Chapter 27: Drug Therapy to Enhance the Adrenergic Response

An emergency department nurse enters a patient's room with an order to administer epinephrine subcutaneously to treat his asthma attack. The patient's wife asks the nurse why it could not be given by mouth. Which of the following is the best response by the nurse? A. "The medication is administered this way because it works faster than by mouth." B. "The medication he is to receive is only given by an injection in the arm." C. "The medication is given many ways, but this is the way it was ordered." D. "The medication will not absorb in the GI tract if given by mouth."

"The medication will not absorb in the GI tract if given by mouth." Epinephrine is not given orally because enzymes in the GI tract and liver destroy it. The medication can be given through inhalation, intravenously, and subcutaneously. The medication will work more quickly in a parenteral form but is not given orally. Stating to the patient that this method is the way the physician ordered it to be given will belittle the patient and not provide adequate patient teaching.

A clinic nurse is teaching the parents of toddler about the safe and effective use of an EpiPen after the child was diagnosed with severe nut allergies. What instruction should the nurse convey to the parents? A. "Keep administering repeated doses of epinephrine until your child's symptoms abate." B. "It's prudent to administer a small dose of epinephrine if you want to prevent a future reaction." C. "The thigh is usually the ideal place to inject the EpiPen." D. "Only use your EpiPen if you've tried oral medications and they've been ineffective."

"The thigh is usually the ideal place to inject the EpiPen." The thigh is the preferred site for autoinjection, providing more rapid absorption and higher blood levels of epinephrine than the arm in children and adults for either intramuscular or subcutaneous administration. Epinephrine is not administered as a prophylactic treatment. Emergencies preclude the use of oral medications, and repeated injections may result in toxicity.

A 19-year-old has been brought to the emergency department (ED) by ambulance after a suspected overdose of a herbal preparation that contained ephedra. Due to the risk of seizures and intracranial hemorrhage, the nurse should prioritize what assessment? A. Assessing extremities for color, warmth, movement, and sensation B. Blood pressure monitoring C. Continuous oxygen saturation monitoring D. Respiratory auscultation

Blood pressure monitoring Ephedrine and ephedra-containing herbal preparations (e.g., ma huang, herbal ecstasy) are often abused as an alternative to amphetamines. The primary clinical manifestation of this adrenergic drug toxicity is severe hypertension, which may lead to headache, confusion, seizures, and intracranial hemorrhage. Vigilant blood pressure monitoring is thus a high priority.

A teenage boy has been brought to the emergency department (ED) by his football coach, who states that the boy has not responded to his normal rescue inhaler. The care team has opted for the administration of subcutaneous epinephrine. The ED nurse should anticipate what assessment finding subsequent to the administration of this drug? A. Bronchodilation within 5 to 10 minutes B. Immediate bronchodilation C. Increased level of consciousness within 2 to 5 minutes D. An immediate decrease in respiratory rate

Bronchodilation within 5 to 10 minutes For acute asthma attacks, subcutaneous (Sub-Q) administration of epinephrine usually produces bronchodilation within 5 to 10 minutes; maximal effects may occur within 20 minutes. An increase in LOC is not a priority, and respiratory rate would not likely decrease.

A patient has been resuscitated using epinephrine following an episode of asystole and is now being monitored in the intensive care unit (ICU). When monitoring the patient's status, the nurse should anticipate which of the following effects of epinephrine administration? Select all that apply. A. Hypercapnia B. Hyperglycemia C. Decreased urine output D. Increased blood pressure E. Increased serum potassium levels

Decreased urine output, Hyperglycemia, Increased blood pressure Administration of epinephrine is associated with decreased urine output, increased blood glucose, hyperkalemia, and increased blood pressure. Excess CO2 levels are not anticipated.

A patient suffers from bronchial asthma. Which of the following medications is a mixed-acting adrenergic drug that may be administered? A. Ephedrine B. Epinephrine C. Pseudoephedrine D. Isoproterenol

Ephedrine 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.

A patient is experiencing anaphylaxis. Which of the following medications will most likely be administered? A. Epinephrine B. Norepinephrine C. Dantrolene sodium (Dantrium) D. Acetylcysteine (Mucomyst)

Epinephrine 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 is not administered. Acetylcysteine (Mucomyst) is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia.

A nurse is participating in a "code blue" response to a patient who lost consciousness after a short period of distress. The physician leading the code has ordered the administration of IV epinephrine. When preparing this drug for administration, the nurse should recognize what goal of this treatment? A. Increased release of dopamine B. Increased cardiac contractility C. Increased peripheral blood circulation D. Increased blood flow to the heart and brain

Increased blood flow to the heart and brain Epinephrine is often administered during cardiopulmonary resuscitation (CPR). The most important action of epinephrine during cardiac arrest is constriction of peripheral blood vessels, which shunts blood to the central circulation and increases blood flow to the heart and brain. The goal of epinephrine administration is not increased contractility or dopamine release.

A patient is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce? A. Increased vasoconstrictive effects B. Decreased cerebral circulation C. Increased bronchoconstriction D. Decreased coronary circulation

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 suffers from bradycardia. Which of the following medications is a synthetic catecholamine for the treatment of bradycardia? A. Ephedrine B. Epinephrine C. Pseudoephedrine (Sudafed) D. Isoproterenol (Isuprel)

Isoproterenol (Isuprel) Isoproterenol (Isuprel) is a synthetic catecholamine that acts on beta1- and beta2-adrenergic receptors to stimulate heart rate. Pseudoephedrine (Sudafed) is not a synthetic catecholamine. Ephedrine and epinephrine are not synthetic catecholamines.

