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Sunday, September 14, 2008

Adrenergic Blockers - Interactive Nclex Pharmacology Tutorial

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Adrenergic Blockers - Interactive Pharmacology Tutorial Slideshow transcript
Slide 1: Drugs Affecting The Autonomic Nervous System Adrenergic Agents and Adrenergic-Blocking Agents Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 2: Instructors may choose to insert EIC Image #48: The Sympathetic Nervous System in Relationship to the Entire Nervous System Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 3: Adrenergic Agents • Drugs that stimulate the sympathetic nervous system (SNS) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 4: Adrenergic Agents Also known as • adrenergic agonists or sympathomimetics Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 5: Adrenergic Agents Mimic the effects of the SNS neurotransmitters: • norepinephrine (NE) and epinephrine (EPI) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 6: Adrenergic Receptors • Located throughout the body • Are receptors for the sympathetic neurotransmitters Alpha-adrenergic receptors: respond to NE Beta-adrenergic receptors: respond to EPI Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 7: Alpha-Adrenergic Receptors • Divided into alpha1 and alpha2 receptors • Differentiated by their location on nerves Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 8: Alpha1-Adrenergic Receptors • Located on postsynaptic effector cells (the cell, muscle, or organ that the nerve stimulates) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 9: Alpha2-Adrenergic Receptors • Located on presynaptic nerve terminals (the nerve that stimulates the effector cells) • Control the release of neurotransmitters Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 10: The predominant alpha-adrenergic agonist responses are: • Vasoconstriction and CNS stimulation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 11: Beta-Adrenergic Receptors All are located on postsynaptic effector cells • Beta1-adrenergic receptors—located primarily in the heart • Beta2-adrenergic receptors—located in smooth muscle of the bronchioles, arterioles, and visceral organs Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 12: The beta-adrenergic agonist response results in: • Bronchial, GI, and uterine smooth muscle relaxation • Glycogenolysis • Cardiac stimulation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 13: Dopaminergic Receptors • An additional adrenergic receptor • Stimulated by dopamine • Causes dilation of the following blood vessels, resulting in INCREASED blood flow – Renal – Mesenteric – Coronary – Cerebral Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 14: Adrenergic Receptor Responses to Stimulation LOCATION RECEPTOR RESPONSE Cardiovascular Blood vessels alpha1 and beta2 Constriction / dilation Cardiac muscle beta1 Increased contractility AV Node beta1 Increased heart rate SA Node beta1 Increased heart rate Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 15: Adrenergic Receptor Responses to Stimulation LOCATION RECEPTOR RESPONSE Gastrointestinal Muscle beta2 Decreased motility Sphincters alpha1 Constriction Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 16: Adrenergic Receptor Responses to Stimulation LOCATION RECEPTOR RESPONSE Genitourinary Bladder alpha1 Constriction sphincter Penis alpha1 Ejaculation Uterus alpha1 and beta2 Contraction/ relaxation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 17: Adrenergic Receptor Responses to Stimulation LOCATION RECEPTOR RESPONSE Respiratory Bronchial beta2 Dilation/relaxation muscles Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 18: Catecholamines Substances that can produce a sympathomimetic response Endogenous: • epinephrine, norepinephrine,dopamine Synthetic: • isoproterenol, dobutamine, phenylephrine Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 19: Adrenergic Agents Mechanism of Action Direct-acting sympathomimetic: • Binds directly to the receptor and causes a physiologic response Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 20: Instructors may choose to insert EIC Image #52: Direct-Acting Sympathomimetics Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 21: Adrenergic Agents Mechanism of Action Indirect-acting sympathomimetic: • Causes the release of catecholamine from the storage sites (vesicles) in the nerve endings • The catecholamine then binds to the receptors and causes a physiologic response Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 22: Instructors may choose to insert EIC Image #53: Indirect-Acting Sympathomimetics Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 23: Adrenergic Agents Mechanism of Action Mixed-acting