Mod 4- Adrenergic Agonists Drugs that Stimulate the Sympathetic Nervous System

In sympathetic nervous system do bronchioles constrict or dilate

bronchioles dilate.

What 3 muscles might relax during sympathetic activation NS

Urinary bladder, Gi smooth muscle, bronchiole smooth muscle.

What receptors does epinephrine stimulate

Alpha 1, beta 2, beta 1

Stimulation of which adrenergic receptor by epinephrine causes increased heart rate

Beta-1 receptors

Stimulation of which adrenergic receptor by epinephrine causes vasoconstriction and increased blood pressure?

Alpha-1 receptors

Through stimulation of which specific receptor does epinephrine achieve bronchodilation?

Beta-2 receptors

A patient is experiencing laryngeal swelling and hypotension due to a severe peanut allergy. Is epinephrine indicated for this emergency?

Yes, it is indicated

A nurse is responding to a code blue for cardiac arrest is epinephrine part of indicated treatment ?

Yes, it is indicated

A patient with asthma is having an acute bronchospasm and is struggling to breathe. Is epinephrine indicated to relieve this symptom?

Yes, it is indicated

A patient has symptomatic bradycardia that is not responding to other treatments. Is epinephrine indicated to increase their heart rate and perfusion?

Yes it is indicated

A patient is having an allergic reaction but has a known severe allergy to epinephrine itself. Is epinephrine indicated for this patient?

No, it is not indicated

A patient with chest pain is diagnosed with an acute myocardial infarction (heart attack). Is epinephrine indicated to manage their blood pressure?

No, it is not indicated

A patient with a history of unstable ventricular tachycardia (a dangerous arrhythmia) is experiencing mild wheezing. Is epinephrine indicated for their breathing?

No it is not indicated

A patient with advanced, uncontrolled heart failure (cardiovascular disease) needs treatment for anaphylaxis. Is epinephrine still the first-line drug?

Yes, it is indicated for the life-threatening anaphylaxis, but it must be used with extreme caution and close monitoring due to their heart disease.

A patient is receiving epinephrine for anaphylactic shock. They become extremely anxious and their heart is racing. What is the nurse's best understanding of these symptoms?

These are expected side effects of epinephrine. The drug must be continued because the life-threatening nature of anaphylaxis outweighs these risks

A patient receiving epinephrine for cardiac arrest develops a new cardiac arrhythmia. Would this typically be a reason to immediately stop the epinephrine?

No. In a cardiac arrest, the goal is to restart the heart. The benefit of trying to achieve a rhythm outweighs the risk of causing a new arrhythmia.

A patient with a history of migraines receives epinephrine and develops a severe headache. The nurse recognizes this as:

A known side effect of the medication, but not a reason to withhold a dose in an emergency.

A patient with a history of coronary artery disease receives epinephrine for a severe asthma attack. Shortly after, they report new substernal chest pain (angina). What is the most likely cause of this pain?

The epinephrine is increasing cardiac workload and oxygen demand, potentially causing myocardial ischemia (angina).

A diabetic patient requires epinephrine for anaphylaxis. The nurse should anticipate what potential effect on the patient's blood glucose levels?

Epinephrine can cause hyperglycemia (high blood sugar) by stimulating the release of stored glucose.

What is a severe risk to the tissue if intravenous (IV) epinephrine leaks into the surrounding skin (infiltrates)?

Necrosis and gangrene

nurse notices an epinephrine IV has infiltrated. Which medication must be prepared to inject into the area to prevent tissue damage?

Phentolamine mesylate

What is the critical time window to administer phentolamine after an epinephrine extravasation to prevent tissue necrosis?

Within 12 hours of the infiltration.

A patient taking propranolol (a beta-blocker) for high blood pressure receives epinephrine for a severe allergic reaction. The nurse should anticipate that the epinephrine's effect might be:

Decreased or less effective.

A patient taking nitroglycerin for angina receives epinephrine. The nurse should be most concerned about which potential effect?

Severe hypotension (low blood pressure) from amplified vasodilation.

A patient taking a monoamine oxidase inhibitor (MAOI) antidepressant requires epinephrine. This combination is dangerous because it can cause:

Life-threatening hypertension.

Before giving epinephrine, why must a nurse assess baseline heart rate and blood pressure?

To have comparison point to identify the drug's effects and potential side effects like tachycardia or hypertension.

What must a nurse listen for in a patient's lung sounds before administering epinephrine for respiratory distress?

wheezing which indicates limited airflow and provides a baseline to measure improvement.

What specific type of monitoring is essential during IV epinephrine administration in cases of dangerous arrhythmias.

