-Are receptors for the sympathetic neurotransmitters-Alpha-adrenergic, Beter-adrenergic, and dopaminergic receptors
Bronchial, gastrointestinal, and uterine smooth muscle RELAXATION
Response: dilation of renal, mesenteric, coronary, and cerebral blood vessels.
Causes release of catecholamine from storage sites (vesicles) in nerve endings
catecholamine then binds to receptors and causes a physiologic response
Vasoconstriction of blood vessels
Relaxation of GI smooth muscles (decreased
Constriction of bladder sphincter
Contraction of uterus
Contraction of pupillary muscles of the eye (dilated pupils)
Increased force of contraction (positive inotropic effect)
Increased heart rate (positive chronotropic effect)
Increased conduction through AV node (positive dromotropic effect)
Uterine relaxation, glycogenolysis in liver, increased renin secretion in kidneys, relaxation of GI smooth muscle (decreased motility)
A patient has two inhalers that are due to be taken at the same time. One is a bronchodilator; the other is a corticosteroid. Which inhaler should the patient take first?
A. The bronchodilator
B. The corticosteroid
C. it does not matter which one is taken first.
Bronchodilators that stimulate beta2 adrenergic receptors of bronchial smooth muscles causing relaxation resulting in bronchodilation
albuterol, ephedrine, epinephrine, formoterol, levarbuterol, metaproterenol, pirbuterol, salmeterol, and terbutaline
A patient is experiencing bronchospasms after running half a mile. He has several inhalers with him. Which one would be appropriate for treatment at this time?
D. salmeterol and fluticasone combination (Advair Diskus)
Rationale: Albuterol is a beta2 agonist that is used for acute bronchospasms
intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestionexamples:
ephedrine, naphazoline, oxymetazoline, phenylephrine, and tetrahydrozoline
Alpha adrenergic receptors
Examples: epinephrine, naphazoline, phenylephrine, tetrahydrozoline
Also called cardioselective sympathomimetics
Used to support the heart during cardiac failure or shock; various alpha and beta receptors affected
catecholamine dopamineStimulates beta1 receptors on heart muscle (myocardium); increases cardiac output by increasing contractility (positive inotropy), which increases the stroke volume, especially in patients with heart failure.
Intravenous drug; given by continuous infusion
Naturally occurring catecholamine neurotransmitter
Potent dopaminergic as well as beta1- and alpha1-adrenergic receptor activity
Low dosages: can dilate blood vessels in the brain, heart, kidneys, and mesentery, which increases blood flow to these areas (dopaminergic receptor activity).
Higher infusion rates: improve cardiac contractility and output (beta1-adrenergic receptor activity).
Highest doses: vasoconstriction (alpha1-adrenergic receptor activity).
Endogenous vasoactive catecholamine
Acts directly on both the alpha- and beta-adrenergic receptors of tissues innervated by the SNS
Prototypical nonselective adrenergic agonist
Administered in emergency situations
One of the primary vasoactive drugs used in many advanced cardiac life support protocols
Stimulates alpha-adrenergic receptors
Direct-stimulating beta-adrenergic effects on the heart (beta1-adrenergic receptors)
No stimulation to beta2-adrenergic receptors of the lung
Treatment of hypotension and shock
Administered by continuous infusion
Works almost exclusively on the alpha adrenergic receptors
used primarily for short term treatment to raise blood pressure in patients in shock
Control of supraventricular tachycardia
vasoconstriction in regional anesthesia
Topical opthalamic drug
A patient on a dobutamine drip starts to complain that her intravenous line “hurts.” The nurse checks the insertion site and sees that the area is swollen and cool. What will the nurse do first?
A. Slow the intravenous infusion.
B. Stop the intravenous infusion.
C. Inject the area with phentolamine.
D. Notify the physician health care provider.
B) Stop the intravenous infusion
Rationale: Infiltration of an intravenous solution containing an adrenergic drug may lead to tissue necrosis from excessive vasoconstriction around the IV site.
-Headache, restlessness, excitement, insomnia, euphoria
-Palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension
-Loss of apeptite,dry mouth, nausea, vomiting, taste changes
– MIld tremors, headaches, nervousness, dizziness
-Increased heart rate, palpitations (dysrhythmias), fluctuations in blood pressure
-Sweating, nausea, vomiting, and muscle cramps
Check IV site often for infiltration
use clear IV solutions
Use an infusion pump
Infuse drug slowly to avoid dangerous cardiovascular effects
monitor cardiac rhythm
A patient on a dobutamine drip starts to complain that he feels a “tightness” in his chest that he had not felt before. What will the nurse do first?
A. Check the infusion site for possible extravasation.
B. Increase the infusion rate.
C. Check the patient’s vital signs.
D. Order an electrocardiogram.
A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulizer treatment with albuterol. The nurse’s immediate assessment priority would be to
A. determine the time of the child’s last meal.
B. monitor Spo2 with a pulse oximeter.
C. monitor the child’s temperature.
D. provide education on asthma management.
B. monitor Spo2 with a pulse oximeter.
Rationale: During administration of albuterol, a fast-acting beta2 agonist, the nurse should monitor the patient’s respiratory status including SpO2 (with a pulse oximeter), respiratory rate, and breath sounds to ensure that the medication is having a therapeutic effect. The other items can be handled after her respiratory status is stable