CH 15: Adrenergic -- Atenolol & Epinephrine

CH 14: Adrenergic antagonist and agonist. Yellow: prototype drug | purple: topics from review | "*" sign: deemed important by chatgpt | red: drug class-related to prototype drug

*(1) The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist (albuterol) to treat bronchospasm. The nurse knows this drug can potentially cause which side effect?

a. Increased drowsiness

b. Decrease blood pressure

c. Increased heart rate

d. Increased gastrointestinal (GI) motility

ANS: C

an adrenergic agonist (albuterol) medication will lead to (C) increased heart rate.

→ adrenergic agonist: allows SNS. increased heart rate is one of “fight/flight’s” triggers.

Epinephrine (drug) adrenergic agonist / sympathomimetic (drug class) — adrenergic agonist side effects —> tachycardia

adrenergic agonists vs. antagonists — beta₂ agnosits —> tachycardia

*(2) A patient who has asthma requires treatment with a beta blocker to manage his cardiovascular disease. The nurse understands that which drug will be the safest to give this patient?

a. Pindolol (Visken)

b. Metoprolol (Lopressor)

c. Nadolol (Corgard)

d. Propranolol (Inderal)

ANS: B

if the patient has a cardiovascular disease the safest drug to select as an asthma beta blocker medicine would be (B) metropolol

→ metropolol: same class with ATENOLOL. they are cardioselective, evading the PNS effect (bradycardia, Low BP)

Atenolol (drug) adrenergic antagonist (drug class) — cardioselective beta blocker (metoprolol) vs. nonselective beta blockers in asthma

adrenergic agonists vs. antagonists — beta blockers and bronchoconstriction

*(3) The nurse administers epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect which of the following?

a. Bradycardia

b. Decreased urine output

c. Hypotension

d. Nausea and vomiting

ANS: B

when administering epinephrine to an anaphylactic patient, (B) decreased urine output is expected.

—> apinephrine = SNS: renal vasoconstriction is done. the “rest and digest” system is CLOSED OFF.

epinephrine (drug type) — dopamine agonist / sympathomimetic (drug class)

adrenergic agonists vs. antagonists —epinephrine effects during anapylaxis

(4) An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has

a. overused the albuterol.

b. not been using albuterol.

c. taken a beta-adrenergic blocker.

d. taken a monoamine oxidase (MAO) inhibitor

ANS:A

an asthma patient that comes in for tachycardia, restlesness, and tremors while on albuterol is due to (A) overuse of albuterol.

→. high doses of albuterol can affect beta1 resceptors. this then leads to tachycardia.

adrenergic agonists vs. antagonists —overuse causing sympathetic effects

(6) The nurse is teaching a patient how to use phenylephrine HCl (Neo-Synephrine) nasal spray to treat congestion from a viral upper respiratory infection. What instruction will the nurse give the patient?

a. Use this product for a maximum of 3 days.

b. Spray the medication into the nose while lying supine.

c. Use frequently since systemic side effects do not occur.

d. Use the medication prophylactically to prevent future nasal congestion during cold season.

ANS: A

when taking Phenylephrine HCl (neo-synephrine) nasal spray, it should be instructed that the patient should (A) use this product for a maximum of 3 days

→ phenylephrine HCl = adrenergic aagonist → causes rebound nasal congestion. should not be administered for long periods of times

adrenergic agonists vs. antagonists —phenylephrine nasal spray (adrenergic agonist)

(10) A patient is taking doxazosin mesylate (Cardura) 1 mg/day to treat hypertension. The nurse notes a blood pressure of 110/72 mm Hg and a heart rate of 92 beats per minute. The nurse will contact the provider to discuss which change to the drug regimen?

a. Changing to an alternative medication class to treat hypertension

b. Decreasing the doxazosin dose

c. Increasing the doxazosin dose

d. Adding a diuretic

ANS: A

(A) Changing to an alternative medication class to treat hypertension would be appropriate to avoid hypotensive events. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well controlled.

→ Alpha-adrenergic blockers: can cause orthostatic hypotension and reflex tachycardia

→ why change meds? the patient is already dfeeeling the unwanted effects of adrenergic antagonists which are:

• hypotension

• tachycardia

Atenolol (drug) adrenergic antagonist (drug class) — alpha blocker causing hypotension/tachycardia (helps compare adrenergic antagonists)

adrenergic agonists vs. antagonists - alpha blockers causing orthostatic hypotension

(11) A patient who has Raynaud’s disease will begin taking an alpha-adrenergic blocker. The patient asks the nurse how the drug works to treat symptoms. The nurse explains that alpha-adrenergic blockers treat Raynaud’s disease by causing

a. decreased peripheral vascular resistance.

b. orthostatic hypotension.

c. reflex tachycardia.

d. vasodilation

ANS: D

when using adrenergic blockers, it helps with raynaud;s disease directly through (A) vasodilation (blood vessels loosened/widened)

→ raynaud’s diseasse: vasoconstriction (blood vessels are tightened/narrow/constricted) of the in fingers/toes

adrenergic agonists vs. antagonists - vasodilation from alpha blockers

*(14) A patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to thenurse of feeling weak and fatigued. Which is thebest response from thenurse?

a. “I will hold your next dose of themedication.”

b. “You may need an increase in your next dose of themedication.”

c. “This is an adverse reaction to themedication. I will stop thedrug.”

d. “This is a side effect of themedication. I will notify your physician.”

ANS: D

Weakness and fatigue can be a side effect of atenolol. Beta blockers should not be stopped abruptly, thus it would be appropriate to notify thepatient that these symptoms could be due to themedication and that thephysician will be notified.

→ why sympathomimetic is contraindicated with DM: these drugs causes fight or flight, which triggers blood glucose spike

Atenolol (drug) adrenergic agonist (drug class) — atenolol causing weakness/fatigue

side effects that need monitoring/teaching - fatigue with atenolol

(15) The patient has been ordered to receive pseudoephedrine (Sudafed) to treat nasal congestion. the nurse performing an admission assessment learns that thepatient has diabetes mellitus. What action is appropriate for thenurse to take?

a. Administer themedication as ordered.

b. Contact theprovider to discuss a lower dose.

c. Give themedication and monitor serum glucose closely.

d. Hold themedication and contact theprovider.

ANS: D

Sympathomimetic drugs should be used with caution in patients with diabetes. thenurse should verify the order with theprovider before administration

epinephrine (drug) sympathomimetic/adrenergic agonist (drug class) —- hyperglycemia concern with sympathmomimetics in diabetics

adrenergic agonists vs antagonists — sympathomimetics caution in diabetics

*(1) The nurse caring for a patient who is taking a non-specific adrenergic agonist will expect which of thefollowing side effects? (Select all that apply.)

a. Dilated pupils

b. Increased heart rate

c. Increase gastrointestinal motility

d. Vasodilation

e. Bronchospasm

ANS: A,B

Adrenergic agonists stimulate thesympathetic nervous system, evoking the“fight or flight” response. This response increases those functions needed to respond to stress (increased heart rate to perfuse muscles, bronchodilation to increase oxygen exchange). Adrenergic drugs shunt blood away from thegastrointestinal tract, as digestion is not critical during a fight or flight response.

adrenergic agonists vs antagonists — “fight-or-flight” effects directly