PNE 104. Ch. 25 - Adrenergic Blocking Drugs. Clinical Pharm. Susan Ford 11th Ed.

Timolol Uses:

(Ophthalmic) Glaucoma.

Metoprolol Adv. Reactions:

1. N/V 2. diarrhea 3. dizziness 4. cardiac arrhythmia 5. hypotension 6. HF

a-Adrenergic blocking drugs actions:

1. Stimulation of a-adrenergic nerves results in vasoconstriction. If stimulation of a-adrenergic nerves is interrupted or blocked, the result is vasodilation. 2. This is the direct opposite of the effect of an adrenergic drug with (a) activity. 3. The primary drugs used in this category cause vasodilation by by relaxing the smooth muscle of blood vessels.

a/B Adrenergic Contraindications:

1. patients with hypersensitivity to the drugs 2. bronchial asthma 3. decompensated HF 4. severe bradycardia.

Sympatholytic

Blocking the sympathetic nervous system

When norepinephrine is blocked in the sympathetic nervous system, which of the following occurs?

Blood pressure monitoring

Centrally and Peripherally acting drugs Uses

Cardiac arrhythmia, hypertension, BPH

Heart Failure (HF)

Condition in which the heart cannot pump enough blood to meet the tissue needs of the body, commonly called congestive heart failure (CHF)

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart

Decrease the heart rate

B-adrenergic blocking precautions

Diabetes, thyrotoxicosis, peptic ulcer

T/F: Antiadrenergic drugs are used cautiously in patients with diabetes, thyrotoxicosis, and peptic ulcer.

False

B-adrenergic blocking Uses

Hypertension, cardiac arrhythmias, migraine headaches, heart failure, Angina pectoris, glaucoma, reinfarction

Nadolol Uses:

Hypotension, angina.

First-dose effect

Marked adverse reaction within the first dose

The home care nurse is caring for a client newly prescribed a nonselective beta-blocking agent. What should the nurse include in the teaching plan related to this drug? Select all that apply.

Take with meals Change position slowly Avoid driving or operating hazardous machinery

A client is to receive a β-adrenergic drug for hypertension. Before the drug is administered, the most important assessment the nurse performs is ___________.

Taking the blood pressure on both arms

T.F: Betaxolol (Betoptic) and timolol (Timoptic) are used to treat glaucoma.

True

T/F: Alpha-adrenergic blocking drugs are used to treat tissue damage caused by extravasation of dopamine.

True

ą/B-adrenergic blocking

Work on both ą and B nerve fibers

A pregnant woman has severe hypertension and the provider orders a beta blocker. The client wants to know if it is safe for the fetus. How should the nurse respond?

"Beta blockers are recommended for pregnant women because the risk to the fetus is less than with other drugs."

A male client diagnosed with bone cancer has an order for clonidine on his chart. The nurse is concerned that this may be a mistake and asks another nurse why clonidine would be ordered for this client. What would be an appropriate response from the second nurse?

"Clonidine is sometimes prescribed for severe pain in cancer clients like this client."

The nurse has provided teaching for a client who has a new order for nadolol (Corgard) to treat hypertension. What statement by the client concerning nadolol (Corgard) would indicate that the teaching has been effective?

"I should never stop taking this drug abruptly, but will taper the doses gradually."

The male client is prescribed prazosin (Minipress) for hypertension. He asks the nurse how the medication works. What is the nurse's best response?

"It works by making your blood vessels dilate."

The nurse is reviewing several clients' medication administration records and notes that many of the adrenergic blocking antagonists have what suffix?

-lol

Timolol Adv. Reactions:

1. (Opthalmic) Ocular irritation, tearing.

Four groups

1. Alpha Adrenergic blocking 2. Beta Adrenergic blocking 3. Alpha/Beta Adrenergic blocking 4. Centrally and Peripherally

B-Adrenergic Adv. Reactions:

1. Cardiac reactions that affect the body in a generalized manner include orthostatic hypotension, bradycardia, dizziness, vertigo and headache. 2. Gastrointestinal (GI) reactions: Hyperglycemia, nausea, vomiting, diarrhea. Bronchospasm (especially in those with a history of asthma).

B-Adrenergic Used cautiously:

1. Diabetes 2. thyrotoxicosis -clinical manifestation of excess thyroid hormone action at the tissue level due to inappropriately high circulating thyroid hormone concentrations. 3. peptic ulcer.

