NUR 119 Mod 3

Any that cause mydriasis.

Adrenergic or Anticholinergic

Note that sympatholytics & parasympathemimetics do NOT

Assess why med was chosen based on history

Contraindications

HR & BP OK and Pt voiding OK

Discuss stress relieving measures

• Indications:
• - Decrease Gl motility (Colitis, peptic ulcer disease,diverticulitis)
• - Antispasmodic (cystitis, urethritis prostatitis, urgency tovoid)

• Contraindications:
• - Glaucoma
• - Prostatic hypertrophy
• - Tachycardia
• - Ml
• - CHF

• Prototype:
• - Atropine

• Other drugs:
• - Bentyl (decrease Gl motility)
• - Robinul (decrease Glmotility)
• - Pro-Banthine (decrease Gl motility)
• - Detrol & Detrol LA (decrease secretions)
• - Homatropine (dilate pupils)
• - Atrovent (bronchodilator)
• - Artane (Parkinsons)
• - Cogentin (Parkinson's)
• - Scopolamine (CNS depression, decreases secretions)

• Increase Pulse rate
• Decrease mucous secretions
• Decrease Gl motility
• Increase urinary retention
• Dilate pupils

• Indications:
• - Dx & Tx myasthenia gravis
• - Reverse curare
• - Alzheimer's
• - Glaucoma

• Contraindications:
• - Urinary tract obstruction
• - Asthma
• - CAD

• Prototype:
• - Prostigmin (myasthenia gravis, antidote for curare)

• Direct Acting Drug:
• - Urecholine (relieve unnary retention)

• Indirect Acting Drug:
• - Tensilon (dx myasthenia gravis or cholinergic crisis)
• - Mestinon (Tx myasthenia gravis long acting)
• - Prostigmin

• Cholinesterase Inhibitors:
• - Cognex (Alzheimer's)
• - Ancept (Alzheimer's)

• Muscarinic 1,2,3 & 4
• - Stimulate smooth muscle
• - Slow heart rate

• Nicotinic 1 & 2
• - Affect skeletal muscle

Acetylcholine

• ↓ BP
• ↓ Pulse rate
• Dilate blood vessels
• ↓ Heart rate
• ↑ secretions of Gl, lung, skin
• ↑ Gl movement
• Bladder contraction
• Skeletal contraction
• Constrict bionchi
• Constrict pupils

If admin of Tensilon (of edrophonium chloride) improves muscle contraction, then Dx myasthenia gravis

Muscle weakness

Fatigue

Difficulty chewing

Drooping eyelid

Drooling

Resp failure possible

Hypotension

• Beta-blockers:
• - Lower HR (negative chronotrophy)
• - Decrease force of contraction (negative inotrophy)
• - Decrease conduction and cardiac output
• - Bronchoconstriction

• Adverse affects:
• - Blocks symptoms of tachycardia related to hypoglycemia
• - Don't stop abruptly -> rebound HTN
• - Bradycardia OD -> atropine
• - CHF (Dx dyspnea, fatigue, edema)
• - Bronchoconstriction Ax-> bronchodialators
• Prototype:
• - Inderal [beta_1&2](HTN, angina pectoris)

• Other drugs:
• - Tenormin [beta₁](prevent Ml)
• - Lopressor [beta₁](prevent Ml)
• - Timpotic (glaucoma)
• - Betopic [beta₁](glaucoma)
• - Corgard (HTN, angina)
• - Clonidine (HTN)

• Indications:
• - Angina
• - HTN
• - Tachycardia
• - Glaucoma

• Contraindications:
• - Bradycardia
• - Heart block
• - CHF
• - Asthma
• - Pulmonary condition with vasoconstriction

• Alpha blockers:
• - Vasodilation
• - decrease BP
• - Constrict pupils
• - Othostatic hypotension
• - Reflex tachycardia

• Prototype:
• - Prozosin 1st dose syncopy (fainting)

• Other drugs:
• - clonidine HCl (Catapres) (decrease BP)
• - Methyldopa (peak effect in 2days)
• - Cardura (mild HTN, BPH (benign prostatic hypertrophy)
• - Minipress [prazosin HCl] (HTN)
• - Hytrin

• Indications:
• - HTN
• - Improve blood flow
• - Reynaud's disease
• - Frostbite
• - Prevent necrosis of vasoconstricting drugs

• Contraindications:
• - Angina
• - Stroke
• - Ml

• ↓ Pulse rate
• ↓ BP
• Constrict Bronchioles
• Constrict pupils

• Indications:
• - Cardiac emergency
• - Respiratory emergency
• - Allergic reactions

• Contraindications:
• - HTN
• - Angina
• - Stroke
• - Glaucoma
• - Hyperthyroidism

• Prototype:
• - Epinephrine (cardiac arrest, acute bronchospasm and laryngeal edema)

• Other drugs:
• - Albuterol (bronchospasm)
• - Sudafed (decongestant)
• - Isuprel
• - NeoSynephrine (nasal congestion, cold)
• - Dexatrim
• - Dopamine (hypotension)
• - Ephedrine (HTN, bronchspasm)

