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What is the basic principal of Adrenergic drugs?
They stimulate the SNS & are also called sympathomimetics or adrenergic agonists
What are the characteristics of Adrenergic drugs?
The mimic the effects of the SNS neurotransmitters.
What are the neurotransmitters of the SNS?
- Norephinephrine (NE)
- Epinephrine (EPI)
Where are the Adrenergic receptors located?
t/o the body
Name the Adrenergic receptors:
- Alpha 1 & 2
- Beta 1 & 2
- Dopaminergic: respond only to domapine
What are the effects of the Alpha 1 Adrenergic receptor sites?
- ^cardiac contractility
- vasoconstricion (^BP)
- Dilate pupils
- <salivary gland secretion
- ^bladder & prostate contraction
What are the effects of the Alpha 2 Adrenergic receptor sites?
- Inhibit norepinephrine release
- Vasodilation (<BP)
- <GI motility & tone
What are the effects of the Beta 1 Adrenergic receptor sites?
- ^cardiac contractility & ^HR
- ^renin secretion = ^BP
What are the effects of the Beta 2 Adrenergic receptor sites?
- ^blood flow in skeletal muscles
- <uterine tone
- <GI motility & tone
- Activates liver glycogenolysis which ^blood glucose
What are the effects of the Dopaminergic Adrenergic receptor sites?
Vasodilation ^blood flow
What are the classifications of Adrenergics?
- Direct-acting sympathomimetic (Epinephrine)
- Indirect-acting sympathomimetic (Amphetamine)
- Mixed-acting sympathomimetic (Ephedrine)
Catecholamines produce what types of sympathomimetic responses?
- Bronchial dilation
- Dilates pupils
Noncatecholamines produce what types of sympathomimetic responses?
- act on Beta 2
- ^blood flow in skeletal muscles
- <uterine tone
What is the action of Epinephrine (Adrenalin)?
- Vasoconstriction (alpha 1)
- ^BP (beta 1)
- Promote bronchodilation (beta 2)
Why would Ephinephrine (Adrenaline) be used?
- Anaphylaxis (shock)
- Cardiac arrest
What types of patients would Epinephrine be contraindicated in?
- Cardiac dysrhythmias
What are the s/e of Epinephrine (Adrenalin)?
What are the adverse reactions to Epinephrine (Adrenalin)?
- Ventricular Fibrillation (V-fib)
- Pulmonary edema
- (drug interaction: work opposite of beta-blockers)
What are the nursing interventions for Epinephrine (Adrenalin)?
- Monitor BP, PULSE, Urine output
- Report tachycardia, palpitations, tremors, dizziness, HTN
- Avoid cold meds/diet pills if HTN, diabetic, CAD, or dysrhythmias
- Avoid adrenergics when nursing infants
- Avoid continuous use of adrenergic nasal sprays
- Monitor IV site for infiltration
What receptor sites does Albuterol (Proventil) & Salmeterol (Serevent) effect?
- Beta 2 adrenergic receptors
- Promotes bronchodilation
What is Albuterol (Proventil) & Salmeterol (Serevent) used for?
Albuterol (Proventil) is only used what?
- Tx of ACUTE bronchospasms
- ONLY a rescue inhaler
Salmeterol (Serevent) is used for short or long term?
- long term, routine inhaler
- *PREVENT bronchospasms
What are the s/e or a/r to Albuterol (Proventil) & Salmeterol (Serevent)?
- Reflex Tachycardia
- Cardiac dysrhythmias
What are the nursing implications for Albuterol & Salmeterol?
- Avoid factors that exacerbate their condition
- Encourage fluid intake to loosen thick mucosal secretions
- Educate on proper dosing & equipment
If the patient is using another inhaler that is a corticosteroid, what should the nurse instruct the patient to do?
- Give bronchodilator first (Albuterol or Salmeterol) & wait 5 minutes before giving corticosteroid.
- This helps open up the airways for better absorption of the corticosteroid (potent anti-inflammatory)
What should the nurse monitor for with the use of Albuterol or Salmeterol?