B-Adrenergic Used to treat:

1. Hypertension (first choice drug for patients with stable angina). 2. Cardia arrhythmia (abnormal rhythm of the heart) such as ventricular or supraventricular tachycardia. 3. Migraine headaches 4. heart failiure 5. Angina pectoris (chest pain) 6. Glaucoma (topical ophthalmic eye drops)

a-Adrenergic uses:

1. Hypertension caused by pheochromocytoma (a tumor of the adrenal gland that produces excessive amounts of epinephrine and norepinephrine). 2. Hypertension during preoperative preparation. 3. To prevent or treat tissue damage caused by extravasation of dopamine.

a/B Adrenergic Adverse Reaction:

1. Most adv. effects of a/B adrenergic blocking drugs are mild and do not require discontinuation of therapy. 2. General body system adv. reactions include: fatigue, dizziness, hypotension, drowsiness, insomnia, weakness, diarrhea, dyspnea, chest pain, bradycardia, and skin rash.

Atenolol Adv. Reactions:

1. N/V 2. diarrhea 3. dizziness 4. nervousness 5. bronchospasm 6. Bradycardia 7. hypotension.

Propranolol Adv. Reactions:

1. N/V 2. dizziness 3. bradycardia 4. bronchospasms 5. hypotension 6. hyperglycemia 7. pulmonary edema.

Nadolol Adv. Reactions:

1. N/V 2. diarrhea 3. dizziness 4. cardiac arrhythmia 5. hypotension 6. HF

In what client is propranolol (Inderal) contraindicated?

35-year-old post-MI female with heart rate 42

Phentolamine Adverse Reactions:

: 1. Weakness 2. dizziness 3. flushing 4. N/V 5. orthostatic hypotension.

Cardiac Arrhythmia

Abnormal rhythm of the heart, also known as cardiac dysrhythmias

Centrally and Peripherally acting drugs Contraindication

Active hepatic disease,antidepressants therapy using MAOIs, history of hypersensitivity

First-dose effect occurs when the client experiences marked hypotension and syncope with sudden loss of consciousness with the first few doses of the sympatholytic. Which intervention might be helpful for the nurse to do to decrease the risk for first-dose effect?

Administer the dose at bedtime

Centrally and Peripherally acting drugs interactions

Adrenergic= increased risk of hypotension; Levodopa= decreased effect of the Levodopa, hypotension; anesthetic agent= increased effect of the anesthetic;B-blockers=increased risk of hypertension; lithium= increased risk of lithium toxicity; haloperidol increased risk of psychotic behavior

The client has been ordered a nonselective beta-blocking agent called propranolol, PO. Propranolol is used in the treatment of which disorders?

All the above Rationale: Propranolol is a nonselective beta-blocking agent with indications that include hypertension, angina, cardiac arrhythmias, hypertrophic subaortic stenosis, migraine prophylaxis, and myocardial infarction.

B-adrenergic blocking Contraindication

Allergies to B-blockers, sinus bradycardia, second- or third-degree heart block, HF

B-adrenergic blocking

Also called B-blockers. These drugs decrease the stimulation of the sympathetic nervous system on certain tissues. Receptors are found mainly in the heart.

Adrenergic blocking drugs:

Also called sympatholytic drugs, these agents block the transmission of norepinephrine in the sympathetic system. Drugs blocking neurotransmission in the sympathetic nervous system work directly by blocking the receptor or indirectly by preventing release of norepinephrine.

Chapter 25 Review: Prepare for NCLEX: Alternate-Format-Questions #9 Select the terms that describe drugs that block the sympathetic branch of the ANS. Select all that apply. 1. sympathomimetic 2. sympatholytic 3. antiadrenergic 4. anticholinergic

Answer: 2, 3 2. Sympatholytic 3. Antiadrenergic

Chapter 25 Review: Prepare for NCLEX: Apply your knowledge #7 Mr. Garcia was seen with a blood pressure of 210/120 and has taken one dose of metoprolol and returned for a blood pressure reading. Which of the following blood pressures should be reported to the primary health care provider immediately?

Answer: 250/130

Chapter 25 Review: Prepare for NCLEX: Alternate-Format-Questions #10 A client has just had a dose increase to 12.5 mg of carvedilol. The client has a bottle with 3.125 mg tablets and insists on finishing the bottle before buying a different strength. The nurse tells the client to take ____________.

