Quiz Review Notes

Herbal Medications

• Review all herbal medications included in the slides. Herbal medications can interact with conventional medications, potentially causing serious adverse effects.

• Focus on their indications (what they are used for). Understanding the specific uses of each herbal medication is crucial for patient education and safety.

• Crucially, identify herbal medications that can cause bleeding. These include, but are not limited to, garlic, ginger, ginkgo biloba, ginseng, and feverfew. These should be discontinued before surgical procedures to minimize the risk of excessive bleeding.

Adrenergic Drugs and Adrenergic Blockers

• Adrenergic drugs mimic the sympathetic nervous system response. They are also known as sympathomimetic drugs.

• Adrenergic agonists produce the same stimulation/response as the sympathetic nervous system, leading to effects like increased heart rate and bronchodilation.

Adrenergic Drug Effects

• Increase in heart rate, vasoconstriction, bronchodilation. These effects make adrenergic drugs useful in treating conditions like asthma and hypotension.

• Effects depend on whether they are alpha or beta adrenergic drugs. Alpha and beta receptors mediate different responses in the body.

Alpha-1 Adrenergic Drugs

• Located in blood vessels. Stimulation leads to vasoconstriction.

• Cause vasoconstriction, leading to increased blood pressure. This effect is useful in treating hypotension and nasal congestion.

Beta-1 Adrenergic Drugs

• Located in the heart. Stimulation increases heart rate and contractility.

• Increase heart rate and force of contraction (positive inotropic effect). This is beneficial in treating heart failure and shock.

Beta-2 Adrenergic Drugs

• Concentrated in bronchioles. Stimulation causes bronchodilation.

• Cause bronchodilation. This effect is crucial in treating asthma and COPD.

• Used for asthma and COPD. Examples include albuterol and salmeterol.

Alpha-1 Adrenergic Agonists

• Can increase blood pressure; called vasopressors. Used to treat hypotension.

• Examples: epinephrine, phenylephrine, norepinephrine. Epinephrine is also used in anaphylaxis.

• Used for nasal and conjunctival congestion (available as nasal sprays and ophthalmic preparations). Phenylephrine is commonly used in decongestant medications.

• Caution: Use topical forms instead of oral forms in patients with high blood pressure. Oral forms are contraindicated in severe hypertension due to the risk of hypertensive crisis.

Alpha-2 Agonists

• Examples: clonidine, methyldopa. These drugs are centrally acting antihypertensives.

• Decrease norepinephrine release, thus lowering blood pressure. Used in the treatment of hypertension.

Adrenergic Blockers

• Both alpha and beta blockers decrease blood pressure, used in hypertension. They work by blocking the effects of adrenergic agonists.

Beta Blockers

• Names end in "olol" (e.g., metoprolol, atenolol, propranolol).

• Can cause bradycardia (slow heart rate). Monitor heart rate regularly.

• Contraindicated in patients with a history of sinus bradycardia or heart failure (though can be used with careful monitoring in heart failure). Use with caution in these patients.

• Monitoring for Fluid Retention:

  • Symptoms: Weight gain (2 lbs/day or 5 lbs/week), dyspnea (difficulty breathing), edema, orthopnea (can't breathe lying flat), crackles in lungs. Report these symptoms to a healthcare provider immediately.

Alpha Adrenergic Blockers

• Names often include "zosin" (e.g., prazosin, terazosin, doxazosin).

• Phentolamine: Used to diagnose pheochromocytoma and treat extravasation (review what extravasation is). Extravasation is the leakage of intravenously infused, and potentially dangerous, drugs into the extravascular tissue around the site of infusion.

• Tamsulosin: Primarily used for benign prostatic hypertrophy (BPH) to relieve urinary symptoms of enlarged prostate. It works by relaxing the muscles in the prostate and bladder neck.

• Important Drug Interaction: Tamsulosin should not be taken with erectile dysfunction (ED) drugs (sildenafil, tadalafil). This combination can cause severe hypotension.

• Nonselective beta blockers should be given cautiously or are contraindicated in patients with asthma due to potential for bronchoconstriction. Nonselective beta blockers block both beta-1 and beta-2 receptors.

