Autonomic nervous system

phenylephrine (pseudoephedrine)

classification: alpha agonist

indications: upper respiratory tract infections

MOA: stimulate muscarinic receptors in respiratory tract

considerations:

• limited use due to illicit drug manufacture

• contraindicated w/ MAOI use

• cautious use in glaucoma, hypertension, and enlarged prostate

• do not administer within 2 hours of bedtime = hyperactivity

side effects:

• urinary retention

• abnormal heart beat

• SOB

tamsulosin (flomax)

classification: alpha 1 agonist

indications: treatment of benign prostatic hyperplasia

MOA: selectively blocks alpha receptors in prostate and urethra (vasodilates)

side effects:

• hypotension

• orthostatic hypotension

clonidine

classification: alpha 2 agonist

indications: HTN, ADHD

MOA: decreases peripheral resistance and vasodilation

considerations:

• monitor BP and HR

• avoid alcohol

• do not stop abruptly

• caution with alc and exercise = works on CNS

side effects:

• hypotension

• bradycardia

• sedation

dobutamine

classification: beta 1 agonist

indiactions: cardiogenic shock, severe heart failure

MOA: stimulate beta 1 receptors; increase HR, force of contractions and conductivity velocity

considerations:

• ekg

• notify provider immediately for chest pain, SOB, numbness, tingling in extremities (2 min activation/half-life)

side effects:

• hypertension

• tachycardia

• palpitations

metoprolol

classification: beta 1 agonist (beta blocker)

indications:

• HTN

• angina

• arrhythmias

• early MI intervention

MOA: blocks beta 1 receptors in heart = decrease HR and BP

considerations:

• higher doses effect beta 2 receptors

• take apical pulse first

• do not stop abruptly

• sensitivity to cold

• limit caffeine

side effects:

• hypotension

• worsening heart failure

• insomnia

• nightmares

• erectile dysfunction

• dyspnea and wheezing

• masking hypoglycemia

albuterol

classification: beta 2 agonist

indications: asthma, COPD

MOA: stimulate selective beta 2 receptors in the lungs but can also affect beta 2 receptors in the heart

consideration: take RR, HR, O2

side effects:

• paradoxical bronchospasm

• increased HR/BP

propranolol

classification: beta 2 antagonist

indication:

• HTN

• angina

• tremors

• migraine prevention

MOA: blocks beta ½ receptors (nonselctive)

considerations:

• check BP and apical HR

• causes bronchoconstriction in asthma and copd

• mask s/s of hypoglycemia of diabetics

• hepatic and renal impairment

• do not stop abruptly

side effects:

• hypersensitivity

• bronchoconstriction

Epinephrine/Norepinephrine

classification: alpha and beta receptor agonist

indications:

• anaphylaxis

• bronchospasm

• cardiac resuscitation

MOA: acts on both alpha and beta receptors

• increases vascular permeability (alpha)

• smooth muscle relaxation (beta)

Considerations:

• monitor BP, HR, RR

side effects:

• hypertension

• tachycardia

• anxiety

• epipen increases vascular permeability and may increase fluid volume and cause hypotension

dopamine

classification: alpha and beta receptor agonist

indications: improve cardiac output to perfuse to organs

MOA (dose dependent):

• low = stimulates dopamine receptors and dilates renal vasculature

• moderate = stimulate beta receptors and has a positive inotropic effect

• high = stimulate alpha receptors constricting blood vessels and increases blood pressure

consideratiosn:

• monitor BP, HR, RR

• urine output

side effects:

• hypotension

• dizziness

• decreased blood flow to extremities

nicotine patch

classification: nicotinic receptor agonist

indications: aid in nicotine cessation

side effects:

• allergic reactions

• palpitations

• nicotine OD

pilocarpine

classification: muscarinic receptor agonists

MOA: constricts pupil

considerations: apply light finger pressure to lacrimal sac for 2 min after instilling

side effects:

• hypotension

• poor night vision

atropine

classification: muscarinic receptors

MOA: acts on specific muscarinic receptors and provide dose dependent effects

• small = inhibits secretions

• moderate = increase HR

• large = decrease GI motility

side effects

• urinary retention '

• abnormal HR

• faiting

• tremors

• weakness