Answer: 4 TABS

Chapter 25 Review: Prepare for NCLEX: Alternate-Format-Questions #8 The primary health care provider prescribed 60mg propranolol to be given via the GI tube. The drug is available in an oral solution of 5mg/mL. The nurse uses a total of 30 mL of warm water to flush before and after administering the drug. Total volume of fluid for this procedure was:

Answer: 42mL of water and drug solution

Chapter 25 Review: Prepare for NCLEX: Apply your knowledge #6 When norephedrine is blocked in the sympathetic nervous system, which of the following occurs?

Answer: Blood Pressure Lowers

Chapter 25 Review: Prepare for NCLEX: Build your knowledge #3 When an adrenergic blocking drug is given for a life-threatening cardiac arrhythmia, which of the following activities would the nurse expect to be a part of client care?

Answer: Continued cardiac monitoring

Chapter 25 Review: Prepare for NCLEX: Build your knowledge #1 Antiadrenergic drug block which of the following transmitters?

Answer: Norepinephrine

Chapter 25 Review: Prepare for NCLEX: Build your knowledge #2 A client is to receive a beta-adrenergic drug for hypertension. Before the drug is administered, the most important assessment the nurse performs is ________________.

Answer: Taking the blood pressure on both arms.

Chapter 25 Review: Prepare for NCLEX: Build your knowledge #4 To prevent complications when administering a beta-adrenergic blocking drug to an elderly client, the nurse would be particularly alert for ________________________.

Answer: Vascular insufficiency (e.g. weak peripheral pulses and cold extremities).

Chapter 25 Review: Prepare for NCLEX: Build your knowledge #5 The client with glaucoma will likely receive ___________________.

Answer: a beta-adrenergic blocking drug

ą/B-adrenergic blocking Interactions

Antidepressants (Tricyclics and SSRIs)= increased risk of tremors; cimetidine= increased effect of the Adrenergic blocker;clonidine=increase effect of the clonidine; digoxin= increased serum level of the digoxin and higher risk of digoxin toxicity

B-adrenergic blocking Interactions

Antidepressants MAOIs and SSRIs= increased effect of B blocker, bradycardia; NSAIDs and salicytes= decreased effect of B blockers; Loop diuretic= increase risk of hypotension; clonidine= increased risk of paradoxical hypertensive effect; Cimetidine= increased serum level of B blocker higher risk for toxicity; Lidocaine= increased serum level of B blockers higher risk for toxicity

The nurse knows that which class of drugs prevents epinephrine and norepinephrine from occupying receptor sites on the cell membranes?

Beta-adrenergic blocking drugs Rationale: Beta-adrenergic blocking drugs prevent epinephrine and norepinephrine from occupying receptor sites on cell membranes. Beta-adrenergic drugs stimulate epinephrine and norepinephrine release so that they can occupy more of the receptor sites. Beta Blocking agonist cause epinephrine to bind to sites causing airways to open. There is no such thing as beta-helping drugs.

Alpha (ą) Adrenergic blocking

Block the ą-adrenergic receptors, that control the vascular system

Beta (B) Adrenergic blocking

Blocks B-adrenergic receptors, receptors of the heart

Antiadrenergic

Blocks the neurotransmission of the sympathetic nervous system

ą/B-adrenergic blocking Actions

Bock stimulation of both resulting in peripheral vasodilation

A client has been admitted to the cardiac unit for heart failure and has been ordered carvedilol (Coreg). The client's blood pressure is 80/50. What should the nurse do?

Call the provider and advise them of the client's blood pressure prior to administering the medication. Rationale: Coreg can cause hypotension. If the client's blood pressure is already 80/50, giving the medication may cause the blood pressure to drop to a dangerous level. Calling the provider and getting further instructions prior to giving the medication is appropriate nursing care. Coreg will not increase the client's blood pressure. Do not give the medication and then call the provider. Continuing to use other BP machines until obtaining a better blood pressure is not appropriate. Use the same BP device continually during a hospitalization for a cardiac client so that all results are based on the same machine. Thus, a true trend in blood pressure can be obtained.

When an adrenergic blocking drug is given for a life-threatening cardiac arrhythmia, which of the following activities would the nurse expect to be a part of client care?

