cholinergic and adrenergic: agonist and antagonist

Alpha 1 receptors are found where

found on smooth muscle of vasculature, the eyes and genitourinary

Alpha 2 receptors are found where

located in the CNS

what do Alpha 1 receptors cause when stimulated

smooth muscle contraction and vasoconstriction

what do alpha 2 receptors cause when stimulated

inhibitory effect on SNS, causing vasodilation and decreased BP

beta 1 receptors are found where

heart and kidneys

beta 2 receptors are found where

smooth muscles of lungs, liver, uterus, GI system, bladder

what do beta 1 receptors do when stimulated

increased CO, heart rate and renin production this will contribute to elevation in BP

what do beta 2 receptors do when stimulated

smooth muscle relaxation occurs (bronchodilation)

where are nicotinic 2 receptors found

muscle cells in the somatic nervous system

where are nicotinic 2 receptors found

nervous system, ACh activated N2 causing release of neurotransmitters such as epi and nor api

what do muscarinic receptors do

5 types, M1-M5 all in CNS divided across organs stimulated during rest and digest

Cos helps with memory learning brain development

albuterol

common sympathomimetic med, called b2 adrenergic agonist; binds to b2 in SNS with strong affinity for those receptors within smooth muscle surrounding bronchioles of lungs

effects on body: causes bronchioles to dilate allows for increase airflow and oxygenation, good for patients with COPD and asthma, emphysema and chronic bronchitis, short term relief “rescue”med

nursing assessment: assess lung sounds, pulse, BP, sputum color, pulmonary function, potassium

route: inhaler, nebulizer, oral

side effects: nervousness, restlessness, termor, chest pain, palpations, HTN, hyperglycemia, hypokalemia, V, HA, hyperactivity in kids

contraindications: children less then 2

propranolol

therapeutic use: HTN, angina, dysrhythmias, anxiety, PTSD, alcohol withdraw, HA

nonselective beta blocker → inhibits both b1 and b2 receptors on target organs of SNS

nursing assessment: Assess HR and BP before giving, monitor for fluids overload, rash orthostatic hypotension, review labs such as BUN, k+ blood glucose

route: IV, Oral

side effects: fatigue, weakness, erectile dysfunction, orthostatic hypotension, dizziness, N/V/C, wheezing, arythmias, bradycardia, HF, pulmonary edema, SJS

client teaching: dont stop abruptly will cause cardiac excitation and may cause MI if pt has HX, assess pulse before taking it and change position slowly

metoprolol

cardioselective beta blocker, limits of meds compared to propranolol

meds do not affect b2 receptors but they are still used caustionsouly in pt with asmtha and DM

therapeutic use: HTN, angina (reduces mortality in pt who have MI, HF)

nursing assessment: assess pulse proper to giving: do not give if its less than 50, monitor HR, BP and ECG, fluid overload

route: IV, IV push, PO

side effects: fatigue, weakness, erectile dysfunction, decreased HR, dizziness, N/V/C, wheezing, bradycardia, HF, pulmonary edema, heart block

outcome should be a decrease in BP and anginal attacks, increase activity tolerance

bethanecol

used to reverse acute postoperative urinary retention, patients with neurogenic bladder

action: stimulates muscarinic receptors to cause bladder contraction increasing urinary output

nursing assessment: assess vitals proper to and after administration, monitor I&O, and palpate bladder for distention

route: oral on empty stomach → reduces N/V

side effects: N/V/D, salvation, cramps, hypotension, urinary urgency, sweating, bradycardia, heart block, syncope, cardiac arrest

counter indications: obstruction of genitourinary or GI tract

precautions: CVD, peptic ulcer disease, asthma, hyperthyroidism, epilepsy A cholinergic agonist that stimulates muscarinic receptors.

atropine

main use is bradycardia, dry out salvation for procedures and can counteract cholinergic overdose

therapeutic use: decrease oral secretions and reverse bradycardia

nursing assessment: for IV, assess VS and ECG frequently, I&O and bowel sounds

Route: IV push

side effects: tachycardia, blurry vision, dry mouth, urinary hesitancy, drowsiness, arythmias, pulmonary edema, coma

counter indications: glaucoma, obstructive disease of GI tract, avoid in older adults

teachings: may cause drowsiness avoid when driving mainly used to treat

prazosin

used for HTN and benign prostatic hyperplasia (enlarged prostate)

helps BPH by: relieving urinary symptoms caused by a noncancerous enlargement of the prostate gland

route: PO,IV,SQ

nursing assessment: assess BP

side effects: orthostatic hypotension, dizzy, drowsy, fatigue, first dose phenomenon (a sudden, severe drop in blood pressure that happens shortly after a person takes their very first dose of a new medication)

counter indications: osteoarthritis, renal impairment, CAD

recommend: take at nighttime because it will decrease the fall risk as they are sleeping through the sudden drop in BP urinary retention; lowers BP

dobutamine

sympathomimetic mimics SNS → vasoactive med

therapeutic use: acute exacerbation of HF (rapid/sudden worsening of HF signs, severe SOB, fatigue, fluid retention)

nursing assessment: monitor HR, BP and hemodynamics

route: central line recommended based on weight and response

counter indications: hypovolemia

side effects: hypertension, tachycardia, palpations, N/V/HA, chest pain, severe hypo or hypertension, dysrhythmias, tissue necrosis

teach pt: notify if chest pain, respiratory manifestations occur, burning, tingling in arms and legs used to improve cardiac output by increasing contractility and heart rate.

epinephrine

use for CPR, anaphylaxis, local vasoconstriction, mydriasis (when pupils fail to constrict when exposed to bright light)

route: SQ,IV,IM, inhaled, topical, ophthalmic

nurse assessment: bp and hr

side effects: nervousness, tremors, tachycardia, HTN, dysrhythmias, pulmonary edema, CNS stimulation, local necrosis

counter indications: closed angle glaucoma, CAD