Pharmacology Chapter 18 Adrenergic Drugs

1

Antihistamines can increase the effects of adrenergic drugs and should not be recommended by the nurse before consulting with the health care provider. Applying petroleum jelly would not relieve the itching and is not the best action. Itching is not a common side effect of adrenergic medications.

A patient who was recently prescribed an adrenergic medication now complains of itching in both legs. What is the nurse’s best action?
1
Notify the health care provider.
2
Apply petroleum jelly on both legs.
3
Explain that itching is an expected side effect.
4
Recommend an over-the-counter antihistamine.

4

Administration of adrenergic drugs with monoamine oxidase inhibitors may cause a potentially life-threatening hypertensive crisis.

The nurse is caring for a patient who is scheduled to begin treatment with one of the adrenergic drugs. During the admission assessment he tells the nurse that he is undergoing treatment for mental illness with monamine oxidase inhibitor (MAOI) medications. Based on this information, the nurse will perform which action?
1
Administer the adrenergic drug as prescribed.
2
Monitor the patient closely during treatment for evidence of side effects.
3
Plan for the health care provider decreasing the dose of the adrenergic drug.
4
Hold the dose of the adrenergic drug and notify the health care provider of the use of the MAOI medication.

1

Although the drug must be administered according to specific instructions, it is not designed to relieve acute symptoms and thus would not be useful during an asthma attack. It may be combined with another inhalant, such as a corticosteroid, and is usually ordered as one puff twice daily.

The patient has been placed on salmeterol. The patient tells the nurse, “I don’t understand why this inhaler doesn’t help when I’m having an asthma attack.” The nurse frames the response based on which information?
1
Salmeterol is not designed to relieve acute symptoms.
2
Salmeterol can be given as needed throughout the day.
3
Salmeterol should never be combined with another inhalant.
4
Salmeterol must be administered according to specific instructions.

4

Although the patient can gain information from both the health care provider and the pharmacist, the nurse should explain that a better therapeutic response can be gained from use of more than one drug.

The patient has been ordered two drugs of the same class to be used for treatment of asthma. The patient asks the nurse, “Why do I have to use more than one medication to treat this? Isn’t one enough?” What is the nurse’s most appropriate response?
1
“You need to ask your health care provider questions like that.”
2
“I will arrange for the pharmacist to do a presentation for you.”
3
“No, in this case, one drug is not enough to do what’s needed for you.”
4
“Sometimes use of more than one drug will give a combined therapeutic effect.”

1

Although it is important for the patient to know why she is receiving the medication that is administered and for the nurse to verify that the medication is mixed properly and infusing accurately, the most important action for the nurse when working with dopamine is to check the intravenous site hourly for evidence of infiltration.

The nurse is administering dopamine intravenously. What is the most important action on the part of the nurse?
1
Check the patient’s intravenous site hourly for infiltration.
2
Verify that the medication is mixed with the proper diluent.
3
Determine that the medication is infusing at the proper rate.
4
Verify that the patient understands why the medication is being given

1, 2, 4

Alpha1 receptors are located in the eyes, blood vessels, sex organs, gastrointestinal system, and bladder. Activation of these receptors results in mydriasis (dilation of pupils), vasoconstriction, ejaculation, and bladder and uterine contractions. The patient’s skin should feel cool as a result of vasoconstriction.

The nurse is administering an alpha1 agonist to a postpartum patient. How will the nurse evaluate the therapeutic effectiveness of the medication? Select all that apply.
1
Monitor pulse rate.
2
Assess blood pressure.
3
Listen to breath sounds.
4
Palpate fundal firmness.
5
Auscultate bowel sounds.
6
Check level of consciousness.

1

Salmeterol is designed to be administered as one puff twice a day, 12 hours apart.

The patient has been ordered salmeterol as a medication to treat asthma symptoms. Which statement indicates that the patient understands how to take the medication?
1
“I will give myself one puff twice a day at 7 am and 7 pm.”
2
“I will give myself two puffs at bedtime; that’s when I really need it.”
3
“I will give myself a puff anytime I start to experience asthmatic symptoms.”
4
“I will give myself two puffs three times a day, at 7 am, noon, and bedtime.”

4

The patient should use one inhalant drug, wait 5 minutes, and then use the second drug so as to achieve the desired combined therapeutic response and avoid mucous membrane irritation. The bronchodilator is a rescue medication and should be used to treat symptoms, and not twice daily, with the corticosteroid.

The patient has been using both a corticosteroid inhalant and a bronchodilator for treatment of asthma symptoms. Which patient statement indicates understanding of how to appropriately administer these medications?
1
“I will use the bronchodilator drug in the morning and the corticosteroid at bedtime.”
2
“I will use both of the drugs in the morning, and both again at bedtime to get the full effect.”
3
“I will use the bronchodilator first, and then immediately follow with the corticosteroid inhalant.”
4
“I will use the bronchodilator first, wait 5 minutes, and then use the corticosteroid inhalant.”