Cardiac Monitoring

Propranolol Uses:

Cardiac arrhythmias, Mi, angina, hypertension, migraine prophylaxis, hypertrophic subaortic stenosis, pheochromocytoma, essential tremor.

A client has come to get lab results at the cardiology clinic. The nurse notes that the digoxin level is elevated. The nurse knows that what other medication may be responsible for the increase in digoxin level?

Carvedilol

Beta-blockers have a variety of therapeutic uses. Which agent is a beta-blocker used for the treatment of heart failure?

Carvedilol (Coreg) Rationale: Carvedilol is available only orally and is used to treat hypertension as well as congestive heart failure and left ventricular dysfunction after an MI.

a/B Adrenergic Uses:

Carvedilol is used to treat essential hypertension and in HF to reduce progression of the disease. labetalol is used in the treatment of hypertension, either alone or in combination with another drug, such as a diuretic.

The clinic nurse is documenting the history of a client who is to begin α-adrenergic blocking drug therapy. In which of these conditions are α-adrenergic blocking drugs contraindicated?

Coronary artery disease

Postural hypotension

Decrease in blood pressure after a sudden change in body position

Orthostatic Hypotension

Decrease in blood pressure occurring after standing in one place for an extended period

Before discharge from the cardiac step-down (status post-MI), a client questions the prescription for beta-blockers. What should the client be told about the purpose for taking beta-blockers? (Select all that apply.)

Decrease mortality rates over several years. Protect the heart from reinfarction.

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart?

Decrease the heart rate

B-adrenergic blocking Actions

Decrease the stimulation of the sympathetic nervous on tissue, B-adrenergic receptors are gound in the heart which increase the heart rate,blocking these will decrease the heart rate and dilate the blood vessels. Thesedrugs decrease cardiac workload and oxygen consumption

ą/B-adrenergic blocking precautions

Drug controlled HF, chronic bronchitis, impaired hepatic,cardiac function,diabetes, pregnancy Cat. C,lacation

a/B Adrenergic Cautiously used:

Drug controlled HF, chronic bronchitis, or impaired hepatic or cardiac function in those with diabetes, and during pregnancy (C) and lactation.

Alpha adrenergic blocking drugs:

Drugs that block (a) adrenergic receptors. These drugs produce their greatest effect on the a-receptors of the adrenergic nerves that control the vascular system.

Beta B adrenergic blocking drugs:

Drugs that block B adrenergic receptors. These drugs produce their greatest effect on the B receptors of adrenergic nerves, primarily the B receptors of the heart.

Centrally and Peripherally acting drugs Adverse Reactions

Dry mouth, drowsiness, sedation, anorexia, rash, malaise,weakness, hypotension, lightheadedness, bradycardia

Phentolamine use:

Dx. of pheochromocytoma, hypertensive episode before and during surgery, prevention/treatment of dermal necrosis after IV administration of norepinephrine or dopamine.

ą/B-adrenergic blocking Uses

Essential Hypertension, HF to reduce progression, Labetalol is used for hypotension, either alone or combined with other drugs such as diuretic

B-Adrenergic Interactions:

Everything increases the B-adrenergic drugs making the B-blockers at higher risk for toxicity. One thing is decreased that is NSAIDS, which are used for pain relief. THEY decrease effect of the B-blocker.

a/B Adrenergic Interactions:

Everything is increased some increase the other drug, cimetidine, halothane increase The effect of the Adrenergic blocker.

T/F: Blocking the nerve impulse of beta-adrenergic nerves causes excitability of the heart and the blood vessels to dilate.

False

ą/B-adrenergic blocking Adverse Reactions

Fatigue,dizziness, hypotension,drowsiness, insomnia, weakness, diarrhea, dyspnea, chest pain,bradycardia, skin rash

Phentolamine (Regitine)

For vasodilating effect on peripheral blood vessels = will lower blood pressure in conditions of hypertension due to pheochromocytoma (tumor of adrenal gland that will result in increase production of epinephrine which is vasoconstrictive in nature and thus contributes to hypertensive condition)

Glaucoma

Group of diseases of the eye characterized by increased intraocular pressure; results in changes within the eye, visual field defects, and eventually blindness (if left untreated)

Alpha-adrenergic blocking drugs are used in the treatment of _________________________ during preoperative preparation.

