Comprehensive Pharmacology of Adrenergic, Cholinergic, and Diuretic Drugs

Adrenergic drugs

Produce effects similar to the sympathetic nervous system.

Positive inotropic effect

An adrenergic drug that stimulates beta1-adrenergic receptors causes an increased force of contraction.

Increased heart rate

An expected effect when a patient is taking an adrenergic drug.

Increased cardiac output

The primary intended effect of an adrenergic agonist for a patient in shock.

Epinephrine

Appropriate for use in cardiac arrest.

Chest tightness, palpitations, anxiety, and elevated BP

Immediate concern for a patient on a dobutamine drip.

Salmeterol

Not effective for acute asthma attacks; indicated for prevention of bronchospasms.

Drug of choice for anaphylaxis

Epinephrine.

Beta2 adrenergic receptors

Stimulated by adrenergic drugs to cause bronchodilation.

Dopamine administration

Correctly administered via continuous IV infusion with an infusion pump.

Effects of sympathetic nervous system stimulation

Include bronchodilation, increased heart rate, pupil dilation, and glycogenolysis.

Developing heart failure

Concern for a patient on beta blockers who develops swollen feet, rapid weight gain, shortness of breath, and dizziness.

Atenolol (Tenormin)

Important teaching point is to never stop taking abruptly.

Phentolamine

Injected around the site of dobutamine extravasation to increase blood flow by vasodilation to prevent tissue damage.

Metoprolol (Lopressor)

Given after myocardial infarction to increase survival rates (cardioprotective).

Tamsulosin (Flomax)

Patients should get up slowly from sitting or lying positions to avoid orthostatic hypotension.

Nonspecific beta blockers

May cause serious problems in patients with asthma.

Carvedilol (Coreg)

Indicated for heart failure.

Pulse below 60 beats per minute

A patient on beta blockers should notify the prescriber if this occurs.

Impotence

An adverse effect of beta blockers that often causes patients to stop taking them.

Sildenafil (Viagra)

Should not be taken by a patient on tamsulosin (Flomax) due to interaction.

Orthostatic hypotension

A potential drug effect that must be monitored in a patient on an alpha blocker.

Drugs that interact with beta blockers

Include diuretics, anticholinergics, oral hypoglycemics, and alcohol.

Bradycardia

Cardiovascular effect of a low-dose cholinergic drug.

Spironolactone (Aldactone)

Diuretic for which the nurse should monitor a patient for signs and symptoms of hyperkalemia.

Mannitol (Osmitrol)

Drug that should be administered intravenously, through a filter, for a patient with acute renal failure.

Furosemide (Lasix)

Diuretic prescribed for a patient who should be instructed to change positions slowly to prevent dizziness and possible fainting.

Loop diuretics

Diuretics that have a rapid onset of action and cause rapid diuresis.

Hydrochlorothiazide (HydroDIURIL)

Diuretic that may cause a severe interaction with Digitalis.

Fluid volume status assessment

Best reflected by intake, output, and daily weight during diuretic therapy.

Diuretic administration timing

A patient on a single daily dose of a diuretic should take it in the morning.

Thiazide diuretics

Diuretic class likely used initially for antihypertensive therapy.

Osmotic diuretics

Class of diuretic used to reduce intracranial pressure in patients with cerebral edema.

Orthostatic hypotension precautions

Important teaching point for a 79-year-old patient taking a diuretic for hypertension.

Diuretic therapy complications

Advice for a patient who has had vomiting and diarrhea for 2 days is to come into the clinic for an evaluation.

Potassium deficiency manifestations

Include muscle weakness, anorexia, and lethargy in a patient on a loop diuretic.

Transdermal patch for testosterone therapy

Used instead of a pill for better absorption of the medication.

Fluid retention monitoring

What the nurse should monitor for when a male patient is receiving androgen therapy.

Finasteride (Proscar) effects

May cause increased hair growth in a patient.

Androgenic steroids adverse effect

Possible liver damage in a 21-year-old athlete.

Finasteride (Proscar) handling precaution

Must not be handled by pregnant women during administration.

Sildenafil (Viagra) problem

Potential issue for a 73-year-old male taking nitrates who wants to use sildenafil.

Significant decrease in blood pressure

A notable drop in blood pressure levels.

Preferred body locations for transdermal testosterone gel (AndroGel)?

Back, thighs, abdomen, upper arms.

How does dextromethorphan suppress the cough reflex?

Having direct action on the cough center.

Most common adverse effect of antihistamines?

Drowsiness.

Benefit of orally administered decongestants?

Lack of rebound congestion.

Patient teaching for guaifenesin (Humibid)?

Force fluids to help loosen and liquefy secretions.

Systemic effect of excessive topical adrenergic nasal decongestant use?

Palpitations.

Which drug helps remove thick mucus from the respiratory tract?

Guaifenesin (Humibid).

How long should use of an adrenergic nasal spray be limited?

3 to 5 days.

Primary use of echinacea?

Boosting the immune system.

Antihistamine patient teaching instructions?

Take with food to minimize gastrointestinal distress, drink extra fluids, avoid activities that require alertness until effects are known.

Therapeutic response to intravenous aminophylline?

Increased ease of breathing.

Adverse effects of xanthine derivatives?

Palpitations.

Medication used for acute asthma attack?

Short-acting beta2 agonist such as albuterol (Proventil).

Important point about montelukast (Singulair)?

It needs to be taken every day on a continuous schedule, even if symptoms improve.

Patient complains of nervousness after beta agonist nebulizer treatment. What should the nurse say?

This is an expected adverse effect. Let me take your pulse.

Which inhaler should be used first, bronchodilator or corticosteroid?

Bronchodilator inhaler first.

Potential adverse effects of inhaled corticosteroids?

Oral candidiasis and dry mouth.

Theophylline level of 22 mcg/mL indicates?

Above the therapeutic level.

Patient unable to coordinate MDI use. Appropriate intervention?

Obtain an order for a spacer device.

Advair inhaler (fluticasone and salmeterol) is used for?

Prevention of bronchospasms.

Drugs used for acute asthma attacks?

Albuterol (Proventil) nebulizer solution, epinephrine.

Patient statements indicating need for further instruction with corticosteroid MDI?

"I will gargle after using the inhaler and then swallow." and "I will use this inhaler for asthma attacks."