• If a patient on a nonselective beta blocker starts wheezing, they should stop the medication and contact their provider. This indicates bronchospasm.

• Do not discontinue beta blockers or alpha blockers abruptly, as it can cause rebound hypertension. Gradual tapering is necessary to prevent withdrawal symptoms.

• Adverse effects of blockers include hypotension, especially orthostatic hypotension; advise patients to change positions slowly. This helps prevent dizziness and falls.

Cholinergic and Anticholinergic Drugs

Cholinergic Drugs

• Mimic the parasympathetic nervous system response (cholinergic agonists). Also known as parasympathomimetic drugs.

• Response: Decreased heart rate, constriction of pupils (used for glaucoma to decrease intraocular pressure), increased peristalsis and GI motility (can cause diarrhea), increased urination. These effects are mediated by acetylcholine.

• Remember SLUDGE:

  • Salivation

  • Lacrimation

  • Urination

  • Defecation

  • Gastric upset

  • Emesis

Anticholinergic Drugs

• Opposite effect: cause dryness (dry mouth). They block the action of acetylcholine.

• Examples: atropine, benztropine, scopolamine. These drugs have various uses, including treating overactive bladder and Parkinson's disease.

• Can cause dry mouth, constipation, urinary retention, tachycardia. Monitor patients for these side effects.

• Cholinergic drugs: Remember SLUDGE plus the three B's:

  • Bronchorrhea

  • Bradypnea

  • Bradycardia

• Anticholinergic effects are the opposite. They cause bronchodilation, increased heart rate, and decreased secretions.

Cholinergic Drug Examples

• Donepezil: Used for Alzheimer's disease. It improves cognitive function by increasing acetylcholine levels in the brain.

  • Because it mimics the parasympathetic response, watch out for diarrhea and urinary frequency. Manage these side effects with appropriate interventions.

  • Report muscle weakness or cramping immediately (serious side effect). This could indicate cholinergic crisis.

  • It’s a cholinesterase inhibitor, preventing the breakdown of acetylcholine. This leads to increased acetylcholine levels.

• Bethanechol: Used post-surgery to stimulate urination in patients with difficulty voiding. It helps to empty the bladder.

  • Increases peristalsis, monitor bowel sounds for increase, and potential passage of flatus. This indicates increased GI motility.

Dopamine

• Adrenergic agonist. It affects dopaminergic and adrenergic receptors.

• At low doses, increases blood flow to kidneys, brain, and mesentery, increasing urine output. Useful in patients with renal impairment.

• Used in low doses for heart failure patients to increase urine output. Monitor urine output and renal function.

Adrenergic Bronchodilators

• Review adverse effects such as palpitations, tremors, and dizziness. These are common side effects due to sympathetic stimulation.

• Primarily affect bronchioles, GI, and heart; less impact on blood vessels and blood pressure. This makes them useful in treating respiratory conditions with fewer cardiovascular side effects.

Beta-3 Agonist

• Mirabegron (Myrbetriq): Used to treat overactive bladder. It has fewer anticholinergic side effects.

• Relaxes detrusor muscles to increase bladder capacity, reducing frequent urination. This improves bladder control.

Epinephrine

• Adrenergic drug, used in anaphylactic shock. It reverses the symptoms of anaphylaxis.

• Commonly used in emergency situations for cardiac support. It increases cardiac output and blood pressure.

• Increases blood pressure and heart rate; is a vasopressor. Monitor blood pressure and heart rate closely.

Atropine

• Anticholinergic drug, causes dry mouth. It blocks the action of acetylcholine.

• Relieve dry mouth by sucking on ice chips, chewing gum or candy, and practicing proper oral care. This can improve patient comfort.

• Used for reversal of cholinergic crisis. It counteracts the effects of excessive acetylcholine.

• Review the signs and symptoms of cholinergic crisis from the slides. These include SLUDGE symptoms.

Other Medications

• Memantine: Used for Alzheimer's disease. It works by regulating glutamate activity in the brain.

• Anticholinergic drugs are also part of the treatment for Parkinson's disease. They help to reduce tremors and rigidity.