PH Chapter 24 - Adrenergic Drugs
Select the terms that describe drugs that stimulate the sympathetic branch of the ANS. Select all that apply 1. Sympathomimetic 2. Sympatholytic 3. Adrenergic 4. Cholinergic
1, 3
Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction? 1. a1 receptors 2. a2 receptors 3. b2 receptors 4. b1 receptors
4
When dobutamine is administered with the b-adrenergic blocking drugs, the nurse is aware of an increased rate for.... 1. Seizures 2. Arrhythmias 3. Hypotension 4. HTN
4
When norepinephrine is transmitted in the sympathetic nervous system, which of the following occurs? 1. Heart rate slows 2. BP lowers 3. GI system speeds up 4. Bronchi relax
4
This system activates the production of hormones and the release of epinephrine and norepinephrine
Hypothalamic-pituitary-adrenal system (HPA)
The sympathetic nervous system is regulated by ____________ control and it is known as the "fight-or-flight" response
Involuntary
Norepinephrine is C/I in patients who are...
Hypotensive from blood volume deficits
A patient is experiencing insomnia during epinephrine therapy. Which of the following interventions should the nurse perform while caring for the patient? Select all that apply 1. Identify circumstances that disturb sleep 2. Draw curtains over windows 3. Provide bedtime back rub to the patient 4. Give frequent sips of tea and coffee 5. Administer drugs only during daytime
1, 2, 3
A nurse is caring for a patient who has been administered metaraminol. Which of the following changes should the nurse report to the doctor immediately? 1. Consistent fall in BP 2. Rise in blood glucose levels 3. Decrease in gastric motility 4. Increase in HR
1
A nurse observes leakage of norepinephrine from the IV line. Which of the following interventions should the nurse perform to minimize tissue injury? 1. Discontinue old IV line immediately 2. Do not add another IV line unless instructed 3. Move the head of the bed to an elevated position 4. Mix alkaline solutions with norepinephrine infusions
1
A patient has been prescribed midodrine. Which of the following is an adverse effect of midodrine that the nurse should monitor for? 1. Supine HTN 2. Tachycardia 3. Orthostatic hypotension 4. Respiratory distress
1
At what intervals would the nurse monitor the blood pressure of a patient administered norepinephrine? 1. Continuously 2. Every 30 mins 3. Every hour 4. Every 4 hours
1
Which of the following adrenergic receptors is responsible for decreased tone, motility, and secretions of the GI tract? 1. a2 receptors 2. b1 receptors 3. a1 receptors 4. b2 receptors
1
Which of the following adrenergic receptors is responsible for the vasoconstriction of peripheral blood vessels? 1. Alpha receptors 2. a2 receptors 3. Beta receptors 4. b2 receptors
1
Which of the following is stimulated during the body's fight-or-flight response to a stressful condition? 1. Sympathetic nervous system 2. Parasympathetic nervous system 3. CNS 4. Somatic nervous system
1
Which of the following is the primary neurotransmitter of the sympathetic nervous system? 1. Norepinephrine 2. Dopamine 3. Serotonin 4. Acetylcholine
1
A nurse is required to administer dopamine to a patient. Which of the following nursing interventions should the nurse perform when caring for the patient? Select all that apply 1. Administer dopamine only via IV route 2. Mix dopamine with alkaline solutions before administering 3. Use an electronic infusion pump to administer these drugs 4. Monitor BP every 30 mins 5. Inspect needle site and surrounding tissues at frequent intervals
1, 3, 5
A 65 YO patient has been prescribed isoproterenol. Which of the following should the nurse report immediately to the doctor? 1. Feeling of nausea 2. Changes in pulse rate 3. Severe headache 4. Urinary urgency
2
For which of the following patients is isoproterenol C/I? 1. Patient with narrow-angle glaucoma 2. Patient with tachycardia 3. Patient with hypotension 4. Patient with pheochromocytoma
2
If a patient uses an auto-inject epineprhine device after an allergic reaction, the best disposal would be... 1. Container the injector is packaged in 2. Held until seen by the emergency dept 3. Hard plastic container 4. Sharps box or needle container
2
The adrenergic branch of the autonomic nervous system is also known by which of the following names? 1. Parasympathetic nervous system 2. Sympathetic nervous system 3. CNS 4. Somatic nervous system
2
The doctor prescribes norepinephrine, a potent vasopressor, to be administered to a patient in shock. The rate of administration of the IV fluid containing norepinephrine is: 1. Maintained at a set rate of infusion 2. Adjusted per protocol to maintain the patient's blood pressure 3. Given at a rate not to exceed 5 mg/min 4. Discontinued when BP is 100 mmHg systolic
2
What is the transmitting substance in the sympathetic branch of the nervous system? 1. Serotonin 2. Norepinephrine 3. Dopamine 4. Acetylcholine
2
A nurse is required to administer metaraminol for a patient who is taking digoxin. The patient is at an increased risk for which of the following? 1. Epigastric distress 2. Pheochromocytoma 3. Cardiac arrhythmias 4. Decrease in BP
3
Drugs that produce activity similar to the neurotransmitter norepinephrine are known as which of the following? 1. Sympatholytics 2. Antiadrenergic 3. Sympathomimetics 4. Anticholinergic drugs
3
Shock is described as... 1. Result of blood 2. Compensation for bodily assault 3. Inadequate tissue perfusion 4. The "flight of fight" response
3
Which of the following are the common adverse reactions the nurse would expect with the administration of the adrenergic drugs? 1. Bradycardia, lethargy, bronchial constriction 2. Increase in appetite, nervousness, drowsiness 3. Anorexia, vomiting, hypotension 4. Headache, nervousness, nausea
4
Which drugs are short-acting b2 agonists (SABAs- used for acute respiratory symptom relief)?