- Return to normal respiratory rate
- Improved breath sounds
- ^air exchange
- Check pulse Ox
- ^blood gases
- ^activity tolerance
What is Dopamine used for?
Dobutamine is used for?
to Tx cardiac decompensation
Pseudoephedrine (Sudafed, Afrin) are used to Tx what?
What can happen with over use of Afrin?
What is Terbutaline (Brethine) used for?
Tx of bronchospasms
What is the basic action of Adrenergic Blockers?
Block the effects of adrenergic neurotransmitter
What ways can Adrenergic blockers block the effects of adrenergic neurotransmitters?
- By blocking the alpha or beta sites:
- Directly: by occupying receptors
- Indirectly: by inhibiting release of neurotransmitters epinephrine & norepinephrine
What are other names for the Adrenergic Blockers?
- Adrenergic Antagonists
- Sympatholytics ("lyse" or inhibit SNS)
The Alpha-Adrenergic Blockers work by doing what?
Blocking either Alpha 1 receptors (selective), or by blocking Alpha 1 & 2 receptors (Non-selective).
Alpha 1 Blockers can cause what?
- Reflex tachycardia
- Miosis (pupil constriction)
- Suppresses ejaculation
- <contraction of smooth muscles in bladder neck & prostate.
The action of Alpha Blockers causes what to happen?
- Arterial & venous dilation-->reducing peripheral vascular resistance & BP
- Effects receptors on the prostate gland & bladder causing <resistance to urinary outflow (^possibility of incontinence)
Name some Alpha Blockers & what they are used for.
- Doxazosin (Cardura)
- *HTN & BPH
- Prazosin (Minipress)
- *HTN & PTSD
- Terazosin (Hytrin)
- * HTN & BPH
What suffix indicates Alpha-Adrenergic Blockers?
With the Alpha Blockers the nurse should warn the patients first starting these meds of what effect?
The "first dose effect": may cause orthostatic hypotention, dizziness, & syncope
What are the effects of Adrenergic Blockers at the beta 1 & 2 sites?
- Beta 1; <cardiac contractility, <pulse
- Beta 2; Bronchoconstriction, Contracts Uterus, Inhibits glycogenolysis
What are indications for Beta Blockers use?
- Antianginal: <demand for myocardial oxygen
- Cardioprotective: Inhibits stimulation from circulating catecholamines
- Class II Antidysrhythmics
- Heart Failure (only some)
- Tx of Migraine HA
Explain the action of selective beta blockers verses nonselective beta blockers.
- Selective Beta blockers: <BP & Pulse
- Nonselective Beta blockers:
- Blocks Beta 1: <BP & Pulse
- Blocks Beta 2: Bronchoconstriction
Name some Beta Blockers.
- Propranolol (Inderal)
- Atenolol (Tenormin)
- Metoprolol (Lopressor)
- Carvedilol (Coreg)
- Nadolol (Corgard)
- Timolol (Blocadren, Timoptic: glaucoma)
The "olol" drugs are what type of drugs?
Propranolol is a nonselective beta blocker, when is it contraindicated?
in patients with COPD
Propranolol is a nonselective beta blocker, what are it's s/e or a/r?
- Weight gain
- Alopecia (reversible)
Metoprolol (Lopressor), & Atenolol (Tenormin) are selective beta adrenergic blockers. Which receptor do they block and what are the effects?
- Blocks beta1 only
- *<BP & Pulse
- *fewer s/e
What are the s/e of selective Beta1 adrenergic blockers like Metoprolol, or Atenolol?
- Mental Depression
What are the nursing implications with Adrenergic Blockers (Alpha & Beta blockers)?
- Assess: Allergies, Hx of COPD, Hypotension, Cardiac dysrhythmias, Bradycardia, Heart Failure, etc. cardio problems.
- NEVER stop taking abruptly d/t REBOUND TACHYCARDIA
- Teach pt's to change position slowly
- Avoid caffeine, alcohol & hazardous activites until blood levels become stable
Nurses should monitor patients on Adrenergic Blocking drugs (Alpha & beta blockers) for what?
