Ch. 30: Adrenergic Agonists Prep U
The nurse is teaching a client about safe use of adrenergic drugs. Which statement should be included in the teaching?
"Talk to your health care provider before taking any other medications." Clients taking adrenergic drugs should be instructed to take no other medications without their HCP's knowledge and approval. Many over-the-counter cold remedies and appetite suppressants contain adrenergic drugs, and use of these along with prescribed adrenergic drugs can result in overdose and serious cardiovascular or central nervous system problems. In addition, adrenergic drugs can interact with numerous other drugs to increase or decrease effects. Patients who are allergic to sulfites should alert their health care providers, since adrenergic drugs are contraindicated in that population.
A client is receiving phenylephrine via intramuscular injection. The nurse would expect the drug to begin acting in approximately which amount of time?
10 - 15 minutes
A client is being treated for asthma. What would the nurse expect to administer?
Beta-2-specific adrenergic agonist Most of the beta-specific adrenergic agonists are beta-2-specific adrenergic agonists, which are used to treat and manage bronchial spasm, asthma, and other obstructive pulmonary conditions.
Epinephrine causes relaxation of:
Bronchioles Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock.
A patient has been administered dobutamine HCL. Which adverse reactions should the nurse monitor for in the patient? cardiac arrhythmias elevated temperature urinary retention sleeplessness
Cardiac arrhythmias The nurse should monitor for cardiac arrhythmias (bradycardia and tachycardia) because they are common adverse reactions observed in patients being administered dobutamine HCL. Dobutamine HCL does not cause urinary retention, elevated temperature, or sleeplessness.
The home health nurse is caring for a 77-year-old male patient who has just been discharged from the hospital. The patient is taking dobutamine for congestive heart failure. What would be most important to monitor in this patient?
Compliance with drug regimen Monitor effectiveness of comfort measures and compliance with regimen. While it would be important to address all options given, it would be most important to monitor the patient's compliance with the drug regimen.
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? thyrotoxicosis glaucoma diabetes vasomotor spasm
Glaucoma Glaucoma is a contraindication for the use of midodrine, an alpha-specific adrenergic agonist, because the condition could be exacerbated by the arterial constriction. Thyrotoxicosis requires cautious use of midodrine, an alpha specific adrenergic agonist. Diabetes requires cautious use of midodrine, an alpha specific adrenergic agonist. Vasomotor spasm requires cautious use of midodrine, an alpha-specific adrenergic agonist.
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. Applying larger-than-recommended doses to the normal eye or usual doses to the traumatized, inflamed, or diseased eye may result in systemic absorption of the drug sufficient to cause increased blood pressure and other adverse effects.
Which assessment finding would indicate to the nurse that the administered isoproterenol is effective?
Improved cardiac contractility The desired effects of isoproterenol include improved contractility and conductivity, increased heart rate, bronchodilation, relaxation of the uterus, and increased blood flow to skeletal muscles and splanchnic beds.
A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?
Increased vasoconstrictive effects Epinephrine is added to local anesthetics for vasoconstrictive effects, which include prolonging the action of the local anesthetic drug, preventing systemic absorption, and minimizing bleeding. Epinephrine will not decrease cerebral circulation or coronary circulation. Epinephrine will not increase bronchoconstriction
A patient is receiving salmeterol. The nurse would expect this drug to be given by which route?
Inhalation Salmeterol, a beta-specific adrenergic agonist, is administered by inhalation.
The nurse would contact the health care provider before administering an adrenergic drug to a client who is also taking which drug?
MAO inhibitor Adrenergic drugs are contraindicated in clients taking MAO inhibitors. It is essential not to give MAO inhibitors with adrenergic drugs because the combination may cause death. Concurrent use of MAO inhibitors and adrenergic drugs may lead to a danger of cardiac arrhythmias, respiratory depression, and acute hypertensive crisis, with possible intracranial hemorrhage, convulsions, coma, and death.
Epinephrine is contraindicated in clients with which diseases or disorders? asthma bronchoconstriction narrow-angle (closed angle) glaucoma bronchoconstriction
Narrow-angle (or closed-angle) glaucoma Epinephrine and other adrenergic drugs are contraindicated in clients with narrow-angle glaucoma (closed-angle glaucoma) because the drugs increase intraocular pressure and mydriasis. Asthma, bronchoconstriction, and hypotension are among the disorders and diseases treated with adrenergic drugs.