• Alpha 1:
• - Vasoconstriction
• - ↑ BP
• - ↑ contractility of heart
• - Pupil dilation
• - Bladder contraction
• - Prostate contraction

• Alpha 2:
• - ↓ BP(reduce norepinephnne)
• - ↓ GI motility

• Beta 1:
• - ↑ HR and force of contraction

• Beta 2:
• - Bronchoditation of lungs
• - ↓ Gl motility
• - Relax uterus
• - Activates glycogenolysis in liver
• - ↑ blood sugar

• ↑ BP
• ↑ pulse rate
• ↑ blood flow/fight or fnght
• ↑ metabolism
• ↑ breakdown of glycogen
• ↑ increase blood sugar
• ↑ mental activity
• ↑ muscle strength
• ↑ blood coagulation
• ↑ respiratory rate
• Pupil dilates to help with vision

• IND:
• Tx HTN

Improve blood flow

Raynauds disease & frostbite

• CONTRA:
• Decreases BP, reflex tachycardia might result

Angina

MI

Stroke

They can cause orthostatic hypotension leading to reflex tachycardia.

Note: The body has several feedback mechanisms to maintain adequate blood flow and blood pressure. If blood pressure decreases, the heart beats faster in an attempt to raise it. This is called reflex tachycardia.

They are: Sympatholytic

Decrease or block the effects of sympathetic nerve stimulation

Adrenergic

Treatment of hypotension & shock

Also causes improved urinary output - looking for a kinimum of 30 mL/hr

Adrenergic

Appetite suppressant/decongestont

Adrenergic

Decongestont

Watch for increased BP & reflex bradycardia

Adrenergic

Cardiac stimulant, used for bronchospasm / bronchodilator

Adverse reaction - tachycardia

May have pink tinged sputum

Adrenergic

Bronchodilation decongestant effects

Excessive use can cause rebound nasal congestion

Constricts broncholes, could lead to trouble breathing for COPD & asthma Pt

Decreases HR

Reduces force of contractions

Adrenergic

Less potent than albuterol, longer acting

Used to treat hypotension from anesthesia

Adrenergic

↓BRONCHOSPASM → bronchodilation

Stimulates both alpha and beta receptors.

Drug of choice for acute bronchospasm and laryngeal edema

Used in cardiac arrest

Not given orally/destroyed by enzymes in the GI tract and liver

Increases blood sugar

anxiety

High BP

Angina

Stroke

Glaucoma

Hyperthyroidism

Epinephrine (never PO becaue it is wholly metabolized by the liver) for anphylaxis.

Albuterol for asthma.

Either a

adrenolytic

or a

Cholinergic

Sympathomimetic

Exogenous

Selective or non-selective

nicotinic 1 & 2

muscorinic 1 - 4

• alpha₁
• - vasoconstriction, ↑BP, ↑HR
• - Mydriasis (pupil dilation)

• alpha₂
• - ↓ BP (via reduced norepinephrin)
• - ↓ GI

• beta₁
• - ↑ HR & force of contraction
• - ↑ BP (via ↑angiotensin to kidney)

• beta₂
• - ↓ GI
• - ↑ Bronchdilation
• - ↑ Vasodilation
• - ↑ blood sugar (via glycogenolysis)

_dopamine

• A: acetylcholine
• B: inhibitory
• C: cholinergic

• A: norepinehrine
• B: excitatory
• C: adrenergic

• Tx:
• - ACETYLCHOLINE

• Syn:
• - CHOLINERGIC
• - INHIBITORY

• Rx:
• - Muscarinic
• - Nicotinic

• Tx:
• - NOREPINEPHRINE
• - DOPAMINE

• Syn:
• - ADRENERGIC
• - EXCITATORY

• Rx:
• - alpha 1
• - beta 1&2
• - dopamine

1. Dilate blood vessels

2. ↑ secretions - GI, lung, skin

3. ↓ HR

4. ↑ GI

5. No blood sugar effects

6. No chg mental activity

7. No chg muscle strength

8. No chg blood coagulation

9. Bronchi constriction

10. Pupil constriction

11. Bladder contraction

12. Skeletal contraction

Decreases tremors and rigidity of muscles.

Drowsiness, disorientation and hallucinations can result from large doses.

Dilates the bronchi, and decreases bronchial secretions.

Decreases salivation, perspiration, and bronchial secretions.

Dilates pupils (mydriasis) and paralyzes ciliary muscle (cycloplegia), causing a decrease in accommodation.

• Relaxes the bladder detrusor muscle
• and increases constriction of the internal sphincter.

Urinary retentioncan result.

Relaxes smooth muscle tone of Gl tract

Decreasing Gl motility and peristalsis.

Decreases gastric and intestinal secretions.

Increases heart rate with large doses.

Small doses can decrease heart rate.

1. ↑ BP/cardiac output

2. ↑ blood flow for "fight or flight"

3. ↑ metabolism and use of O₂

4. ↑ breakdown of glycogen

5. ↑ blood sugar

6. ↑ mental activity

7. ↑ muscle strength

8. Blood coagulation increased

9. ↑ respiratory rate

10. Pupil dilation to help vision