HTN

In which organ are the majority of the β-adrenergic receptors found?

Heart

What would be a contraindication to the use of a non-selective adrenergic blocker?

Heart block

Centrally and Peripherally acting drugs precautions

History of liver disease or renal impairment, pregnancy, lacation. Peripherally Contraindication hypersensitivity to any of the drugs. Reserpine is con. =active peptic ulcers or ulcerative colitis,mental depressed. Cautiously with history of depression, renal impairment, cardiovascular disease, pregnancy, lacation

A nurse is caring for a client taking both an antidepressant and an adrenergic blocking drug. Which of the following actions should the nurse perform when the client receiving adrenergic blocking drugs shows a dramatic decrease in blood pressure?

Hold the drug dose

ą/B-adrenergic blocking Contraindication

Hypersensitivity, bronchial asthma, decompensated HF,severe bradycardia,

ą-adrenergic blocking Contraindication

Hypersensitivity,coronary artery disease

ą-adrenergic blocking Uses

Hypertension caused by pheochromocytoma, hypertension during preoperative preparation, also used to prevent tissue damage caused by extravasation of dopamine

Chronic Care Considerations (p. 276):

Hypertension research studies demonstrate better pt outcomes for African Americans when B-blockers are used in combination with diuretics than other drugs to treat hypertension, such as angiotensin-converting enzyme (ACE) inhibitors.

Metoprolol Uses:

Hypertension, angina, MI, HF

Atenolol Uses:

Hypertension, angina, acute Mi

A new nurse in the cardiac unit is told by another nurse to be careful of "first-dose effect" when giving an adrenergic blocking medication. What should the nurse look for as symptoms of "first-dose effect"?

Hypotension and syncope with sudden loss of consciousness with the first few doses of a medication

The nurse is caring for a 64 year-old male client with diabetes who is being treated with a nonselective beta-blocker. What health education should the nurse prioritize with this client?

Identifying the signs and symptoms of hypo- or hyperglycemic reactions

B-Adrenergic Contraindications:

In pt. with a allergy to B-blockers, sinus bradycardia, second or third degree heart block, or heart failure, and in those with asthma, emphysema, or hypotension.

A client in an acute psychiatric unit has been administered an antiadrenergic drug. The client has also been given haloperidol for the treatment of psychosis. Which of the following interactions should the nurse monitor for in the client?

Increased risk of psychotic behavior

A nurse is caring for a client on β-adrenergic blocker therapy. The client is also to be administered lidocaine. Which of the following interactions may occur?

Increased serum level of the β blocker

Norepinephrine

Is a substance that transmits nerve impulses across the sympathetic branch of the autonomic nervous system. Activation of these nerves is sometimes called our fight-or-flight response.

A client presents to the emergency department reporting rapid heart rate, severe headache, and pounding in the chest. While obtaining the clients history, the nurse learns the client stopped taking medications because the prescriptions ran out and had no funds to refill them. The nurse knows that which medications being abruptly stopped could be causing these symptoms?

Labetalol

A nurse is caring for a client who has been administered Prazosin. For which of the following adverse reactions should the nurse monitor the client who is administered peripherally acting antiadrenergic drugs?

Lightheadedness

A nurse is caring for a client with glaucoma. The client is administered a β-adrenergic blocking ophthalmic preparation, such as timolol. How will the effectiveness of the drugs be determined?

Measure intraocular pressure of the client

A nurse is caring for a client who has been prescribed the sympatholytic drug propranolol by the primary health care provider. What nursing interventions should the nurse perform when the client is administered the sympatholytic drug?

Measure the apical pulse rate

A nurse is providing discharge instructions to a client who is taking atenolol (Tenormin) for hypertension. What would the nurse teach the client regarding the possible drug-to-drug interactions and what the client is advised to avoid?

NSAIDs

Antiadrenergic drugs block which of the following transmitters?

Norepinephrine

Preadministration onging Assessment

Observe the patient continually for the appearance of adverse reactions; hypertensive patients monitor their own bp between visits

Lifespan Considerations: Gerontology: (p. 276)

Older adults are at increased risk for adverse reactions when taking B-adrenergic blocking drugs. The nurse should monitor the older adult closely for confusion, heart failure, worsening of angina, shortness of breath, and peripheral vascular insufficiency.

Which adverse reaction should the nurse monitor for in a patient taking an alpha (α)-adrenergic blocking drug?