Albuterol Epinephrine Bitolterol Levalbuterol Metaproterenol Pirbuterol Terbutaline
How can supine HTN be minimized when administering midodrine to a patient?
Administer in the morning while patient is in upright position
Because the sympathetic nervous system is activated by the precursor of epinephrine, another name for the sympathetic nervous system is the ___________ ____________
Adrenergic Branch
Which drugs are long-acting b2 agonists (LABAs- used for long-term respiratory management)?
Arformoterol Formoterol Indacaterol Salmeterol
Adrenergic drugs are classified as pregnancy category __________ and are used with extreme caution during pregnancy
C
Ephedra should not be taken with...
Cardiac glycosides Halothane Guanethidine MAOI antidepressants Oxytoxin With St John's wort
This type of shock occurs when cardiac output is insufficient and perfusion to vital organs cannot be maintained. Usually occurs as a result of MI, ventricular arrhythmias, CHF, or severe cardiomyopathy
Cardiogenic shock
Adrenergic drugs are used cautiously in patients with...
Coronary insufficiency Cardiac arrhythmias Angina pectoris Diabetes Hyperthyroidism Occlusive vascular disease Prostatic Hypertrophy
This type of shock occurs when there are changes to the blood vessels causing dilation but no additional blood volume. The body is redistributed within the body. Septic, anaphylactic, and neurogenic shock fall under this category
Distributive Shock
This herb has been used to relieve cold symptoms, improve respiratory function, and as an adjunct in weight loss. It has been shown to cause stroke or heart attack though, so it is typically not recommended to take this herb
Ephedra
Adrenergic drugs produce what type of effects on the heart?
Increase in heart rate
Patients with diabetes will need an ________ dose of insulin while taking adrenergic drugs
Increased
If an adrenergic drug is taken in conjunction with an oxytoxin, what may occur as a result?
Increased risk of HTN
If dobutamine is administered with b-adrenergic blocking drugs, what may occur as a result?
Increased risk of HTN
If metaraminol is taken in conjunction with an digoxin, what may occur as a result?
Increased risk of cardiac arrhythmias
If an adrenergic drug is taken in conjunction with an phenytoin (Dilantin), what may occur as a result?
Increased risk of seizures, hypotension, and bradycardia
If an adrenergic drug is taken in conjunction with an antidepressant, what may occur as a result?
Increased sympathomimetic effect
Adrenergic drugs produce what type of effects on metabolism?
Increased use of glucose and liberation of fatty acids from adipose tissue
This drug should only be given to patients whose lives are impaired despite standard treatment offered
Midodrine
Adrenergic drugs are useful in improving hemodynamic status by improving ____________ contractility and increasing heart rate
Myocardial
Epineprhine is C/I in patients with...
Narrow-angle glaucoma As a local anesthetic adjunct in fingers and toes
This type of shock occurs when there is interference with the PNS control of blood vessels usually due to a spinal injury
Neurogenic Shock
If an adrenergic drug is ___________, it means that it acts on both alpha receptors and beta receptors
Nonselective
This neurotransmitter is the primary one of the sympathetic nervous system and the substance that keeps the nerve impulse going from the brain to the target organ.
Norepinephrine
This type of shock occurs when obstruction of blood flow results in inadequate tissue perfusion. Usually occurs as a result of pericardial tamponade, restrictive pericarditis, and severe cardiac valve dysfunction
Obstructive Shock
Epinephrine may temporarily increase tremors and rigidity in older adults with __________________ disease
Parkinson's
Dopamine is C/I in patients with...
Pheochromocytoma (Adrenal gland tumor) Unmanaged arthritis Ventricular fibrillation
Adrenergic drugs produce what type of effects in the autonomic nervous system?
Relaxation of smooth muscles of the bronchi Constriction of blood vessels Dilation of coronary blood vessels Decrease in GI motility
If an adrenergic drug is ___________, it means that it acts on alpha receptors or beta receptors
Selective
This type of shock occurs when circulatory insufficiency results from overwhelming infection
Septic Shock
What is the suggested dosing schedule for midodrine?
Shortly before arising in the morning, midday and late afternoon Should not be administered after 6PM
What is a major adverse reaction of taking midodrine?
Supine HTN
The autonomic nervous system is divided into what 2 sections?
Sympathetic and Parasympathetic
The adrenergic drugs produce pharmacological effects similar to the effects that occur in the body when the _____________ ___________ (norepinephrine) and the _______________ (epinephrine) are stimulated
Sympathetic nerves/ Medulla
Adrenergic drugs are also known as _______________ which means to mimic the actions of the sympathetic nervous system
Sympathomimetic
Isoproterenol C/I in patients with...
Tachyarrhythmias, tachycardia, or heart block caused by digitalis toxicity, ventricular arrhythmias, and angina pectoris
What is the purpose of stimulating the sympathetic nerves?
To divert blood flow to the vital organs so that the body can deal with a stressful situation
________________ are drugs that raise the blood pressure because of their ability to constrict blood vessels
Vasopressors
Adrenergic drugs produce what type of effects in the CNS?
Wakefulness, quick reaction to stimuli, quickened reflexes
This adrenergic receptor works on peripheral blood vessels and causes vasoconstriction of peripheral blood vessels
a1
This adrenergic receptor works on the presynaptic neuron and regulates the release of neurotransmitters and decreases tone, motility, and secretions of the GI tract
a2
This adrenergic receptor works on the myocardium and increases heart rate and the force of myocardial contraction
b1 (1 heart)
This adrenergic receptor works on the peripheral blood vessels and bronchial smooth muscles. It causes vasodilation of peripheral vessels and causes bonchodilation
b2 (2 lungs)