sympathomimetic: • Directly stimulates the receptor by binding to it AND • Indirectly stimulates the receptor by causing the release of stored neurotransmitters from the vesicles in the nerve endings Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 24: Instructors may choose to insert EIC Image #54: Mixed-Acting Sympathomimetics Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 25: Drug Effects of Adrenergic Agents Stimulation of alpha-adrenergic receptors on smooth muscles results in: • Vasoconstriction of blood vessels • Relaxation of GI smooth muscles • Contraction of the uterus and bladder • Male ejaculation • Decreased insulin release • Contraction of the ciliary muscles of the eye (dilated pupils) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 26: Drug Effects of Adrenergic Agents Stimulation of beta2-adrenergic receptors on the airways results in: • Bronchodilation (relaxation of the bronchi) • Uterine relaxation • Glycogenolysis in the liver Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 27: Drug Effects of Adrenergic Agents Stimulation of beta1-adrenergic receptors on the myocardium, AV node, and SA node results in CARDIAC STIMULATION: • Increased force of contraction (positive inotropic effect) • Increased heart rate (positive chronotropic effect) • Increased conduction through the AV node (positive dromotropic effect) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 28: Adrenergic Agents: Therapeutic Uses • Anorexiants: adjuncts to diet in the short-term management of obesity Examples: benzphetamine phentermine dextroamphetamine Dexedrine Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 29: Adrenergic Agents: Therapeutic Uses Bronchodilators: treatment of asthma and bronchitis • Agents that stimulate beta2-adrenergic receptors of bronchial smooth muscles causing relaxation Examples: albuterol ephedrine epinephrine isoetharine isoproterenol levalbuterol metaproterenol salmeterol terbutaline • These agents may also affect uterine and vascular smooth muscles. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 30: Adrenergic Agents: Therapeutic Uses • Reduction of intraocular pressure and mydriasis (pupil dilation): treatment of open-angle glaucoma Examples: epinephrine and dipivefrin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 31: Adrenergic Agents: Therapeutic Uses Nasal decongestant: • Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion. Examples: epinephrine ephedrine naphazoline phenylephrine tetrahydrozoline Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 32: Adrenergic Agents: Therapeutic Uses Ophthalmic • Topical application to the eye surface affects the vasculature of the eye, stimulating alpha receptors on small arterioles, thus relieving conjunctival congestion. Examples: epinephrine naphazoline phenylephrine tetrahydrozoline Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 33: Adrenergic Agents: Therapeutic Uses Vasoactive sympathomimetics (pressors, inotropes), also called cardioselective sympathomimetics • Used to support the heart during cardiac failure or shock. Examples: dobutamine dopamine ephedrine epinephrine fenoldopam isoproterenol methoxamine norepinephrine phenylephrine Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 34: Adrenergic Agents: Side Effects Alpha-Adrenergic Effects • CNS: – headache, restlessness, excitement, insomnia, euphoria • Cardiovascular: – palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension • Other: – anorexia, dry mouth, nausea, vomiting, taste changes (rare) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 35: Adrenergic Agents: Side Effects Beta-Adrenergic Effects • CNS: – mild tremors, headache, nervousness, dizziness • Cardiovascular: – increased heart rate, palpitations (dysrhythmias), fluctuations in BP • Other: – sweating, nausea, vomiting, muscle cramps Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 36: Adrenergic Agents: Interactions • Anesthetic agents • Tricyclic antidepressants • MAOIs • Antihistamines • Thyroid preparations • Antihypertensives • Will directly antagonize another adrenergic agent, resulting in reduced effects Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 37: Adrenergic Agents: Nursing Implications • Assess for allergies and history of hypertension, cardiac dysrhythmias, or other cardiovascular disease. • Assess renal, hepatic, and cardiac function before treatment. • Perform baseline assessment of vital signs, peripheral pulses, skin color, temperature, and capillary refill. Include postural blood pressure and pulse. • Follow administration guidelines carefully. