Nursing Application: Adrenergic, Adrenergic-Blocking, Cholinergic, and Cholinergic-Blocking Drugs

A patient on a dobutamine drip starts to complain that he feels a "tightness" in his chest that he had not felt before. What will the nurse do first?

Check the patient's vital signs.

What can happen with high doses of cholinergics?

Cholinergic Crisis

A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulizer treatment with albuterol. What is the nurse's immediate assessment priority?

Monitor oxygen saturation with a pulse oximeter.

A patient on a dobutamine drip starts to complain that her intravenous line "hurts." The nurse checks the insertion site and sees that the area is swollen and cool. What will the nurse do first?

Stop the intravenous infusion.

1. Benztropine mesylate is indicated as adjunct pharmacotherapy to manage debilitating motor effects (cogwheel rigidity, muscle tremors, pill-rolling movements, and bobbing of the head) of Parkinson's disease.​ 2. Carbidopa-levodopa has side effects, such as nausea, vomiting, dyskinesia, orthostatic hypotension, cardiac dysrhythmias, and psychosis.​ 3. Ropinirole's drug action increases dopamine presynaptic receptors in the brain. It is indicated for early and late state Parkinson's disease. ​ 4. Entacapone is taken with levodopa and begins its effect with the first dose. It benefits patients who experience the wearing-off effect of levodopa and facilitates a lower dose of levodopa being used. 5. Bromocriptine nondopamine works by direct stimulation of presynaptic and/or postsynaptic dopamine receptors in the brain.​ 6. Selegiline is used in combination with levodopa to reduce the dosage needed for symptom control. Adverse effects appear with doses greater than 10 mg.​ 7. Amantadine is indicated for the early stages of Parkinson's disease and is usually only effective for 6 to 12 months, after which it becomes ineffective in relieving hypokinesia and rigidity.​

1. Anticholinergic 2. Dopamine replacement 3. Nondopamine dopamine receptor agonist 4. COMT Inhibitor 5. Dopamine receptor 6. MAO-B inhibitor 7. Dopamine modulator​

1. Cardiovascular Uses 2. Asthma

1. Decreased edema​ Increased urinary output​ Return to normal vital signs​ Improved skin color and temperature​ Increased LOC​ 2. Return to normal respiratory rate​ Improved breath sounds, fewer crackles​ Increased air exchange​ Decreased cough​ Less dyspnea​ Improved blood gasses​ Increased activity tolerance​

Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as 1.________________.

1. Tachycardia or hypertension

1. Monitor older adults carefully for 2. Observe clients for 3. Encourage clients for 4. Advise clients for

1. confusion, orthostatic hypotension, and anorexia​ 2. dry mouth, decreased salivation, reduced gastrointestinal motility resulting in constipation, and dilated pupils interfering with visual acuity​ 3. hydration, the use of hard candy, and a high fiber diet​ 4. reporting any changes in vision

A patient is experiencing bronchospasms after running half a mile. He has several inhalers with him. Which one would be appropriate for treatment at this time?

Albuterol

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition?

Epinephrine

The teaching for a patient who is taking tamsulosin to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these?

Get up slowly from a sitting or lying position.

When administering an alpha blocker for the first time, it is most important for the nurse to assess the patient for the development of what adverse effect?

Hypotension

Cholinergic drugs can result in what hemodynamic state that can result in the need to sit or stand slowly?

Postural hypotension

A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect?

Orthostatic hypotension

When monitoring for cholinergic crisis, what acronym can guide this assessment?

SLUDGE

A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 beats/min, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 beats/min and 120/80 mm Hg). What is the nurse's immediate concern for this patient?

The medication may be causing a worsening of a preexisting cardiac disorder.