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Class| Drugs| MOA| Indications| Contraindications| Drug Effects/Interactions| Adverse Rxns| Unique| Beta1 Adrenergic Sympathomimetics| Dopamine/Intropin (neurotransmitter/catecholemine)| * Dopamin is the only receptor to stimulate these site * A precursor in synthesis of NE * Action: Beta agonist/alpha agonist- dose dependentDopaminergic | * Dilate renal blood vessels, brain, mesentery and heart vessels increased blood flow * Stimulate alpha/beta receptors/vasoconstrictor, increase CO2 improves contractility of the heart also can cause renal dilation.

Drug of choice for shock| | * Tx circulatory shock, heart failure and v BP * Monitor for: Dysrhythmias * ^ HR * Chest pain * Immediate onset * Duration of action < 10 minutes * Cardiac monitoring required! | Extravasation may cause necrosis. | Should be infused into a large vein Prevent possibility of extravasation into tissue adjacent. Infusion site should be continuously monitored for free flow.

| | Dobutamine| Vasoactive adrenergicPrimarily cardioselective effects/beta 1 selective vasoactive adrenergic drug, direct stimulation of B1 receptors| * Increase cardiac output by increasing contractility and increase stroke volume, IV only * Tx for HF and cariogenic shock * Hypotension * Critical care observation| | * Upset stomach * Vomiting * Tingling sensations * Fever * Leg cramps * Headaches * Irregular heartbeat * ^ in blood pressure and heart rate * Chest pain * Shortness of breath * Swelling (lower legs and ankles) * ^ Fatigue * Lightheadedness, dizziness, or faintness * Skin rash * Dysrhythmias| | | | Albuterol Sulfate.

(Proventil, Ventolin)| * Short-acting, selective, ? 2-adrenergic receptor agonist (bronchodialator)| * Sx relief during maintenance * Asthma * Emphysema * Acute/Chronic Bronchitis * Anaphylaxis| | Tachycardia , heart palpitationShakiness, nervousness Hyperkinesias * Overactive, restlessness, agitation * N/V * Aggression * Fluid retention and swelling * Xerostomia (dry mouth) * Hyperactivity * Hypertension * Increased Appetite * Insomnia * Nervousness * Flushing * Nightmares * Nosebleed * Rash.

* Throat irritation * Agitation * Anxiety * Excitement * Headache| | * Protection against exercise-induced asthma * Used as relief of acute asthmatic attack * Administered – Orally/inhalation * Metered dose inhaler, nebulizer, tablets, and syrup * Monitor allergies * Can induce hypokalemia| | Salmeterol or Serevent| * A long-acting beta2 adrenergic receptor agonist * Bronchodilator * Long term maintenance treatment of asthma and COPD * Prevention of bronchospasm| * Exercise induced asthma: 30 to 60 minutes before exercise. * Typically prescribed BID * Doesn’t take place of oral/inhaled corticosteroids.

| | * NOT indicated for acute exacerbations * Metered dose inhaler (MDI) or a proprietary “disk-styled” inhaler * Caution with patients with liver insufficiency| * Palpitations & ^ BP * Tremor & nervousness * Headache * Throat and upper airway irritation | Typically tolerated wellHyperglycemia (rare)A v in K+ of 0. 45 mEq/L have been reportedMay stimulate sodium-potassium ATPase (intracellular shift of potassium)| | Phenylephrine(Allerest)| Alpha-1 adrenergic agonists stimulate alpha-1 receptor directly.

Corrected any blood losses prior to administration * Optimal mydriasis: instill ophthalmic form into conjunctival cul-de-sac| Health statusAssess medical history & baseline assessmentLife span and genderUsed in pregnancy only if absolutely necessaryLifestyle, diet, and habitsDocument patient’s occupation and ADLs EnvironmentClosely monitor in acute care setting (IV administration)Caution when driving at night (opthalmic)| Hypersensitivity, sulfite sensitivity, severe hypertension, ventricular tachycardia, and closed-angle glaucoma | Headache, restlessness, excitability and reflex bradycardiaTo minimizing adverse effects, IV administration through large veinAvoid driving at night (blurred vision) if using opthalmic drops| MAOIs, TCAs, Oxytocics| PharmacotherapeuticsParenterally (vascular failure in shock)Topically (relief of nasal mucosal congestion)PharmacokineticsAdministered: parenterally, orally, or topically Onset: 15 to 20 minutes.

Duration: 1-2 hrsPharmacodynamicsStructurally similar to epinephrine and powerful alpha-1 adrenergic agonist. | | Adrenergic Opthalimic | Decrease Intra ocular pressure (IOP), increase aqueous humor outflowDecrease production of aqueous humor (dilate pupils (mydriasis)| Treat Chronic Open-angle glaucomaOcular HTN| | Burning, eye pain, lacrimationTopical adrenergic ophthalmic considerations: systemic effects uncommon (larger doses: CV effects, HA and syncope| Cardiac dysrhythmias can result when administered with Halogenated anesthetics, Cardiac glycosides, Thyroid hormones, TCAs| 1. Decline in myocardial efficiency 2. Decline in baroreceptors effectiveness 3. Concurrent health problems 4.

