Questions and Answers
What should be done after chronic therapy with Alpha-1 Adrenergic Blocking Agents?
Alpha-1 Adrenergic Blocking Agents can lead to reflex tachycardia.
False
What positive lifestyle changes should patients be educated about?
Diet, exercise, smoking cessation
Name two medications used for mild to moderate hypertension.
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What is a common adverse effect of nonselective Alpha-Adrenergic Blocking Agents?
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Which of the following is a contraindication for beta-blockers?
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Beta-blockers are used to manage __________ symptoms of hyperthyroidism.
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Match the following medications with their primary use:
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What should be monitored regularly in patients on Alpha-1 Adrenergic Blocking Agents?
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To prevent injury, establish safety precautions if __________ effects occur.
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Which of the following is NOT an adverse effect associated with beta-blockers?
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What is shock commonly caused by?
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Which adrenergic drugs affect the cardiovascular system?
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Beta adrenergic agonists are used for bronchospasm.
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What condition does an alpha adrenergic agonist help with in the eye?
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Epinephrine is also known as _____ .
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Which of the following is a contraindication for using phenylephrine?
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What does Midodrine treat?
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What are the common side effects of adrenergic agonists?
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Abrupt withdrawal of clonidine can lead to rebound hypertension.
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Which type of drugs occupy the adrenergic receptor site to prevent norepinephrine from activating it?
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Which drug is used primarily for hypotension under anesthesia?
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Beta-specific adrenergic agonists bind primarily to alpha-receptors.
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What significant effect can sympathomimetic drugs cause?
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Study Notes
Shock
- Complication often caused by acute blood loss, affecting organ and tissue function.
- Adrenergic drugs enhance cardiovascular effects: increase pressure, blood flow, and cause vasoconstriction.
Asthma
- Hypersensitivity reaction triggered by specific sources, leading to inflammation and bronchospasm.
- Beta adrenergic agonists are utilized for bronchospasm and respiratory obstruction conditions.
Adrenergic Agonists
- Medications that stimulate adrenergic receptors, classified as sympathomimetics.
- Act on both alpha and beta receptors to stimulate all adrenergic responses.
Clinical Use of Adrenergic Agonists
- Glaucoma: Condition with elevated intraocular pressure. Alpha adrenergic agonists are used to dilate pupils, reduce aqueous humor secretion, and lower intraocular pressure (IOP).
- Epinephrine (Adrenaline): Non-selective agonist; used in shock for heart stimulation—raises heart rate and contraction strength.
- Dopamine: Increases renal and splanchnic blood flow; utilized in hypotension, shock, and narcolepsy.
Side Effects / Adverse Effects
- Common side effects: headaches, sweating, anxiety, and palpitations due to sympathetic stimulation.
- Cardiovascular effects may include arrhythmias, hypertension, and dyspnea.
- Monitor for gastrointestinal issues like nausea and constipation.
Contraindications and Cautions
- Specific contraindications for adrenergic drugs include allergy to components, severe hypertension, and narrow-angle glaucoma.
- Caution in patients with CV disease, renal or hepatic impairment.
Nursing Responsibilities
- Close monitoring of vital signs and ECG to ensure therapeutic effectiveness without toxicity.
- Respond to extravasation with phentolamine infiltrations to prevent tissue damage.
Interactions
- Significant interactions with MAOIs and TCAs can lead to heightened vascular tone and severe hypertension.
- Other sympathomimetics may enhance the drug effects, requiring careful monitoring.
Beta-Specific Adrenergic Agonists
- Primarily bind to beta receptors; used for treating bronchial spasms and asthma.
- Beta-1 Agonists: Dobutamine, used to improve heart function.
- Beta-2 Agonists: Includes albuterol and salmeterol for bronchodilation.
Adverse Effects of Beta Agonists
- CNS effects: dizziness, insomnia, and fatigue.
- Cardiovascular issues may involve hypotension and arrhythmias.
Nursing Responsibilities for Beta Agonists
- Monitoring BP and heart rate closely, especially during dosage changes.
- Educate patients regarding potential adverse effects and management strategies.
Alpha-1 and Alpha-2 Adrenergic Blocking Agents
- Alpha-1 antagonists lead to vasodilation and reduced BP; examples include prazosin and doxazosin.
- Alpha-2 agonists like clonidine decrease NE release, managing hypertension.
Contraindications for Alpha Blockers
- Caution in patients with renal or heart failure, allergy to drug components, and hypotensive tendencies.
Overall Nursing Considerations
- Educate patients on the significance of adherence to therapy and lifestyle modifications.
- Ensure comfort measures are in place to mitigate drug effects and potential discomfort.### Nonselective Alpha-Adrenergic Blocking Agents
- Phentolamine: blocks α1 receptors, leading to vasodilation and decreased blood pressure; blocks α2, which may cause reflex tachycardia when BP declines.
- Treatment uses: prevent tissue sloughing after IV norepinephrine and dopamine extravasation; manage severe hypertension during pheochromocytoma surgery.
- Cautions: hypersensitivity, coronary artery disease, history of myocardial infarction, pregnancy, and lactation risks to fetus/neonate.
- Adverse effects include:
- CNS: headache, dizziness, fatigue, drowsiness, depression
- Cardiovascular: arrhythmia, hypotension, edema, heart failure, angina
- Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain
- Others: flushing, nasal congestion, priapism
- Drug interactions: enhanced hypotensive effects with nitrates, calcium-channel blockers, ACE inhibitors; decreased efficacy with NSAIDs and epinephrine; risk of peripheral ischemia with ergot alkaloids.
Beta Adrenergic Blocking Agents (Beta-blockers)
- Function: decrease conduction velocity (dromotropism), force of contraction (inotropism), and heart rate (chronotropism).
- Non-selective beta-blockers include Propranolol, Nadolol, Sotalol, and Timolol; selective beta-1 antagonists include Metoprolol, Acebutolol, Atenolol, etc.
- Propranolol indications: managing cardiovascular issues, preventing reinfarction post-MI, treating migraine prophylaxis, and minimizing hyperthyroidism symptoms.
- Cardiovascular benefits include reduced heart excitability, cardiac output, and oxygen consumption; lowers renin levels to decrease blood pressure.
- Adverse effects include:
- CNS: headache, fatigue, sleep disturbances, memory loss
- Cardiovascular: bradycardia, heart block, hypotension
- Respiratory: bronchospasm, difficulty breathing
- Gastrointestinal: nausea, vomiting, gastric pain
- Other: decreased libido, exercise tolerance, risk of hypoglycemia.
- Cautions include allergy to beta-blockers, bradycardia, heart block, shock, and conditions like asthma or COPD.
- Abrupt withdrawal can lead to serious complications including angina or myocardial infarction; should taper dosage over 2 weeks.
Nursing Responsibilities
- Monitor vital signs: blood pressure, pulse, rhythm, and cardiac output; adjust dosage or discontinue if severe cardiovascular effects occur.
- Provide patient education: inform about potential side effects, necessary reporting actions, and compliance with drug therapy.
- Ensure comfort measures: arrange for small, frequent meals to manage GI upset, and implement safety precautions for those experiencing CNS effects or orthostatic hypotension.
- Administer oral forms of metoprolol with food for better absorption; avoid abrupt withdrawal to prevent serious cardiovascular issues.
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Description
This quiz focuses on the pharmacological management of shock, a critical condition often encountered in nursing practice. It covers the essential medications, their mechanisms of action, and considerations in treatment. Test your knowledge and understanding of how to effectively manage shock through pharmacology.