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.
The adrenergic branch of the autonomic nervous system is also known by which name?
Sympathetic nervous system
Drugs that produce activity similar to the neurotransmitter norepinephrine are known as which of the following?
Sympathomimetics
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.
Patients who are receiving alpha-specific adrenergic agents should not stop taking the drug abruptly.
True 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.
Phentolamine is the agent used to treat extravasation of dobutamine.
True Maintain phentolamine on standby in case extravasation occurs.
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?
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. Telling a family that their loved one might die is not an appropriate nursing action at that time. Seizures, hypothermia, and dementia are not common side effects of adrenergic medications, and an adrenergic medication should not be abruptly stopped. The nurse needs to stay close to a client to do frequent assessments; sleep deprivation may occur, but it is not the primary concern when a client is in shock.
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 check blood glucose measure urinary output monitor respiratory rate
assess heart rate. The client's heart rate must be assessed prior to administration of alpha- and beta-adrenergic agonists. There would be no need to check blood glucose or measure urinary output, and though respiratory rate is monitored it is not the priority measure.
Which would the nurse identify as a naturally occurring catecholamine?
dopamine
A nurse in the intensive care unit is caring for a client in shock and has started IV administration of dopamine (Intropin). For a client in shock, dopamine helps to:
increase blood pressure. The alpha stimulation produces increased peripheral resistance, raising the blood pressure as the dose of dopamine increases. The drug's dosage is titrated upward until adequate perfusion of vital organs is achieved. Beta-1 stimulation produces increased cardiac output by increasing the force of contraction and heart rate. The drug does not have a direct effect on body temperature.
An adrenergic drug would be prescribed to produce what physiological effect? urinary incontinence increased heart rate urinary concentration reduce blood pH
increased heart rate Adrenergic drugs cause an increase in heart rate and respiratory rate. They do not directly induce urinary incontinence concentration, and they do not reduce blood pH.
Which medication is a synthetic catecholamine prescribed for the treatment of bradycardia?
isoproterenol Isoproterenol is a synthetic catecholamine that acts on beta1- and beta2-adrenergic receptors to stimulate heart rate. Neither pseudoephedrine, ephedrine, nor epinephrine is synthetic catecholamine.
The intravenous line of a client receiving dobutamine infiltrates and the drug extravasates. The nurse would infiltrate the site with:
phentolamine. If extravasation occurs, the nurse should infiltrate the site with 10 mL of saline containing 5 to 10 mg of phentolamine. Hyaluronidase and sodium bicarbonate may be used for extravasation of certain antineoplastic agents. Lactated Ringer's solution would be inappropriate.
A client is taking an OTC allergy product. The nurse would expect to find that this product mostlikely contains:
phenylephrine Phenylephrine is a common agent found in many OTC cold and allergy products. Ephedra has been banned by the Food and Drug Administration as a drug. Neither epinephrine nor albuterol are found in OTC products.
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.
Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction? a1 a2 b1 b2
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.
Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?
A 47-year-old female with hypertension Phenylephrine is an alpha-1 adrenergic agonist and a drug commonly used topically for relief of nasal and nasopharyngeal mucosal congestion and to produce mydriasis for ophthalmologic procedures. Phenylephrine acts as a vasopressor causing vasoconstriction of the arterioles. The vasoconstriction from phenylephrine use can increase peripheral resistance and blood pressure. People with hypertension should not take over-the-counter cold and allergy preparations containing phenylephrine because it can further increase their already elevated blood pressure. Patients with diabetes and gout have not been identified as being at risk for adverse reactions from the use of phenylephrine. A patient with an upper respiratory infection may actually benefit from use of the drug.
A client receives a beta-specific agonist. What would lead the nurse to determine that the drug is effective? bronchodilation tremor increased heart rate
Bronchodilation A beta-specific agonist would lead to bronchodilation. A beta-specific agonist would cause an increased heart rate. Tremor is an adverse effect of a beta-specific agonist. A beta-specific agonist would increase cardiac conductivity.
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? Respiratory assessment monitoring of icp ABGs cardiac monitoring
Cardiac monitoring The high potential for adverse effects that is associated with the use of dopamine necessitates vigilant cardiac monitoring. Respiratory assessment, ABGs, and monitoring of ICP are likely indicated by the patient's injuries, but these are not directly related to the use of dopamine.