Instruct to: report occurrence of any chest pain, palpitations, blurred vision, headache, seizures, or hallucinations 5. Cautious use of over-the-counter drugs, herbals, supplements, ect. 6. Monitor vital signs 7. Decreased motor and cognitive functioning| | | | | | | | | | | | | | | | | Adrenergic Blocking Drug (aka Adrenergic antagonists, Sympatholytics, Alpha-blockers, Beta-blockers, or Alpha-beta blockersTake 1st dose at bedtime (First does phenomenon), Monitor weight/check for edema, avoid driving or operating machinery 4 hours of first dose, change positions slowly, no alcohol, monitor BP, heart and lung sounds, and edema, Identify potential drug interactons.

| Used to control and prevent hypertension in patients with pheochromocytoma Phentolamine (regitine)Quickly reverses potent vasoconstrictive effects of extravasated vasopressors (norepinephrine)Restores blood flow and prevents tissue necrosis| Class| Drugs| MOA| Indications| Contraindications| Drug Effects/Interactions| Adverse Rxns| Unique| | Prazosin(Minipress) | Cause arterial and venous dilation decrease PVR and BPTX HTN and BPHEffect on receptors on prostate gland and bladderDecrease resistance to urinary outflow, decreased urinary obstruction/relieving effects of BPH| Used to treat HTN (2nd line drug).

Raynaud, Vasospasm, and prostatic outflow obstructionBlocks postsynaptic alpha 1 adrenergic receptors blood pressure| Hypersensitivity, Use caution with angina because hypotension may worsen conditionRenal failure| Other antihypertensive medications| Light-headedness, dizziness, headache, drowsiness, weakness, lethargy, nausea, and palpitations| Important to teach men prescribed these drugs for BPH about Risk of hypotensions| | | Block stimulation of beta receptorsCompete with NE and epinephrine (bine both selective/nonselective)Decrease * Cardiac SNS stimulation * Heart rate * Myocardial contractility * Slow conduction rate * Prolong SA node recovery|.

AnginaCardioprotectiveDysrhythmiasMigraineheadacheGlaucomaAntihypertensiveGlaucoma| Pre-existing bradycardiaHeart failureDecreased conduction with heart block| | Nausea, dry mouth, vomiting, diarrhea, cramps, ischemic colitis, Impotence, rash alopecia, bronchospasmAgrnulocytsis, thrombocytnia, AB block, bradycardia, HF, peripheral vascular insufficiency, Dizziness, mental depression, lethargy, hallucinations, unusual dreamsNonselective beta-blockers may interfere with normal responses to hypoglycemia (tremor, tachycardia, nervousness) May mask signs and symptoms of hypoglycemia| | | Metoprolol (Lopressor)Atenolol (Tenormin)| | Stable Angina| | |.

Bradycardia/hypotensionHeart block,BronchoconstrictionAltered glucose/lipid metabolism| Therapeutic: blocks the harmful effects of blockers,, when taking B, * monitor P daily * Adequate fluid and fiber intake * Monitor Wt * Make take up to 2 wks for the therapeutic effects * May exacerbate CHF, decrease BS, and cause bronchospasms| Nursing implications: Avoid over the counter medications (Antacids, antimuscarinics/anticholinergics, diuretics and cardiovascular drugs, neuromuscular blocking drugs, oral hypoglycemic drugs,Never stop abruptlyReport constipation or development of urinary hesitancy or bladder distention,Change positions slowlyAvoid caffeineAboid alcoholReport palpitations, dyspnea, nausea, or vomiting.

* Weight gain of more than 2 lb in 1 day or 5 lb in a week, * Edema of feet or ankles * Shortness of breath * Excessive fatigue or weakness * Syncope or dizziness | Parasympathetic Nervous System PSNSCholinergic / Cholinergic Agonist| Bethanechol (Urecholine)| Direct-acting muscarinic| Postoperative and postpartum functional urinary retention| Reduce IOP (glaucoma) dx and tx myasthenia gravisAlzheimer’s diseaseExcessive dry mouthPost-op atonyNeurogenic bladderAtrial dysrhythmiasTreat various GI and bladder dx GlaucomaSurgical neuromuscular blocker| AnticholinergicsAtihistaminesAdrenergic agonists| Low HRHypotension/vasodilationHeadacheBronchiole constrictionImpaired night visionSweatingGI cramps|.

* ^ Gastric secretions * ^ GI motility * Pupil constrictions * ^ Salivation * ^ Sweating * v HR * VasodilationAntidote for anticholinergic poisoning (atropine) reverses neuromuscular blocking drugs given IV and topically (ophthalmic solution and ointment)| | Donepezil (Aricept) 3 wks onset of action.

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