- ***BP & PULSE
- Urinary hesitancy
- Bladder distention
The nurse knows that a client on Beta Blockers should be educated to report what s/e?
- Weight gain of >2#/1day, or >5#/1week.
- Edema of feet or ankles
- Excessive fatigue or weakness
- Syncope or dizziness
What are Cholinergic Drugs?
- Drugs that stimulate the PNS
- Mimic the effects of the PNS neurotransmitter (ACh; Acetylcholine)
There are two different Cholinergic receptors, what are they?
Muscarinic & Nicotinic
What effects do Cholinergics have?
- Cardiovascular: <BP & pulse, vasodilation, slows conduction of AV node
- GI: ^tone & motility, ^parastalsis, relaxed sphincter muscles
- GU: Contract bladder, ^uterer tone, relax sphincter muscles, stimulate urination
- EYE: Miosis (pupil constriction), ^accommodation
- LUNGS: Bronchial constriction, ^secretions
- GLANDS: ^salivation, ^perspiration, ^tears
- Striated Muscle: ^neuromuscular transmission
Name a few Direct-acting Cholinergics & what they are used for.
- GI: Metoclopramide (Reglan)
- *Tx of GERD & Gastroparisis (^gastric emptying)
- GU: Bethanachol (Urecholine)
- *Stimulate urination (1-2hrs after taken)
- EYES: Pilocarpine
- *Tx of glaucoma
- *topical app d/t poor oral absorbtion
What are some diseases that Indirect-acting Cholinergics are prescribed for?
- Myasthenia Gravis
- Alzheimer's Dementia
What are the Indirect-acting Cholinergics that are used for Alzheimer's Dementia?
- Tacrine (Cognex)
- Donepezil (Aricept)
- Memantine (Namenda)
- ***NOT A CURE***
- Used to improve memory in A.D., helps slow progression of disease
What are the s/e & nursing implications for Cholinergics?
- Hypotention: Assess BP
- Bradycardia: Assess HR
- Bronchoconstriction: Assess Lungs
- Excessive Salivation: Oral Hygeine
- ^Gastric acid secretion & abdominal cramps: check GI system
- Blurred vision: Safety concerns
- Assess I & O
What should a nurse teach a client who is about to start taking a Cholinergic drug?
- Proper gtts admin
- ***DO NOT ABRUPTLY STOP TAKING***
- Spread doses evenly apart to optimize the effects
- Therapeutic effects of anti-Alzheimer's drugs may not occur for up to 6 weeks
What is a special nursing implication in patients taking Bethanechol?
Should void w/in 60min of administration
What is a special nursing implication for a post-op patient with <GI peristalsis on Metoclopramide
Watch for: ^BP, are they passing gas, COCA poop
Which drugs cause interactions with Cholinergic drugs?
- Anticholinergics, Antihistamines, sympathomimetics
- *b/c they antagonize cholinergic drugs, resulting in <responses
What are Anticholinergics? (cholinergic blocking agents)
Drugs that block or inhibit the actions of acetylcholine (ACh) in the PSNS (parasympathetic nervous system)
How do Anticholinergics effect the body?
- Heart: Lg doses ^pulse, small doses <pulse
- Lungs: Bronchodilation, <secretions
- GI: Relax smooth muscle tone, <motility & peristalsis, <secretions
- Eye: Dilate pupils (Midriasis), <accommodation
- Glands: <salivation, <perspiration
- CNS: <tremors & rigidity
What is the Anticholinergic Atropine used for?
- Pre-op med to <salivary secretions
- Antispasmodic: <GI peristalsis
- ^HR (high doses): used for SEVERE bradycardia, or heart block
What is the Anticholinergic Scopolamine & Dramamine used for?
What is the Anticholinergic Hyoscyamine (Cystospaz) used for?
- Tx of Urinary bladder spasms
- Tx of IBS & peptic ulcers
Tolterodine (Detrol), is an Anticholinergic used for what?
- Tx for Urinary frequency (gotta go, gotta go)
- urgency & incontinence
The Anticholinergic drug Ipratropium (Atrovent) is used for what?
