Complementary and Alternative Therapies

Lifespan, Cultural, and Individual Pharmacotherapy Considerations

Learning Outcomes for Module 3

• Identify types of complementary and alternative therapies used to promote wellness and any identify related adverse effects.

• Discuss pharmacokinetic variables that alter drug responses in pregnant patients.

• Relate pharmacokinetic variables to altered drug responses in pediatric patients.

• Explain how age-related physiological changes and polypharmacy can affect drug responses in older adults.

• Describe how genetic mutations and/or gender can influence pharmacotherapy.

• Discuss the mechanisms of action, indications, contraindications, drug interactions, adverse effects, and nursing interventions related to adrenergic agonists.

Adrenergic Norepinephrine Receptors

Receptor Information

• Alpha 1:

  • Primary Location: All sympathetic target organs except the heart

  • Function: Causes constriction of blood vessels and dilation of pupils.

• Alpha 2:

  • Primary Location: Presynaptic adrenergic nerve terminals

  • Function: Inhibits norepinephrine release.

• Beta 1:

  • Primary Location: Heart and kidneys

  • Function: Increases heart rate and force of contraction; releases renin.

• Beta 2:

  • Primary Location: All sympathetic target organs except the heart

  • Function: Inhibits smooth muscle contraction.

Nonselective Adrenergic Agonists

Prototypes

• Epinephrine (Adrenalin)

• Dopamine (Intropin) (Dopamine, Alpha1 and Beta1 agonist)

• Ephedrine (Efedron)

• Norepinephrine (Levophed)

Epinephrine (Adrenalin) Overview

• Adverse Effects:

  • Nervousness and tremors

  • Tachycardia, hypertension (HTN), dysrhythmias, pulmonary edema

  • CNS stimulation

  • Local tissue necrosis

• Contraindications:

  • Hypersensitivity

  • Closed-angle glaucoma

  • Coronary artery disease (CAD)

  • Pregnancy: Category C

• Routes of Administration:

  • Subcutaneous (SQ), intravenous (IV), intramuscular (IM), inhalation, topical, ophthalmic, intranasal

• Onset of Action: Immediate to 10 minutes

• Duration of Action: 1-4 hours

• Indications:

  • Cardiac arrest

  • Anaphylaxis

  • Local vasoconstriction

  • Mydriasis (dilation of pupils)

  • Nasal congestion

• Mechanisms of Action:

  • Stimulates both alpha- and beta-adrenergic receptors.

Alpha1-Adrenergic Agonists

Prototype: Phenylephrine (Neo-Synephrine)

• Other Examples:

  • Oxymetazoline (Afrin)

  • Pseudoephedrine (Sudafed)

  • Tetrahydrozoline (Visine)

  • Midodrine (ProAmatine)

Phenylephrine (Neo-Synephrine) Overview

• Routes of Administration:

  • Oral (PO), IM, SQ, IV, intranasal, ophthalmic

• Onset of Action: Immediate to 1-2 hours

• Duration of Action: 15 minutes to 3 hours

• Indications:

  • Nasal congestion

  • Hypotension

• Mechanisms of Action:

  • Activates alpha1-receptors in the peripheral nervous system.

• Adverse Effects:

  • Reflex bradycardia

  • Reduced peripheral blood flow

  • CNS stimulation

• Contraindications:

  • Severe HTN

  • Pre-existing bradycardia

  • CAD

  • Narrow-angle glaucoma

  • Pregnancy: Category C

Beta-Adrenergic Agonists

Prototype: Isoproterenol (Isuprel)

• Other Examples:

  • Albuterol (Proventil) (Beta2 agonist)

  • Dobutamine (Dobutrex) (Beta1 agonist)

  • Tocolytic agents (Beta2 agonists)

Isoproterenol (Isuprel) Overview

• Routes of Administration:

  • IV; also available PO and inhalation for others in the same category

• Onset of Action: Immediate to varies

• Duration of Action: Less than 1 hour to 12 hours

• Indications:

  • Increase myocardial contraction

  • Treat transient heart block

• Mechanisms of Action:

  • Activates both beta1 and beta2 receptors.

• Adverse Effects:

  • Dysrhythmias

  • CNS stimulation

  • Headache, nausea, and vomiting

• Contraindications:

  • CAD, HTN, dysrhythmias

  • Hyperthyroidism

  • Diabetes

  • Pregnancy: Category C