2

The site should be monitored every hour for evidence of infiltration.

The patient is being treated with a dopamine intravenous drip. In order to prevent infiltration of the site, the nurse will perform which action?
1
Assess blood pressures in the patient’s other arm.
2
Check the site every hour for evidence of swelling.
3
Encourage the patient to call if the site becomes painful.
4
Encourage the patient to lie with her arm held completely straight.

1

The nurse’s first action is to stop the infusion, followed by infusing phentolamine into the area to counteract the vasoconstrictive effects of the dopamine.

The nurse assesses the peripheral intravenous (IV) infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse’s priority action?
1
Stop the infusion.
2
Pull the IV immediately.
3
Apply a cold pad to the site.
4
Elevate the patient’s extremity

1, 4, 5

The nurse will avoid administration of midodrine, phenylephrine, and norepinephrine to this patient because these medications are alpha1-receptor agonists that cause vasoconstriction. Vasoconstriction aggravates mitral valve regurgitation by increasing preload and impeding the forward flow of blood. These factors can cause the heart to fail because the heart becomes an ineffective pump. Dobutamine is a positive inotrope; fenoldopam is a peripheral dopamine agonist that causes blood pressure to drop.

A nurse obtaining a health history discovers that the patient has been recently diagnosed with mitral valve regurgitation. Because of concern of aggravating the patient’s diagnosis, which prescribed medications will the nurse question? Select all that apply.
1
Midodrine
2
Dobutamine
3
Fenoldopam
4
Phenylephrine
5
Norepinephrine

4

Dobutamine increases the cardiac output by increasing cardiac contractility, due to the stimulation of the beta 1 receptors of the cardiac muscles. Arteriolar vasodilation is caused by fenoldopam through the stimulation of D 1 receptors. Epinephrine causes elevated blood pressure by causing vasoconstriction through the stimulation of alpha-adrenergic receptors. Peripheral vasoconstriction is observed with midodrine by the stimulation of alpha 1 receptors.

Which effect does the nurse expect in the patient with heart failure after administration of dobutamine?
1
Arteriolar vasodilation
2
Elevated blood pressure
3
Peripheral vasoconstriction
4
Increased cardiac contractility

3

Epinephrine causes sympathomimetic actions, including increased heart rate and contractility. Epinephrine does not decrease blood pressure; at high doses, intravenous epinephrine increases blood pressure. Epinephrine causes bronchial dilation, not constriction and does not cause wheezing. Increased bowel sounds is not an indication of therapeutic effect for epinephrine.

The nurse is caring for a patient who is receiving intravenous epinephrine. Which assessment will indicate the patient is having the expected therapeutic effect of this medication?
1
Increased bowel sounds
2
Decreased blood pressure
3
Increased heart rate and strong pulse
4
Bronchial constriction and wheezing

1, 3, 5

Unwanted central nervous system effects of the alpha-adrenergic drugs include headache, restlessness, excitement, insomnia, and euphoria. Possible cardiovascular adverse effects of the alpha-adrenergic drugs include chest pain, vasoconstriction, hypertension, tachycardia, and palpitations or dysrhythmias. Effects on other body systems include anorexia (loss of appetite), dry mouth, nausea, vomiting, and, rarely, taste changes.

The nurse administering alpha-adrenergic medications will monitor the patient closely for which adverse effects? Select all that apply.
1
Dry mouth
2
Vasodilation
3
Tachycardia
4
Hypotension
5
Restlessness

3

Increased heart rate is the response elicited by the activation of beta 1 receptors located on the sinoatrial node. Vasodilation is a response elicited by the activation of beta 2 receptors located on the blood vessels. Vasoconstriction is a response elicited by the activation of alpha 1 receptors located on the blood vessels. Increased contractility is a response elicited by the activation of beta1 receptors of the cardiac muscle.

Which response is elicited by the activation of beta1 receptors located on the sinoatrial node?
1
Vasodilation
2
Vasoconstriction
3
Increased heart rate
4
Increased contractility

4

Phenylephrine is an alpha1 agonist that is administered to produce vasoconstriction in regional anesthesia in order to slow absorption and prolong the effects of the anesthesia. It is not given for its effects on heart rate.

What is the objective of administering phenylephrine as an adjunct to local anesthesia?
1
Bradycardia
2
Tachycardia
3
Vasodilation
4
Vasoconstriction

30

The patient’s weight of 176 lb is converted into kg by dividing by 2.2: 176 ÷ 2.2 = 80 kg. 5 mcg/kg × 80 kg = 400 mcg, or 0.4 mg/min. 0.4 mg/min ÷ 400 mg/500 mL = 0.5 mL/min; 0.5 mL/min × 60 min = 30 mL/hr.