Orthostatic Hypotension

B-adrenergic blocking Adverse Reactions

Orthostatic hypotension, bradycardia, dizziness, vertigo, headache, hyperglycemia, nausea, vomiting, diarrhea

Benign prostatic hyperplasia is treated with which category of antiadrenergic drug?

Peripherally Acting

A nursing instructor determines that a class on adrenergic blockers was successful when the students identify which medications as an alpha-adrenergic blocker?

Phentolamine

A client has received a dose of dopamine intravenously. The client's IV was infiltrated, and the dopamine was injected into the subcutaneous tissues. Which medication will prevent the vasoconstriction and tissue necrosis based on this action?

Phentolamine mesylate (Regitine)

ą-adrenergic blocking precautions

Pregnancy Cat.C, lactating, after recent myocardial infarction, renal failure,Raynaud's disease, when phentolamine is given with

Centrally and Peripherally

Prevent the release of the neurotransmitter. Work on both the central and Peripheral nervous system

A nurse is caring for a client who is receiving haloperidol. Methyldopa is now prescribed. The nurse would assess the client closely for which adverse effect?

Psychotic behavior Rationale: The client faces an increased risk of psychotic behavior due to the effect of interaction of haloperidol with methyldopa. The client faces an increased risk of hypertension due to the effect of interaction of beta blockers with methyldopa. The client faces an increased risk of lithium toxicity due to the effect of lithium with methyldopa. The client faces an increased risk of digitalis toxicity due to the effect of interaction of digoxin with amphotericin B.

Before administering a beta-adrenergic blocker, the nurse should be aware of what information about the client

Pulse and blood pressure

___________________________ is contraindicated in patients who have an active peptic ulcer or ulcerative colitis and in patients who are mentally depressed.

Reserpine

A nurse at an eye care center is assigned to prepare a teaching plan for a client undergoing adrenergic blocking drug therapy for glaucoma. Which of the following should the nurse include in the teaching plan of the client?

Tell the client to contact the primary health care provider if change in vision occurs

A client has been prescribed timolol. What assessment finding would indicate tot the nurse that this medication is effective?

The client's intraocular pressure is reduced

A client with benign prostatic hypertrophy (BPH) has been prescribed prazosin (Minipress). How do alpha1 blocking agents, such as prazosin, assist in treating the symptoms of BPH?

They inhibit contraction of the urinary bladder.

A client is prescribed doxazosin to manage hypertension. What information about the medication's effect should the nurse provide the client?

This medication will not cause the common reflex tachycardia that accompanies a fall in blood pressure.

A provider orders timolol (Timoptic) for glaucoma. The order reads Timoptic 1 gtt PO bid. The nurse knows that something is wrong with this order. What is it?

Timoptic is given in the eye, not PO.

T/F: Alpha/beta-adrenergic blocking drugs block the stimulation of both the alpha- and beta-adrenergic receptors, resulting in peripheral vasodilation.

True

Pheochromocytoma

Tumor of the adrenal medulla characterized by hyper secretion of epinephrine and norepinephrine

To prevent complications when administering a β-adrenergic blocking drug to an elderly client, the nurse would be particularly alert for __________.

Vascular Insufficiency (e.g., weak peripheral pulses and cold extremities

A nurse is caring for an older client. The primary health care provider has prescribed a β-adrenergic blocking drug to the client. What should the nurse monitor for in the older client when administering β-adrenergic blocking drug?

Vascular insufficiency

The use of α-adrenergic blocker will result in which of the following client outcomes?

Vasodilation

ą-adrenergic blocking Adverse Reactions

Weakness, orthostatic hypotension, cardiac arrhythmias, hypotension, tachycardia

Fact

When betaxolol, and timolol are used topically as ophthalmic drips, they appear to reduce the production of aqueous humor in the anterior chamber of the eye, lessening the effects of glaucoma.

Preadministration Assessment

With hypertension check bp and pulse in both arms sitting,standing, and supine before therapy is begun; cardiac arrhythmia take pulse rate rhythm and general appearance; Anginal pain document pain experience of patient ask the onset, type, radiation, location, intensity, duration of anginal pain; Hf evidence of disease, such as dyspnea, peripheral edema, distended neck veins, and cough

a/B Adrenergic Actions:

a/B Adrenergic blocking drugs block the stimulation of both the a/B receptors, resulting in peripheral vasodilation. The two drugs in this category are carvedilol and labetalol.