- Tx of COPD, Asthma, bronchospasms: causes bronchodilation
- <bronchial secretions
Benztropine (Cogentin), & Trihexyphenidyl (Artane) are Anticholinergics used to treat what?
- Parkinsonism & drug induced parkinsonism
- *<muscle rigidity & muscle tremors
What medication groups do Anticholinergics interact with?
- Tricyclic Antidepressants
When given with other Anticholinergic drugs what happens?
Additive effect: ^effects of meds
What are the s/e of Anticholinergics?
- DRY DRY DRY!!!
- Dry mouth
- Dry eyes
- ^intraocular pressure (IOP)
- Visual disturbances--blurred vision
- Midriosis (pupil dilation)
- Urinary retention
- Ortho hypotensin
- Tachycardia (in high doses)
What are the nursing interventions for the s/e of Anticholinergics?
- Dry mouth: good oral hygeine/hard candies
- Dry eyes: NS eye gtts PRN
- Tachy: Monitor pulse
- Ortho hypotension
- Visual disturbances: avoid driving at NOC & wear sunglasses
- Constipation: Assess bowel fxn regularily
- Urinary retention: Assess I&O
What are the nursing implications for Anticholinergics?
- Monitor for confusion/drowsiness (*elderly)
- Elderly: <fluid balance=heat stroke cautions
- Adequate fluid intake
- Urinary hesitancy/retention
When Parkinsonism patients are taking an Anticholinergic like Cogentin what does the nurse need to watch for?
Ensuring the med is working by noting if there is a <in tremors & salivation/drooling
With the Anticholinergic drug Detrol, what is the nurse monitoring for?
- Improved urinary patterns
- ^time between voids
CNS stimulants like Amphetamines, caffeine, Analeptics & Anorexiants are used for what types of issues?
- Reversal of respiratory depression
CNS stimulants are in 3 categories, what are they?
What is the possible pathophysiology of ADHD?
A dysregulation of the transmitters serotonin, norephinephrine, & dopamine.
ADHD typically occurs in what age group?
children, & usually starts before the age of 7
What are the characteristics of ADHD?
- Inability to concentrate
- Inability to complete tasks
What are the characteristics of Narcolepsy?
- Recurrent attacks of drowsiness during daytime
- Unable to control sleep
- Falling asleep while: Driving, Eating, Standing,
What are the Amphetamines, Adderall & Dexedrine used for?
- Adderall: ADHD & Narcolepsy
- Dexedrine: Obesity
The CNS stimulants in Adderall & Dexadring from the Amphetamines category act by doing what?
Stimulating the release of norepinephrine & dopamine.
What are the actions of Amphetamines Adderall & Dexedrine?
- Adderall & Dexedrine:
- ^wakefulness in narcolepsy
- <hyperactivity, impulsiveness & restlessness of ADHD
- Tx of obesity
What are the s/e of a/r of Amphetamines?
- Tachycardia, palpitations, hypertension
- Sleeplessness, restlessness
- Anorexia, dry mouth, Wt loss, diarrhea, constipation
What are some Amphetamine-Like Drugs & what are their uses?
- Methylphenidate (Ritalin) CSS II
- Methamphetamine (Desoxyn)
- NarcolepsyModafinil (Provigil)
- Pemoline (Cylert)
What are the s/e of Ampthetamine-Like drugs?
- wide range, dose related
- **tend to speed up body systems**
What are the nursing interventions for Amphetamines & Amphetamine-Like drugs?
- Take before breakfast & lunch
- Assess HR/rhythm
- **Record Height, Weight, Growth of children**Avoid alcohol & caffeine
- Use sugarless gum for dry mouth
- TAPER OFF - do not abruptly stop
List a few Anorexiants.
- Dextroamphetamine (Dexadrine)
- Sibutramine (Meridia)
- Orlistat (Xenical or Alli)
How do Anorexiants work?
What are the s/e of Anorexiants?
nervousness, restlessness, irritability, insomnia, palpitation, HTN
What is the primary use for Analeptics?
To stimulate respirations
Name some Analeptics.