Continuous cardiac monitoring

How often should blood pressure be monitored during an epinephrine infusion because of the risk of hypertension

Frequently or continuously

Which two types of medications in a patient's history are critical to identify due to dangerous interactions with epinephrine?

MAOIs (risk of hypertension) and Beta-blockers (risk of reduced epinephrine effect).

Name conditions in a patient's health history that are contraindications for epinephrine.

Uncontrolled hypertension

Cardiac arrhythmias

Acute MI
Cardiovascular disease

Two things to verify about an IV site before administering epinephrine?

Patency and large-bore IV to prevent infiltration and tissue damage.

Primary nursing diagnosis for patient in anaphylaxis receiving epinephrine?

Ineffective airway clearance related to bronchospasm and swelling

A patient with symptomatic bradycardia is receiving epinephrine. What is an appropriate nursing diagnosis?

Decreased cardiac output related to low heart rate.

What are two expected respiratory outcomes after successful epinephrine administration?

Oxygen saturation >92% and decreased wheezing upon auscultation.

What are the target ranges for heart rate and systolic blood pressure after epinephrine stabilizes a patient?

Heart rate 60-100 beats per minute Systolic BP 95-110 mmHg.

What is the standard IV dose of epinephrine for an adult in cardiac arrest, and what critical action follows it?

1 mg IV, followed by a 20 mL saline flush.

Why must the nurse monitor the IV site frequently during a vasopressor (like epinephrine) infusion?

To check for extravasation (leakage), which can cause tissue necrosis (death).

What is the name of the antidote injected into the tissue to treat epinephrine extravasation, and how is it prepared?

Phentolamine mesylate, diluted in 10-15 mL of saline.

What bodily function should be monitored during epinephrine administration due to the risk of impaired kidney perfusion?

Urinary output (to detect impaired renal perfusion or urinary retention).

When should a patient self-administer an EpiPen for an allergic reaction?

Immediately upon the initial occurrence of symptoms like difficulty breathing, wheezing, hives, or swelling of the lips.

Where on the body should an EpiPen be injected?

Into the outer thigh.

What should a patient check for visually on their EpiPen before using it?

Discoloration or particles in the solution.

Name two systemic adverse effects a patient should report after using an EpiPen

Palpitations
Headache (or tremors, insomnia, agitation).

How should a nurse evaluate the effectiveness of epinephrine in a patient with low blood pressure?

Systolic blood pressure should be within normal range or trending upward.

What are the two other names for Adrenergic Antagonists?

Adrenergic blocking drugs and Sympatholytics

Name the body systems or organs mostly affected by adrenergic blocking drugs

Eyes, blood vessels, lungs and heart

What two structures in the urinary system relax when alpha-1 blockers are administered?

The bladder and the prostate.

Adrenergic blocking drugs cause effects that are the ________ of the normal sympathetic nervous system response.

Opposite

What two major effects do adrenergic blockers have on the heart and blood vessels?

Decrease heart rate
vasodilation

What is the effect of adrenergic blockers on the lungs?

Bronchoconstriction

How do adrenergic blockers affect the pupils?

pupil constriction (miosis).

How do alpha-1 blockers affect the bladder and prostate?

They reduce smooth muscle tone, leading to relaxation.

What is a common suffix ("last name") for drugs in the alpha-1 blocker class?

-zosin or -losin

Which alpha-1 blockers are used to treat hypertension

doxrazosin, prazosin, terazosin

Mechanism of action for alpha-1 blockers used to treat hypertension

Cause arterial and venous dilation reducing peripheral resistance and blood pressure.

Which alpha-1 blocker is specifically used for BPH, and how does it help?

Tamsulosin.

Mechanism of action for tamulosin

Relaxes smooth muscle in the bladder neck and prostate, improving urine flow and bladder emptying.

What is the key difference between tamsulosin and other "-zosin" drugs like doxazosin?

Tamsulosin, more selective for prostate/bladder receptors; used for BPH while Doxazosin/Prazosin, less selective; used for hypertension (and off-label for BPH).

What is the desired outcome for a patient taking tamsulosin for BPH?

Improved urinary flow

reduced hesitancy

more complete bladder emptying.

What does epinephrine do if it leaks into tissue extravasation

Causes severe vasoconstriction, which can lead to necrosis and amputation.

What class of drug is phentolamine and its main effect?

It is an alpha-blocker. Its effect is vasodilation.

How does phentolamine fix epinephrine extravasation?

It blocks the alpha receptors that epinephrine was over-stimulating, reversing the vasoconstriction.

What is a major contraindication for giving an alpha-1 blocker?