Which herbs has been removed from most weight-loss medications due to potential legal liability? gingko ginseng rose hip ephedra
Ephedra 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. Gingko, ginseng, and rose hips have not had these serious side effects.
An instructor is preparing a teaching plan for a group of students about adrenergic agonists. Which would the nurse include as an alpha- and beta-adrenergic agonist? epinephrine phenylephrine albuterol terbutaline
Epinephrine Epinephrine is an alpha- and beta-adrenergic agonist. Phenylephrine is an alpha-specific adrenergic agonist. Albuterol is a beta-specific adrenergic agonist. Terbutaline is a beta-specific adrenergic agonist.
Which would the nurse expect to be prescribed to a client experiencing acute bronchospasm? dopamine meteraminol norepinephrine epinephrine
Epinephrine Epinephrine would be used to treat bronchospasm. Dopamine is indicated for the treatment of congestive heart failure. Metaraminol is used to treat shock if norepinephrine or dopamine cannot be used. Norepinephrine is used to treat shock and during cardiac arrest to promote sympathetic activity.
A client is being treated in the intensive care unit for cardiogenic shock. The client has been prescribed an intravenous infusion of dopamine 5 mcg/kg/minute. The client weighs 220 lbs and the medication is available in a 500-ml bag containing 400 mg of dopamine. At what rate in mL/hour should the nurse administer the medication? Give your answer to one decimal place.
The client's weight in kilograms is 100 kg (220 lbs divided by 2.2). The ordered dose per minute is 5 mcg/kg, and 5 mcg x 100 kg = 500 mcg, or 0.5 mg. To get the hourly dose, this dose per minute should be multiplied by 60. This yields 30 mg per hour. The concentration of the available medication is 800 mcg/mL (500 ml divided by 400 mg). This is equivalent to 0.8 mg/ml. Dividing the required dose by the available concentration (30 mg divided by 0.8 mg/mL) equals 37.5 ml/hour.
A priority nursing assessment for a client who is to receive an alpha- or beta-adrenergic agonist would be to which action? check blood glucose measure urinary output monitor respiratory rate assess heart rate
assess heart rate. The client's heart rate must be assessed prior to administration of alpha- and beta-adrenergic agonists. There would be no need to check blood glucose or measure urinary output, and though respiratory rate is monitored it is not the priority measure.
Which client is most likely to benefit from the administration of an adrenergic agonist?
man who is cardiogenic shock following a myocardial infarction One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension.
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? oral inhalation injection topical
oral 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.
An instructor is preparing a teaching plan for a group of students about adrenergic agonists. Which would the nurse include as an alpha- and beta-adrenergic agonist? phenylephrine albuterol epinephrine terbutaline
Epinephrine Epinephrine is an alpha- and beta-adrenergic agonist. Phenylephrine is an alpha-specific adrenergic agonist. Albuterol is a beta-specific adrenergic agonist. Terbutaline is a beta-specific adrenergic agonist.
Which would the nurse expect to be prescribed to a client experiencing acute bronchospasm? epinephrine dopamine metaraminol norepinephrine
Epinephrine Epinephrine would be used to treat bronchospasm. Dopamine is indicated for the treatment of congestive heart failure. Metaraminol is used to treat shock if norepinephrine or dopamine cannot be used. Norepinephrine is used to treat shock and during cardiac arrest to promote sympathetic activity.
A client is experiencing anaphylaxis. What drug will the nurse most likely administer?
Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in treatment of cardiac arrest. Norepinephrine used to treat severe hypotension and shock that persists after adequate fluid volume replacement. Acetylcysteine is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia.
The client is given epinephrine for an exacerbation of asthma. What response to the medication would the nurse expect?
Increased ease of breathing and increased heart rate Depending on the location and distribution of receptors, epinephrine exerts a variety of responses in different effector organs and tissues. In the cardiovascular system, epinephrine exerts positive inotropic and chronotropic effects on the myocardium by stimulating beta-1 adrenergic receptors. In the skin and viscera, epinephrine stimulates alpha-adrenergic receptors, causing vasoconstriction and vasodilation in skeletal muscle vessels. The overall effect is to increase systolic pressure and slightly decrease diastolic pressure. In the respiratory system, epinephrine causes bronchodilation by the stimulation of beta-2 adrenergic receptors and is used in this way to treat clients with asthma or to manage anaphylactic shock.