- Caffeine (NoDoz, Coffee, Chocolate, Cold meds)
What are the Analeptics Caffeine & Theophylline used for?
- Caffeine & Theophylline: Stimulate respirations in newborns
- Theophylline: Relaxes bronchioles
What are the s/e of Analeptics?
- Restlessness, tremors, twitching, palpitations, insomnia, tinnitus, nausea, diarrhea
- psychologica dependence
The CNS Depressants: Sedatives are drugs that do what?
Diminishes physical & mental response
The CNS Depressants: Hypnotics do what?
- Cause sleep
- **A sedative can become a hypnotic if given in a large enough dose**
How does dosing affect the effect of Sedatives & Hypnotics?
- Low doses: Calm CNS w/o inducing sleep
- High doses: Calm CNS to the point of causing sleep
What are the categories of Sedative-Hypnotics?
What do the OTC Sedative-Hypnotics Nytol, Sleep-eze & Tylenol PM have in common?
What are the categories of Barbitruates?
Benzodiazepines are Antianxiety agents, name them. (pam, am or lam)
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Diazepam (Valium)
- Chlordiazepoxide (Librium)
Certain long-acting Benzodiazepines are used for alcohol withdrawal, which ones are they?
- Lorazepam (Ativan)
- Diazepam (Valium)
- Chlordiazepoxide (Librium)
Temazepam (Restoril) is a Hypnotic that is generally used long or short term?
Which Nonbenzodiazepines are used as Hypnotics for short term use of insomnia?
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
What are the general s/e of Sedative-Hypnotics?
- Residual drowsiness (Hang-over effect)
- Drug dependence
- Drug tolerance
- Excessive depression
- Respiratory depression
- Withdrawal symptoms
Sedative-Hypnotics like ALL CNS depressents interact with what things?
- Other CNS depressants
What are the nursing interventions for Sedative-Hypnotic drugs?
- Attempt Non-pharm methods 1st
- Take 15-45min before bed
- Report hang-over effect
- Be attentive to safety
- Avoid alcohol & other CNS depressants
- Monitor BP, Resp, withdrawal s/s
What are the 2 classifications of Anesthetics?
What is the purpose of General Anesthesia?
- Muscle relaxation
- Loss of consciousness
What is the purpose of Local Anesthesia?
Analgesic in limited area
Balanced Anesthesia is a combination of drugs given at varying times before, & during sx used for what purpose?
- <Cardiovascular problems
- <Amount of general anesthetic needed
What are the routes used for Anesthetics?
With Inhalation (General) Anesthetics like gas or volatile liquid what are the a/r to watch for?
- ***Malignant Hyperthermia***Resp. depression
- Hepatic dysfunction
Which Anesthetic causes LESS respiratory distress than General Anesthetics?
How do Topical Anesthetics work & name a few.
they <sensitivity of the affected area
- Chloreseptic spray
- Lidocaine Gell
How do Local Anesthetics work & what are they used for?
- Block pain at the site where drug is given
- used for dental procedures & other minor Sxs
- (Lidocaine, Novacaine)
List the Spinal Anesthetic types.
- Spinal Block
- Epidural Block
- Caudal Block
What are the nursing interventions for Anesthetics?
- Monitor: LOC
- Vitals: BP/P
- Resp. rate
- Cardiovascular status
What is the action of Antipsychotics?
Block action of dopamine
What are Antipsychotics used for?
- Bipolar Disorder
- Other types of psychosisis
What are the two major categories of Antipsychotic drugs?
- Typical (1st generation/older drugs)
- Atypical (2nd gen/newer drugs)
Typical Antipsychotic drugs are most effective for Positive s/s, name a few of these drugs.
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
- Rarely Used:
- Fluphenazine (Prolixen)
What are the s/e with Typical (1st Gen) Antipsychotics?
- Drowsiness, Anticholinergic effects (dry, dry)
- Extrapyramidal s/s (parkinson like s/s)
- Temors, rigidity, pill rolling, shuffling gait,
- restlessness (akathisia)
- Tx: Benztropine (Cogentin)
- Tardive Dyskinesia
- Tongue movements, foot tapping, shoulder
- Tx: stop drug
- Neuroleptic Malignant Syndrome (NMS)
- High fever, ^^CPK, muscle rigidity
- **LIFE THREATENING**
- Tx: stop drug, call DR!