What is the "first dose phenomenon" of alpha-1 blockers?

A sudden, severe drop in blood pressure after the first dose.

A patient feels dizzy when standing up after taking their alpha-1 blocker. What is this called?

Orthostatic hypotension.

Name other side effects of alpha-1 blockers (not hypotension).

Headache and nasal congestion, edema, constipation

In which two patient populations should alpha-1 blockers be used with caution?

Those with hepatic (liver) or renal (kidney) disease.

What is the first-line treatment to support blood pressure in an alpha-blocker overdose?

IV fluid administration.

If IV fluids are not enough to raise blood pressure after an overdose, what type of drug is given next?

A vasopressor (e.g., dopamine or norepinephrine).

Taking an alpha-blocker with which two types of drugs can cause a dangerous additive drop in blood pressure?

Beta-blockers and erectile dysfunction drugs (e.g., sildenafil/Viagra).

What happens when an alpha-blocker is given with epinephrine?

Antagonistic effect the alpha-blocker makes the epinephrine less effective.

Before starting a patient on an alpha-blocker, what is a critical part of the medication history to assess?

Check for interactions with other drugs, especially beta-blockers or erectile dysfunction medications.

Which two baseline vital signs are most important to obtain before giving the first dose of an alpha-blocker?

Blood pressure* and heart rate.

What is the primary nursing diagnosis for a patient starting on a new alpha-blocker?

Deficient Knowledge related to drug therapy.

What is one key goal for a patient learning about their alpha blocker

Patient will verbalize the potential side effects of the drugs

What is the target blood pressure range for this patient

between 100/560 and 140/80 mmHg

How long might it take for an alpha blocker to reach its full effect of the blood pressure

Up to 4weeks

Why is it important to weigh yourself daily while taking an alpha blocker

To monitor for fluid retention which is a potential side effect

Why do alpha blockers cuse fluid retention (edema as a side effect)

Due to vasodilation, widened blood vessels let fluid to leak out from the capillaries into surrounding tissues (interstitial space)

A patient reports swelling around their ankles. what side effect of alpha blockers could this be

Ankle Edema (peripheral edema)

When should the very first dose of an alpha blocker be taken and why?

Take at night , help minimize side effect like dizziness and fainting (first dose hypotension)

What if the patient BP hasn’t improved after one week on alpha-blocker, the med isnt working ?

No it takes up to 4 weeks of taking the med to see the full therapeutic effect 

Why must you NEVER stop taking an alpha-blocker abruptly?

It can cause rebound hypertension (a dangerous spike in blood pressure).

Patient teaching on Tamsulosin: when getting up from sitting or lying down, what must you do to prevent dizziness or fainting?

Rise slowly and in stages to prevent orthostatic hypotension

Why is it critical to avoid most over-the-counter (OTC) cold and allergy medicines?

Contain adrenergic stimulants which counteracts the alpha blocker and raise the BP

Patient asks why should i take my tamulosin dose in the evening

To help with urinary frequency/ urgency at night
to minimize the first-dose hypotensive affect (dizziness) 

When weighing yourself daily after tamulosin, when should you call your doctor regarding your weight ? 

If you gain more than 5 pounds in 2 days (signals fluid retention) 

What is a key positive evaluation for a patient taking tamsulosin for urinary symptoms

Ability to start and maintain an steady stream of urine

List ways to know if the drug therapy is effective

BP in target range
Improvement in urinary flow - steady stream 
Pts takes meds as prescribed without side effects 

True or False First dose occur with increase in dose

True

What is the suffix (ending) for beta blockers

OLOL

What receptors do nonselective beta blockers block

beta 1 and beta 2 receptors

Non selective beta blockers can SLOW the heart rate but can cause some bronchoconstriction in what population of patients 

Asthma or COPD 

The MOA of beta blockers? what receptors do they block? what hormones do they compete with? 

They block SNS stimulation, block beta adrenergic receptors, compete with norepinephrine and epinephrine. 

TRUE OR FALSE
Angina is an indication for beta blocker use 

True 

TRUE OR FALSE

MI & cardiac dyrhythmias are an indication of beta blocker use

True

hypertension and heart failure is an indication of beta blocker use true or false ?

True

True or False: Beta blockers are not indicated for monotherapy of hypertension in African American clients; it will be used in combination with a diuretic.

True

A nurse reviews a pts chart before administering metoprolol (beta blocker) and sees a 3rd degree heart block a condition where electrical signals between the atria and ventricles are complete blocked. would beta blockers be advised for this pt ? and why? 

NO it would further suppress only electrical activity initiating heart beat, increasing the risk of asystole (cardiac arrest)