Chapter 30: Adrenergic Agonists

Which would the nurse identify as a naturally occurring catecholamine?

Dopamine is a naturally occurring catecholamine

An increased dosage of digoxin would be needed if the patient is also taking midodrine.

False. Midodrine can precipitate increased drug effects of digoxin; this combination should be avoided.

A client is receiving dopamine intravenously in the right arm. The IV becomes dislodged from the vein, and dopamine has been being given in the surrounding tissue instead of the vein. What should the nurse do immediately after stopping the IV?

Administer phentolamine to the site.. Phentolamine is used to treat/prevent dermal necrosis after IV administration of norepinephrine or dopamine. Placing ice causes vasoconstriction, which could increase the chance of necrosis. Wrapping the site tightly with gauze will not help the tissue absorb the dopamine. Beta blockers will not prevent necrosis at the site of the dopamine infusion.

Adrenergic drugs mimic the effects of stimulating what part of the nervous system?

An adrenergic drug is an agent that produces effects like those produced by stimulation of the sympathetic nervous system and therefore has widespread effects on body tissues.

Alpha- and beta-specific adrenergic agonists are primarily used to treat obstructive pulmonary conditions.

Beta-specific agonists are used primarily to treat obstructive pulmonary conditions; alpha- and beta-specific agonists are used to treat hypotensive states.

A 21-year-old man experienced massive trauma and blood loss during a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what assessment should the care team prioritize?

Cardiac monitoring. The high potential for adverse effects that is associated with the use of dopamine necessitates vigilant cardiac monitoring

Which herbs has been removed from most weight-loss medications due to potential legal liability?

Ephedra has serious adverse reactions, such as hypertension and irregular heart beat. These side effects have been associated with stroke and heart attacks. The Food and Drug Administration has warnings against taking weight-loss pills that have ephedra in them

A patient suffers from bronchial asthma. Which medication is a mixed-acting adrenergic drug?

Ephedrine is a mixed-acting adrenergic drug that acts by stimulating alpha1 and beta receptors and causing release of norepinephrine from presynaptic terminals. It is used in the treatment of bronchial asthma. Epinephrine is not a mixed-acting adrenergic drug. Pseudoephedrine is a related drug, stimulating alpha1 and beta receptors. It is used as a nasal decongestant. Isoproterenol is a synthetic catecholamine that acts on beta1- and beta2-adrenergic receptors.

Epinephrine is contraindicated in clients with which diseases or disorders?

Epinephrine and other adrenergic drugs are contraindicated in clients with narrow-angle glaucoma (closed-angle glaucoma) because the drugs increase intraocular pressure and mydriasis.

Epinephrine causes relaxation of: bronchioles.

Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock.

Which would the nurse expect to be prescribed to a client experiencing acute bronchospasm?

Epinephrine would be used to treat bronchospasm

A male client is prescribed an adrenergic ophthalmic medication. What should the nurse include in the teaching plan

Hypertension may be a side effect of the medication.Ophthalmic preparations of adrenergic drugs should be used cautiously. For example, phenylephrine is used as a vasoconstrictor and mydriatic.

Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly.

Patients who are receiving alpha-specific adrenergic agents should not discontinue the drug abruptly because sudden withdrawal can result in rebound hypertension, arrhythmias, flushing, and even hypertensive encephalopathy and death; taper the drug over 2 to 4 days.

Which agent would the nurse expect to find when reviewing over-the-counter allergy products?

Phenylephrine is found in many cold and allergy products because it is so effective in constricting topical vessels and decreasing the swelling and signs and symptoms of rhinitis.

When applied topically to the eye, which drug produces dilation of the pupil without changing accommodation?

Phenylephrine. Ophthalmic preparations of adrenergic drugs such as phenylephrine are used as a vasoconstrictor and mydriatic.

The nurse is reviewing the history of a client receiving isoproterenol. Which would the nurse identify as being a contraindication?

Pulmonary hypertension. Pulmonary hypertension would be a contraindication for isoproterenol because the drug could exacerbate the condition

A patient is receiving salmeterol. The nurse would expect this drug to be given by which route?