A client has recently been prescribed a drug that treats hypertension by blocking the sympathetic receptors in the sympathetic nervous system. This action is characteristic of which?

an adrenergic antagonist

A priority nursing assessment for a client who is to receive an alpha- or beta- adrenergic blocking agent would be to:

assess heart rate

The nurse is caring for a client who is taking an adrenergic blocking agent. What assessment would be among the nurse's priorities?

assessing heart rate Rationale: The most serious adverse effect would be severe bradycardia, so the nurse's priority would be assessing the heart rate. If the client were identified as having diabetes, then monitoring blood glucose levels would become important because these drugs can aggravate diabetes by blocking sympathetic response including masking the usual signs and symptoms of hypoglycemia and hyperglycemia. Respiratory rate could be impacted if the client was identified as having a condition causing bronchospasm and diabetes because the combination could worsen both conditions. Measuring urine output should be part of the client's care, but it is not the priority assessment.

What is the first drug of choice for treatment of a client with a history of a myocardial infarction (MI) 2 years ago?

beta-blockers

A 72-year-old Asian male, status post-MI, with a 10-year history of cardiovascular disorder has been prescribed clonidine. Because the drug is an alpha2-adrenergic agonist, the expected clinical effect is decreased:

blood pressure

B-adrenergic blocking drugs used for cardiac purposes are _________________ and ________________.

esmolol and propranolol

When describing the action of beta blockers to a client, the nurse would emphasize that the majority of drug action involve stimulation of the receptors in which organ?

heart

The nurse is caring for a 64-year-old client with diabetes who is being treated with a nonselective beta-blocker. What health education should the nurse prioritize with this client?

identifying the signs and symptoms of hypo- or hyperglycemic reactions. Rationale: Because the beta-blockers stop the signs and symptoms of a sympathetic stress reaction, the signs and symptoms associated with hypo- or hyperglycemia, the diabetic client taking a beta-blocker will need to understand this and learn new indicators of these reactions. Heart rate monitoring and weekly weights are good health practices and should be done, but not specifically needed by a diabetic client taking a beta-blocker. There is no particular need for the client to eat multiple, small meals.

Centrally and Peripherally acting drugs Actions

inhibits the release of norepinephrine from certain Adrenergic nerve endingsn the peripheral nervous system; others act on the Central nervous system thereby decreasing some of the activity of the sympathetic nervous system. Different action but same results.

Which observation might indicate that timolol is achieving the desired effect in a client

intraocular pressure decreases

Which observation might indicate that timolol is achieving the desired effect in a client?

intraocular pressure decreases Rationale: Timolol is a beta blocker used for treatment of glaucoma and hypertension. Depending on the intended use, a decrease in the client's intraocular pressure or blood pressure is an indication that the drug is achieving the desired effect.

Beta-adrenergic blockers are used to prevent reinfarction in patients with a recent ______________________ infarction.

myocardial

Antiadrenergic drugs prevent the release of _____________.

neurotransmitters

B-Adrenergic used to prevent:

reinfection in patients with a recent MI (1 to 4 weeks after the MI).

The nurse is providing medication education to a client prescribed an adrenergic blocker. Which nervous system is the specific focus of this classification of medications?

sympathetic Rationale: Adrenergic blocking agents are also called sympatholytic drugs because they lyse, or block, the effects of the sympathetic nervous system.

The teaching priority for a diabetic male client being treated with a non-specific beta-blocker would be to:

understand signs and symptoms of hypo- or hyperglycemic reaction

Stimulation of alpha-adrenergic nerves results in _______________.

vasoconstriction

ą-adrenergic blocking interactions

when phentolamine is given with epinephrine it will decrease vasoconstri tor and hypertensive action

ą-adrenergic blocking Actions

ą-adrenergic nerves stimulation result in vasoconstriction, if blocked there will be vasodilation, by relaxing the smooth muscle of blood vessels. Used in ophthalmic preparations constrict the pupil

Alpha (α)-adrenergic

α receptors of the adrenergic nerves that could control the vascular system

The client with glaucoma will likely receive a(n) ________.

α-adrenergic blocking drug

Beta (β)-adrenergic

β receptors of the adrenergic nerves that primarily control the heart