What are the advantages of Atypical Antipsychotics?
- Effective in Tx of both positive & negative s/s of Schizophrenia
- Less likely to cause EPS or Tardive Dyskinesia
Name a few Atypical Antipsychotics.
- Clozapine (Clozaril): s/e Agranulocytosis- ^infection d/t <WBC (monitor CBC)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
What should a nurse monitor a client for when taking 2nd Gen Atypical Antipsychotics?
- "cheeking" meds
- Give w/food or milk
- watch for: EPS, NMS, TD
- Assess WBC w/Clozaril
- **NEED TO TAPER OFF MED NOT D/C ABRUPTLY**
How long could it take for Atypical Antipsychotics drugs to achieve effectiveness?
Anxiolytics (Antianxiety drugs) like the Benzodiazepines are used for a variety of issues, what are they?
- Preoperative drug
- Tx of Alcohol withdrawal
What are the two major Mood Disorders & how are they characterized?
- Depression: Loss of interest in normal activities, sad affect, vegetative symptoms
- Bipolar: mood swings from mania to depression
What are the major Antidepressant Agents?
- Most Common d/t less s/e
- SSRIs (Selective serotonin reuptake inhibitors)
- *Fluoxetine (Prozac), Sertraline (Zoloft)
- *Duloxetine (Cymbalta), Paroxetine (Paxil)
- *Citalopram (Celexa)
- Serotonin/Norepinephrine reuptake inhibitors
- *Venlafaxine (Effexor)
- *Desvenlafaxine (Pristiq)
- Atypical Antidepressants
- *Bupropion (Wellbutrin), Trazodone
- Not used much:Tricyclic Antidepressants (TCAs)
- *Amitriptyline (Elavil), Nortriptyline (Pamelor)
- Monoamine Oxidase Inhibitors (MAOIs)
- *Isocraboxide (Marplan) or Phenelzine (Nardil)
SSRIs (Selective Serotonin Reuptake Inhibitors) like Fluexetine (Prozac), Sertraline (Zoloft), & Paroxetine (Paxil) are used for what?
- Major depression, Anxiety disorders
- OCD, Panic, Phobias
What are the s/e of the SSRIs like Paxil & Prozac?
- HA, Nervousness, Restlessness, Insomnia/drowsiness= depending on person
- Tremors, GI distress, Sexual dysfunction, Seizures, suicidal ideation
- *s/e often <after 2-3wks
What are TCAs (Tricyclic Antidepressants) like Amitriptyline (Elavil) & Nortriptyline (Pamlor) used for?
- Major Depression
- Neuropathic pain
What are the s/e of TCAs?
- Big s/e:
- Anticholinergic Effects: Dizziness, blurred vision, dry mouth & eyes, urinary retention, constipation
- Wt gan, GI distress, Sexual dysfunction
- Ortho hypotension, dysrhythmias, EPS, blood dyscrasias
What are Mood Stabilizer drugs used for?
- Bipolar Disorder
- Anticonvulsants (Tegretol, Depakote, Lamictal)
Name a few Mood Stabilizer drugs.
- Carbamazepine (Tegretol)
- Valproic Acid (Depakote)
- Lamotrigine (Lamictal)
What is the biggest concern with Lithium?
the narrow therapeutic index
What are the s/e of Lithium?
HA, drowsiness, dizziness, hypotension, restlessness, slurred speech, dry mouth, metallic taste, tremors, muscle weakness, GI distress, edema of hands & ankles, ^urination, dysrhythmias, blood dyscrasias, nephrotoxicity
What are some nursing interventions for clients on Lithium?
- Lithium levels Q1-2 months
- Sodium levels
- suicidal tendencies
- urine output, rena fxn tests
- enc. fluids
- take w/food
What is the therapeutic range for Lithium?
- Toxic range: is >2mEq/L
What should a client taking Lithium wear?
Medic alert bracelet