Salmeterol, a beta-specific adrenergic agonist, is administered by inhalation.

The nurse knows that what is an added benefit of epinephrine in cardiac arrest situations due to asystole or pulseless electrical activity?

Stimulates electrical and mechanical activity. A benefit of epinephrine in arrest situations due to asystole or pulseless electrical activity is the added ability to stimulate electrical and mechanical activity and produce myocardial contraction.

Drugs that produce activity similar to the neurotransmitter norepinephrine are known as which of the following?

Sympathomimetics are drugs that produce activity similar to the neurotransmitter norepinephrine. Drugs that block or inhibit the sympathetic nervous system are called antiadrenergic drugs, adrenergic blocking drugs, or sympatholytics.

A nurse is monitoring the vital signs of a patient who has been administered epinephrine. Which of the readings should nurse report immediately to the primary health care provider?

The nurse must immediately report to the health care provider a fall in systolic blood pressure below 100 mm Hg. Epinephrine should raise the blood pressure, so a continued low systolic pressure indicates the medication has not been effective.

A patient has been administered dobutamine HCL. Which adverse reactions should the nurse monitor for in the patient?

The nurse should monitor for cardiac arrhythmias (bradycardia and tachycardia) because they are common adverse reactions observed in patients being administered dobutamine HCL.

A nurse is caring for an elderly patient who is to be administered isoproterenol. Which change monitored in the patient should the nurse report immediately to the primary health care provider?

The nurse should report any changes observed in pulse rate or rhythm immediately

What would a nurse expect to administer if a client who is receiving isoproterenol develops a severe reaction?

To counteract the effects of isoproterenol, a beta-specific adrenergic agonist, the nurse would administer a beta-adrenergic blocker.

Phentolamine is the agent used to treat extravasation of dobutamine.

True, maintain phentolamine on standby in case extravasation occurs.

The stimulation of beta1 adrenergic receptors in the heart by epinephrine would cause what result?

increased heart rateThe predominant effect in response to activation of beta1 receptors in the heart is cardiac stimulation. Beta1 activation results in increased force of myocardial contraction, or a positive inotropic effect and increased speed of electrical conduction in the heart.

A nurse is caring for a 25-year-old client who has been prescribed an adrenergic drug for shock. Which action should the nurse implement?

Continually assess the client for physiological changes and notify the primary care provider with changes.When caring for a client receiving an adrenergic medication for shock, the nurse will continually assess the client for changes in his vital signs, perfusion, and any adverse reactions.

Which is an effect of epinephrine?

Epinephrine increases heart rate and acts as a bronchodilator. It has peripheral vasoconstrictive effects and increases blood pressure.

A client who is in shock has been prescribed a dopamine intravenous infusion. What component of the client's existing medication regimen most increases the client's risk for adverse effects?

Phenelzine is a monoamine oxidase (MAO) inhibitor; MAO is partially responsible for the deactivation of norepinephrine in synapses of the sympathetic nervous system and alterations in its levels can affect norepinephrine levels.

A need for additional education on the administration of epinephrine is needed when a new nursing graduate indicates that epinephrine can be effectively administered by what route?

Administration of epinephrine is by inhalation, injection, or topical application. Oral administration of the drug is not effective, because enzymes in the GI tract and liver destroy it.

The nurse is reviewing the history of a patient who is to receive midodrine. Which would alert the nurse to a contraindication for the drug?

Glaucoma is a contraindication for the use of midodrine, an alpha-specific adrenergic agonist, because the condition could be exacerbated by the arterial constriction

A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action?

assess heart rate.The client's heart rate must be assessed prior to administration of alpha- and beta-adrenergic agonists.

Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction?

β1 receptors. β1 receptors are responsible for increased heart rate and increased force of myocardial contraction. Vasoconstriction of peripheral blood vessels occurs as the result of stimulation of α1 receptors. Stimulation of α2 receptors inhibits release of norepinephrine into synapses of sympathetic nervous system. Stimulation of β2 receptors leads to vasodilation of the peripheral vessels and also causes bronchodilation.