ALPHA-ADRENERGIC STIMULATORS:
  • Alpha 1- FOCUS of adrenergic drugs; receptors are located on post synaptic effector cells
    • ~ accept neurotransmitters
  • Alpha 2- Presynaptic nerve terminals
    • ~ release neurotransmitters
*Stimulating Alpha 1- VASOCONSTRICTION*
Also cause CNS stimulation: resulting in fight or flight response from the SNS.

Alpha 1 receptors are located on smooth muscle
  • Blood vessels


Alpha 1-Adrenergic Drugs:
*Nasal Decongestants - Constrict blood vessels in nasal mucosa,
*Opthalamic Decongestants - Vasoconstricts arterioles in eyes, decompressing conjunctive & reducing redness
  • Naphazoline - Clear Eyes
  • Phenylephrine - Neo-Synephrine
  • Tetrahydrozoline - Murine, Visine
  • Pseudoephedrine - Sudafed


*Alpha 1 - Adrenergic Rescue drug = Norepinephrine (Lovophed)
Used to treat shock and hypotension by causing systemic vasoconstriction
911 emergency ~ Used as a last resort!


SIDE EFFECTS:

CNS
Headache, restlessness, excitement,
insomnia, euphoria
Cardiovascular
Palpitations (dysrhythmias, tachycardia,
vasoconstriction, hypertension
Other
Anorexia, dry mouth, nausea, vomiting,
taste changes (rare)

Contraindications:
Assess for adrenergic drug allergies & severe hypertension.

Nursing Implications:
—Assess for allergies,hypertension, cardiac dysrhythmias, or other cardiovascular diseases
—Assess renal, hepatic, and cardiac function before treatment
—Perform baseline assessment of VS, peripheral pulses, skin color, temperature, and capillary refill.

Overuse of nasal decongestants may cause
rebound nasal congestion or ulcerations

—
Adrenergic Drugs via IV Administration:
Check IV site often for infiltration
—Use clear IV solutions
—Use an infusion device/IV pump
—Infuse agent slowly to avoid dangerous cardiovascular effects
—Monitor cardiac rhythm

Interactions:
—Anesthetic agents
  • —Cardiac dysrhythmias
—Tricyclic antidepressants
  • —Acute hypertensive crisis
—MAOIs (used to treat depression)
  • —Life threatening hypertensive crisis
—Antihistamines
  • —Increase adrenergic effects



http://farm5.static.flickr.com/4153/5002118958_244d557743_z.jpg
http://farm5.static.flickr.com/4153/5002118958_244d557743_z.jpg




BETA ADRENERGIC RECEPTORS (STIMULATORS)
  • Response results in
    • Bronchial, gastroinstestinal (GI), and uterine smooth muscle relaxation (β2)
    • Glycogeneolysis (β2)
      • Biochemical breakdown of Glycogen to Glucose in Liver
    • Cardiac stimulation (β1)
  • Located on postsynaptic effector cells which accept the neurotransmiter
  • Beta 1
    • Located in the heart
      • Myocardium, conduction system of the heart
    • Stimulation Causes : VASOCONSTRICTION and INOTROPIC EFFECTS
      • Increase in heart rate
      • Increase in force of contraction
      • Increase in conduction of nerve impulses
      • Increase in Blood pressure = Hypertension
    • TAKE HOME MESSAGE: β1 Stimulators speed up the heart, making it work more efficiently
    • Adrenergic Agents
      • Pressors and Inotropes
      • Rescue Drugs
        • Used to sustain heart during Cardiac Failure or Shock
      • Must be titrated carefully for therapeutic response
      • ECG required for Dopamine in larger doses and Dobutamine
  • Beta 2
    • Located in the smooth muscle of
      • Bronchioles
      • Arteriole
      • Visceral organs which would include Uterus
    • Stimulation Causes: RELAXATION
      • Bronchi resulting in Bronchodilation
      • Uterus resulting in relaxation to stop labor
    http://www.drknp.com/wp-content/uploads/2010/03/babe.jpg
    http://www.drknp.com/wp-content/uploads/2010/03/babe.jpg
    • TAKE HOME MESSAGE: β2 Stimulators Relax Bronchi and Uteruses (for Babies)
    • Adrenergic Agents
      • Albuterol
        • Used for Asthma Rescue
      • Epinephrine
        • Used for Asthma 911 Attack to Dilate Bronchioles Immediately
        • Mixed Alpha 1 + Beta 1
      • Levalbuterol (Advair)
        • Used for Asthma Maintenance Only
          • Prevents Attacks but won't help if attack has already begun
      • Terbutaline (Brethine)
        • Used for Uterine Relaxation to stop premature labor
    • Side Effects
      • CNS
        • Mild tremors, Headache, Nervousness, Dizziness
      • Cardiovascular
        • Increased heart rate, palpitations (dysrhythmias), fluctuations in blood pressure
      • Other
        • Sweating, N/V, muscle cramps
NURSING IMPLICATIONS
  • Assess for
    • Allergies
    • History of hypertension, cardiac dysrhythmias, or other cardiovascular diseases
    • Renal, hepatic, and cardiac function before treatment
  • Perform baseline assessment of
    • Vitals (Include postural pressure and pulse)
    • Peripheral pulses
    • Skin color and temperature
    • Capillary Reflll
  • Interactions
    • Do not Administer 2 adrenergic agents together due to possibility of severe cardiovascular effects (Tachycardia, HTN)
    • Avoid OTC or other medications
  • After Administration
    • Monitor Vitals including Cardiac Rhythms
    • Monitor for Reactions
    • Monitor for Therapeutic Effects
      • Return to Normal Vitals
      • Increased Level of Consciousness
      • Improved Skin color and temperature
      • Return to Normal Respiratory Rate
      • Improved breath sounds, fewer rales with less dyspnea
      • Increased air exchange with improved blood gases
      • Increased activity tolerance without shortness of breath
  • Patient Education on use of Advair only for prevention use, not management of acute symptom