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 38: Adrenergic Agents: Nursing Implications 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 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 39: Adrenergic Agents: Nursing Implications With chronic lung disease: • Instruct patients to avoid factors that exacerbate their condition. • Encourage fluid intake (up to 3000 mL per day) if permitted. • Educate about proper dosing and equipment care. Salmeterol is indicated for PREVENTION of bronchospasms, not management of acute symptoms. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 40: Adrenergic Agents: Nursing Implications • Overuse of nasal decongestants may cause rebound nasal congestion or ulcerations. • Avoid OTC or other medications because of possible interactions. • Administering two adrenergic agents together may precipitate severe cardiovascular effects such as tachycardia or hypertension. • Inform patients taking inhaled isoproterenol that their sputum or saliva may turn pink. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 41: Adrenergic Agents: Nursing Implications Monitor for therapeutic effects (cardiovascular uses): • Decreased edema • Increased urinary output • Return to normal vital signs • Improved skin color and temperature • Increased LOC Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 42: Adrenergic Agents: Nursing Implications Monitor for therapeutic effects (asthma): • Return to normal respiratory rate • Improved breath sounds, fewer rales • Increased air exchange • Decreased cough • Less dyspnea • Improved blood gases • Increased activity tolerance Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 43: Adrenergic-Blocking Agents • Bind to adrenergic receptors, but inhibit or block stimulation of the sympathetic nervous system (SNS) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 44: Adrenergic Blocking Agents • Have the opposite effect of adrenergic agents • Also known as – adrenergic antagonists or sympatholytics Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 45: Adrenergic Blocking Agents • Sympatholytics inhibit—or LYSE— sympathetic neurotransmitters (norepinephrine and epinephrine) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 46: Adrenergic Blocking Agents Classified by the type of adrenergic receptor they block • Alpha1 and alpha2 receptors • Beta1 and beta2 receptors Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 47: Instructors may choose to insert EIC Image #55: Alpha-Blocker Mechanisms Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 48: Adrenergic-Blocking Agents: Drug Effects and Therapeutic Uses Ergot Alkaloids (Alpha-Blockers) • Constrict dilated arteries going to the brain (carotid arteries) • Used to treat vascular headaches (migraines) • Stimulate uterine contractions by inducing vasoconstriction • Used to control postpartum bleeding Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 49: Adrenergic-Blocking Agents: Drug Effects and Therapeutic Uses Alpha-Blockers • Cause both arterial and venous dilation, reducing peripheral vascular resistance and BP • Used to treat hypertension • Effect on receptors on prostate gland and bladder decreased resistance to urinary outflow, thus reducing urinary obstruction and relieving effects of BPH Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 50: Adrenergic-Blocking Agents: Drug Effects and Therapeutic Uses Alpha-Blockers • Phentolamine – Quickly reverses the potent vasoconstrictive effects of extravasated vasopressors such as norepinephrine or epinephrine. – Restores blood flow and prevents tissue necrosis. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 51: Adrenergic-Blocking Agents: Side Effects Alpha Blockers Body System Side/Adverse Effects Cardiovascular Palpitations, orthostatic hypotension, tachycardia, edema, dysrhythmias, chest pain CNS Dizziness, headache, drowsiness, anxiety, depression, vertigo, weakness, numbness, fatigue Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 52: Adrenergic-Blocking Agents: Side Effects Alpha Blockers Body System Side/Adverse Effects Gastrointestinal Nausea, vomiting, diarrhea, constipation, abdominal pain Other Incontinence, nose bleeding, tinnitus, dry mouth, pharyngitis, rhinitis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 53: Beta Blockers • Block stimulation of beta receptors in the SNS • Compete with norepinephrine and epinephrine • Selective and nonselective beta blockers Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 54: Beta Receptors Beta1 Receptors • Located primarily on the heart • Beta blockers selective for these receptors are called cardioselective beta blockers Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 55: Beta Receptors Beta2 Receptors • Located primarily on smooth muscles of bronchioles and blood vessels Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 56: Nonspecific Beta Blockers • Beta blockers that block both beta1 and