A home care nurse is visiting a patient, and the assessment will include blood pressure and heart rate. The patient's grandson has a large amount of pseudoephedrine (Sudafed) in the kitchen. For what might the nurse suspect the patient's grandson is using the pseudoephedrine? A. Methamphetamine production B. Treatment of sinusitis C. Treatment of bronchial asthma D. To increase appetite

Methamphetamine production Pseudoephedrine and ephedrine are ingredients used in making methamphetamine, a highly addictive and illegal drug of abuse. Pseudoephedrine is used in the treatment of bronchospasm but is not the drug of choice. Pseudoephedrine is used in the treatment of sinusitis, but, in large quantities, the nurse should suspect methamphetamine production. Pseudoephedrine will increase basal metabolic rate but is not the drug of choice to increase appetite.

Epinephrine is being considered in the treatment of an adult hospital patient. In anticipation, the nurse has reviewed the patient's current medication regimen. The presence of a drug from which of the following drug categories would contraindicate the safe use of epinephrine? A. Potassium-wasting diuretics B. Monoamine oxidase (MAO) inhibitors C. Selective serotonin reuptake inhibitors (SSRIs) D. Sulfonamide antibiotics

Monoamine oxidase (MAO) inhibitors It is essential not to give MAO inhibitors with adrenergic drugs because the combination may cause death. Use of adrenergics with diuretics, SSRIs, or sulfa antibiotics is not necessarily contraindicated.

A patient has been diagnosed with narrow-angle glaucoma. What ocular effect will be produced if the patient is prescribed an adrenergic agent? A. Mydriasis B. Hypertension C. Decreased heart rate D. Hypothyroidism

Mydriasis Narrow-angle glaucoma is a contraindication to adrenergic agents because the drugs result in mydriasis, closure of the filtration angle of the eye, and increased intraocular pressure. Hypothyroidism will not occur with the administration of adrenergic agents. Decreased heart rate will not occur with the administration of adrenergic agents and is not an ocular effect. Hypertension is not an ocular effect.

A patient has been using phenylephrine (Neo-Synephrine) for nasal congestion. He states to the nurse that he is using more every day because his nose is so congested. What effect is the medication producing? A. Rebound congestion B. Mucosal hemorrhage C. Tachycardia D. Reflex bradycardia

Rebound congestion Overuse of nasal decongestants leads to decreased effectiveness (tolerance), irritation and ischemic changes in the nasal mucosa, and rebound congestion. These effects can be minimized by using small doses only when necessary and for no longer than 3 to 5 days. Phenylephrine will not produce reflex bradycardia, mucosal irritation, or tachycardia.

A patient is suffering from hypovolemic shock. Which agents are administered if fluid volume replacement does not restore sufficient blood pressure? A. First-line agents B. Antianginal drugs C. Beta-blockers D. Second-line agents

Second-line agents In hemorrhagic or hypovolemic shock, the drugs are second-line agents that may be used if adequate fluid volume replacement does not restore sufficient blood pressure and circulation to maintain organ perfusion. First-line agents are not used; the first-line therapy is fluid replacement. Beta-blockers decrease heart rate and are not administered with hypovolemic shock. Antianginals are not administered in hypovolemia.

A pediatric patient is administered epinephrine to treat bronchospasm as a result of acute asthma. What effect should the patient be monitored for? A. Hemorrhage B. Edema C. Syncope D. Bradycardia

Syncope Epinephrine is mainly used in children for treatment of bronchospasm due to asthma or allergic reactions. Parenteral epinephrine may cause syncope when given to asthmatic children. Epinephrine will not increase edema or cause bradycardia or hemorrhage.

An adult patient with diagnoses of liver cirrhosis and hepatitis C is exhibiting signs and symptoms of hypovolemic shock. How will the patient's compromised hepatic function affect the possible use of epinephrine? A. The patient should not receive epinephrine by a parenteral route. B. The patient will require a higher-than-normal dose. C. The patient's hepatic function is not a priority consideration. D. The patient should receive a small fraction of the normal dose.

The patient's hepatic function is not a priority consideration. Liver disease is not usually considered a contraindication to administering adrenergic drugs. Dosages do not normally need to be adjusted.

Epinephrine is indicated in the treatment of a 79-year-old patient whose blood pressure has plummeted in the postanesthesia recovery room following prostate surgery. Epinephrine should be used with caution in a patient of this age because of the risk of A. increasing intracranial pressure. B. causing Stevens-Johnson's syndrome C. exacerbating chronic cardiac conditions. D. causing cerebral ischemia.

exacerbating chronic cardiac conditions. Clinicians use adrenergic agents to treat asthma, hypotension, shock, cardiac arrest, and anaphylaxis in older adults. These drugs stimulate the heart to increase rate and force of contraction and blood pressure. Because older adults often have chronic cardiovascular conditions (e.g., angina, dysrhythmias, heart failure, coronary artery disease, hypertension, peripheral vascular disease) that are aggravated by adrenergic drugs, careful monitoring by the nurse is required.