 150mg/24hrs
66
monitoring ephedrine
blood pressure & heart rate
67
isoproterenol MOA
stimulates beta 1 and beta 2 receptors | MUST BE DILUTED
68
indications of isoproterenol
heart block, cardiac arrest, bronchospasm during anesthesia
69
isoproterenol dose
2-10mcg/minute
70
monitoring isoproterenol
ECG, heart rate & respiratory rate
71
alpha adrenergic side effects on the CNS
headaches, restlessness, excitement, insomnia, euphoria
72
alpha adrenergic side effects on the cardiovascular system
palpitations, tachycardia, vasoconstriction, hypertension
73
alpha adrenergic side effects (other)
anorexia, dry mouth, nausea, vomiting, taste changes
74
beta adrenergic side effects on the CNS
mild tremors, headache, nervousness, dizziness
75
beta adrenergic side effects on the cardiovascular system
increased heart rate, palpitations, fluctations in BP
76
beta adrenergic side effects (other)
sweating, nausea, vomiting, muscle cramps
77
nursing implications for intravenous administration
- check IV site often for infiltration - use clear IV solutions - use infusion device/IV pump - infuse agent slowly to avoid dangerous cardiovascular effects - monitor cardiac rhythm.

Pharmacology (3 decks)

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