beta2 receptors Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 57: Beta Blockers: Mechanism of Action Cardioselective (Beta1) • Decreases heart rate • Prolongs SA node recovery • Slows conduction rate through the AV node • Decreases myocardial contractility, thus decreasing myocardial oxygen demand Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 58: Beta Blockers: Mechanism of Action Nonspecific (Beta1 and Beta2) • Effects on heart: Same as cardioselective • Bronchioles: Constriction, resulting in narrowing of airways and shortness of breath • Blood vessels: Vasoconstriction Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 59: Beta Blockers: Therapeutic Uses • Anti-angina: decreases demand for myocardial oxygen • Cardioprotective: inhibits stimulation by circulating catecholamines • Class II antidysrhythmic Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 60: Beta Blockers: Therapeutic Uses • Antihypertensive • Treatment of migraine headaches • Glaucoma (topical use) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 61: Beta Blockers: Side Effects Body System Side/Adverse Effects Blood Agranulocytosis, thrombocytopenia Cardiovascular AV block, bradycardia, congestive heart failure, peripheral vascular insufficiency CNS Dizziness, mental depression, lethargy, hallucinations Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 62: Adrenergic-Blocking Agents: Side Effects Beta Blockers Body System Side/Adverse Effects Gastrointestinal Nausea, dry mouth, vomiting, diarrhea, cramps, ischemic colitis Other Impotence, rash, alopecia, bronchospasms Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 63: Adrenergic Blocking Agents: Nursing Implications • Assess for allergies and history of COPD, hypotension, cardiac dysrhythmias, bradycardia, CHF, or other cardiovascular problems Any preexisting condition that might be exacerbated by the use of these agents might be a CONTRAINDICATION to their use. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 64: Adrenergic Blocking Agents: Nursing Implications • Remember that alpha blockers may precipitate hypotension. • Remember that beta blockers may precipitate bradycardia, hypotension, heart block, CHF, and bronchoconstriction. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 65: Adrenergic Blocking Agents: Nursing Implications • Avoid OTC medications because of possible interactions. • Possible drug interactions may occur with: – Antacids (aluminum hydroxide type) – Antimuscarinics/anticholinergics – Diuretics and cardiovascular drugs – Neuromuscular blocking agents – Oral hypoglycemic agents Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 66: Adrenergic Blocking Agents: Nursing Implications • Encourage patients to take medications as prescribed. • These medications should never be stopped abruptly. • Report constipation or the development of any urinary hesitancy or bladder distention. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 67: Adrenergic Blocking Agents: Nursing Implications • Teach patients to change positions slowly to prevent or minimize postural hypotension. • Avoid caffeine (excessive irritability). • Avoid alcohol ingestion and hazardous activities until blood levels become stable. • Patients should notify their physician if palpitations, dyspnea, nausea, or vomiting occur. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 68: Beta Blocking Agents: Nursing Implications • Rebound hypertension or chest pain may occur if this medication is discontinued abruptly. • Patients should notify their physician if they become ill and unable to take medication. • Inform patients that they may notice a decrease in their tolerance for exercise; dizziness and fainting may occur with increased activity. Notify the physician if these problems occur. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 69: Beta Blocking Agents: Nursing Implications Patients should report the following to their physician: • Weight gain of more than 2 pounds (1 kg) within a week • Edema of the feet or ankles • Shortness of breath • Excessive fatigue or weakness • Syncope or dizziness Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 70: Adrenergic Blocking Agents: Nursing Implications Monitor for side effects, including: Hypotension Fatigue Tachycardia (alpha blockers) Lethargy Bradycardia Depression Heart block Insomnia CHF Vivid nightmares Increased airway resistance Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 71: Adrenergic Blocking Agents: Nursing Implications Monitor for therapeutic effects • Decreased chest pain in patients with angina • Return to normal BP and P • Other specific effects, depending on the use Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.





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