A patient is to receive dopamine 5 mcg/kg/min. The patient weighs 176 pounds. An infusion of dopamine 400 mg in 500 mL of D5W is available. The nurse will infuse this drug at a rate of how many milliliters per hour? ___ mL/hr

4

Albuterol is a beta2 agonist that predominantly acts on beta2 receptors in the lungs to cause bronchodilation. Side effects include tachycardia and jitteriness because the medication is not 100% selective on beta2 receptors. It is not necessary to notify the health care provider because the patient is describing side effects of the medication. The next treatment should not be held because the patient’s breathing takes priority over side effects. A decreased dose of albuterol is not necessary.

A patient diagnosed with asthma just completed an albuterol nebulizer treatment. The patient tells the nurse, “I feel like my heart is fluttering, and my hands are very shaky.” What is the nurse’s most appropriate action?
1
Notify the health care provider.
2
Hold the next albuterol treatment.
3
Request a decreased dose of albuterol.
4
Explain this sensation as a side effect.

4

The blood pressure and respiratory readings will give the most accurate information for outcomes criteria; the other information is vague and subjective.

What is the most accurate outcome criteria for the nurse to use when determining if a patient is responding appropriately to use of an adrenergic drug?
1
Patient is able to correctly state three side effects of the medication.
2
Patient is alert to time, person, and place and makes coherent conversation.
3
Patient awakens easily during nurse’s morning rounds and states, “I feel fine.”
4
Patient’s respiratory rate is 16 breaths/minute and blood pressure is 130/72 mm Hg.

4

Norepinephrine is directly metabolized to dopamine and is used primarily in the treatment of hypotension and shock. The beta2 agonists are helpful in treating conditions such as asthma. Hypertension is a contraindication to the use of norepinephrine. Epinephrine is used in the treatment of anaphylaxis.

The nurse recognizes that which condition is an indication for the use of norepinephrine?
1
Asthma
2
Anaphylaxis
3
Hypertension
4
Cardiogenic shock

2

Epinephrine is administered in emergency situations and is one of the primary vasoactive drugs used in many advanced cardiac life support protocols. Naphazoline and oxymetazoline are administered intranasally to ease congestion. Naphazoline may also be used as an ophthalmic medication. Salmeterol is given via the respiratory tract because of its affinity for beta2 receptors that act on the lungs.

During a cardiopulmonary resuscitation emergency, the nurse expects to administer which injectable, fast-acting medication?
1
Salmeterol
2
Epinephrine
3
Naphazoline
4
Oxymetazoline

1, 4

Dopamine is the first choice of drug in hypovolemic shock. Due to beta1 stimulation, it increases the force of myocardial contraction, which causes more cardiac output, resulting in increased blood pressure. Epinephrine is the drug of choice in cardiac arrest because it increases arterial blood pressure and coronary perfusion via alpha1 receptor-agonist effects. Midodrine is given to patients with orthostatic hypotension. When there is cardiac decompensation, dobutamine is used. Norepinephrine is used in hypotensive states.

A patient with hypovolemic shock is admitted to the emergency department. On assessment, the nurse is unable to palpate a carotid pulse and the patient is unresponsive. Which medications does the nurse expect the patient to be prescribed? Select all that apply.
1
Dopamine
2
Midodrine
3
Dobutamine
4
Epinephrine
5
Norepinephrine

4

Although it’s important for the medication vial to have a clearly documented expiration date and for the medication to be a clear solution, it is most important for the patient to avoid contaminating the eyedropper used for administration by allowing the dropper to touch the eye during administration. The eyedrops should be administered into the conjunctival sac, not onto the eye itself.

The patient is administering an ophthalmic form of a beta-adrenergic agonist drug. What is the most important information for the nurse to give the patient regarding administration of the drug?
1
“Administer the eyedrops directly onto the eye itself.”
2
“Make sure that the medication is a clear solution before administering.”
3
“Make sure that the medication vial has a clearly documented expiration date.”
4
“Do not allow the eyedropper to touch the eye when administering the medication.”

3

An adrenergic agonist causes vasoconstriction, leading to high blood pressure. Blood pressure is the most important assessment because of the detrimental effects of high blood pressure, such as stroke, which can be life threatening. Skin integrity, temperature, and respiratory rate are not directly affected by adrenergic agonists.

Before administering an adrenergic agonist, what is the most important assessment for the nurse to complete?
1
Skin integrity
2
Temperature
3
Blood pressure
4
Respiratory rate

2

Although it is important to gain as much information as possible from the patient, such as use of over-the-counter medications and details provided in a symptom diary, because of the likelihood that beta-adrenergic agonists will affect blood pressure and pulse rate, the prescribing health care provider should be notified of incidence of chest pain, palpitations, headaches, or seizures.