ALPHA BLOCKERS:
Mechanism of action: Interupts the stimulation of the SNS at the alpha1-adrenergic receptors. Works by either a competitive or non competitive process with norepinephrine.
*Blocking an alpha receptor= Vasoconstriction*


ALPHA.jpg
Indications:
1. Used to treat Hypertension-it causes arterial and venous dilation which leads to reduced peripheral vascular resistance and blood pressure
2. Used to treat Benign Prostatic Hypertrophy(BPH)-has an effect on receptors on prostate gland and bladder which decreases urinary resistance and obstruction.
3. Used to treat migraines by constricting dilated arteries going to the brain
4. Controls post-partum bleeding by stimulating uterine contractions and inducing local vasoconstriction.

*Do not take if have known drug allergy or peripheral vascular disease!!*

Adverse reactions:
Cardiovascular-Palpitations, orthostatic hypotension, tachycardia, edema, dysrhythmias, and chest pain.
CNS-Dizziness, H/A, drowsiness, anxiety, depression, vertigo, weakness, numbness, and fatigue.
GI- N/V/D, constipation, and abdominal pain.
OTHER- incontinence, nosebleed, tinnitus, dry mouth, pharyngitis, rhinitis.

Interactions:
Alpha blockers are highly protein bound and compete for binding sites with other drugs who are also highly protein bound.

DRUG NAMES:
1. Ergotamine Tartrate- for migraines and post-partum bleeding
2. Phentolamine(Regitine)- used IV, IM, or SUBQ to decrese Blood Pressure and treat IV extraevasion
3. Prazosin(Minipress)- used PO to decrease Blood Pressure and increase urinary outflow with BPH
4. Tamsulosin(Flomax)- used PO to decrease Blood Pressure and increase urinary outflow with BPH


BETA BLOCKERS:

Mechanism of action: Block SNS stimulation of the beta adrenergic receptors by competing with the endogenous catecholamines norepinephrine and epinephrine.

beta_blockers.gif


Beta 1 Blockers: Cause vasodilation- decreased heart rate, decreased contractility, decreased conduction, and reduces damage after an MI and angina. Drugs for Beta 1 blockers are cardioselective and they only block beta 1.

Beta 2 Blockers: Cause constriction (bronchoconstriction). Drugs are non-specific beta blockers and and they block both beta 1 and beta 2. They have the same uses as beta 1 blockers, but are also used for maintenance treatment (migraines).

Indications:
1. Treatment of angina- work by decreasing the demand for myocardial energy and oxygen consumption, which helps shift the supply/demand ratio to the supply side and allows more oxygen to get to the heart muscle.
2. Cardioprotective: Because they inhibit stimulation of the myocardium by circulating catecholamines.
3. Treatment of various types of dysrhythmias.
4. Treatment of hypertension.
5. Treatment of heart failure.
6. Treatment of migraine headaches.

*Do not take if you have known drug allergies!*

Adverse Effects:
Blood: Agranulocytosis.
Cardiovascular: AV block, bradycardia, peripheral vascular insufficiency.
CNS: Dizziness, mental depression, lethargy, hallucinations.
Gastrointestinal: Nausea, dry mouth, vomiting, diarrhea, cramps, ischemic colitis.
Other: Impotence, rash, alopecia, bronchospasm.

Drugs:
Cardioselective:
*Metoprolol (Lopressor): Use in patients after an MI. Oral and injectable use.
*Acebutolol (Sectral): Angina, hypertension, dysrhythmias.
Non-specific:
*Propranolol (Inderal): Same use as cardioselective drugs but also used for migraine headaches. Contraindicated in patients with reactive airway conditions (asthma, COPD). Oral and injectable.
*Carvedilol (Coreg): Treatment of heart failure, angina, and hypertension. Oral and injectable.

QUIZ!

1. Which drug is used for post-partum bleeding?

2. Beta 2 blockers cause_ .

3. Drug used to stop labor.

4. Alpha 1 Adrenergic Rescue Drug.


QUIZ ANSWERS!

1. Ergotamine tartrate
2. Bronchoconstriction
3. Terbutaline (Brethine)
4. Norepinephrine (Lovophed)

References:

Lane, L, Collins, S, Harrington, S, Rainforth, S, & S., J. (2010). Pharmacology and the nursing process. Mosby Inc.
Petges, Nancy RN MSN. Pharmacology: Adrenergic and Adrenergic Blocking Agents PowerPoint, 2011Rapmaster Shannon. "Feel it Flow." (2008). http://www.youtube.com/watch?v=VnaJ2sWjbzU