The patient is an older adult who has been placed on a beta-adrenergic agonist. The patient complains to the nurse of experiencing headaches after being on the drug for several days. What is the nurse’s highest priority action?
1
Reassure the patient that this is an expected side effect of the medication.
2
Take the patient’s blood pressure and notify the prescribing health care provider.
3
Question the patient about what over-the-counter medications he uses to treat headaches.
4
Instruct the patient to maintain a symptom diary documenting the incidence of the headaches.

1

If unusual demands are placed on the aging heart, problems and complications may arise. Examples of unusual demands include strenuous activities, excess stress, heat, and medication use. The stress heat from slow jogging may lead to significant increases in blood pressure and pulse rate. The older adult may then react negatively, with a diminished ability to compensate adequately for these changes. A short daily walk and visiting a family member are not considered strenuous activities. Older adults are already at risk for polypharmacy and should not take any over-the-counter medications or herbal supplements without a prescription from the health care provider.

When teaching an 83-year-old patient about the effects of adrenergic agonists, the nurse will advise the patient to avoid which activity?
1
Slow jog in summer
2
Daily walk around the block
3
Visiting wife in long-term care facility
4
Taking prescribed herbal supplements

4

The intranasal application of certain adrenergics, such as oxymetazoline, can cause the constriction of dilated arterioles, which can decrease bleeding. Dobutamine, epinephrine, and norepinephrine are not indicated for a nosebleed.

Which medication will the nurse recommend for the patient to take while experiencing an episode of epistaxis?
1
Dobutamine
2
Epinephrine
3
Norepinephrine
4
Oxymetazoline

2

Stimulation of beta1 receptors in the “fight-or-flight” response results in stronger ventricular contraction due to increased contractility of myocardium. Beta 2 agonist stimulation results in vasodilation and decreased resistance of peripheral vessels. Beta 1 agonists act most specifically on the heart; relaxation of uterine smooth muscle is a result of taking alpha 1 antagonists. Bronchial smooth muscle is affected by beta 2 agonists.

Which outcome would be most appropriate to establish for patients taking beta1 agonists?
1
Relaxation of uterine smooth muscle
2
Increased contractility of myocardium
3
Relaxation of bronchial smooth muscle
4
Increased resistance of peripheral vessels

4

Phenylephrine works almost exclusively on the alpha-adrenergic receptors. It is used primarily for short-term treatment to raise blood pressure in patients in shock, to control some dysrhythmias (supraventricular tachycardias), and to produce vasoconstriction in regional anesthesia.

The nurse recognizes that which medication is classified as an alpha-adrenergic agonist?
1
Ephedrine
2
Terbutaline
3
Dobutamine
4
Phenylephrine

2

Thyroid preparations can increase the effects of adrenergic drugs. Opioids, selective serotonin reuptake inhibitors, and nonsteroidal anti-inflammatory drugs do not have reported interactions with adrenergic drugs.

The nurse knows that drugs in which class may interact with adrenergic drugs?
1
Opioids
2
Thyroid preparations
3
Nonsteroidal antiinflammatory drugs
4
Selective serotonin reuptake inhibitors

Drugs that effect the sympathetic nervous system are termed adrenergic agonists and adrenergic blockers Adrenergic agonists are also called sympathomimetics or adrenomimetics WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my …

alpha 1- found where? – vascular smooth muscle in skin and gut alpha 1- effect? – activates vasoconstriction – during flight or fight want reduced blood flow to skin and gut – End result: VASOCONSTRICTION at skin and gut WE …

Two groups of drugs that affect the sympathetic nervous system: The adrenergic agonists (sympathomimetics or adrenomimetics) and the adrenergic blockers (sympatholytics or adrenolytics) The alpha adrenergic receptors are located in the: vasculature tissues (vessels) of muscle WE WILL WRITE A …

Drugs that stimulate the sympahetic nervous system are known as Adrenergic agonists Sympathomimetrics Catecholamines Substances that can produce a sympathomimetic response. They are either endogenous catecholamines (such as epinephrine, norepinephrine, and dopamine) or synthetic catecholamine drugs (such as dobutamine). WE …

Adrenergic Blockers Mech of Action -Bind to adrenergic receptors, but inhibit/block SNS stimulation Adrenergic Blockers are also known as… -Adrenergic antagonists -Sympatholytics -Alpha blockers, beta blockers, or alpha-beta blockers WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY …

adverse effect drug effects that are not the desired therapeutic effects; may be unpleasanr or even dangerous brand name name given to a drug by the pharmaceutical company that developed it; also called trade name WE WILL WRITE A CUSTOM …

David from Healtheappointments:

Hi there, would you like to get such a paper? How about receiving a customized one? Check it out https://goo.gl/chNgQy