Pharm Chapter 15
Adrenergic blockers, adrenergic antagonists, and sympatholytics
Drugs that block the effects of the adrenergic neurotransmitter are called:
B, C, D
A patient who is taking epinephrine is also taking several other medications. The nurse should realize that there is a possible drug interaction with which drugs? (Select all that apply) A. Albuterol B. Metaprolol C. Propranolol D. Digoxin E. Methyldopa
Epinephrine, norepinephrine, and dopamine
3 examples of endogenous catecholamines are:
B
A cholinergic drug, Bethanechol, was given to a patient to manage bladder problems. Which effect would the drug have on the bladder? A. Decrease incontinence B. Promote emptying of the bladder C. Decrease painful urination D. Increase amount of urine produced by the kidney
A
A nurse is administering epinephrine to a patient during a cardiac arrest. The primary desired action of this medication is to: A. Stimulate a heart rate B. Decrease cerebral blood flow C. Initiate respirations D. Increase blood flow to the kidneys
A, D, E
A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? (Select all that apply) A. Angina pectoris B. Cardiogenic shock C. COPD D. CHF E. Hypertension F. Sinus bradycardia
B
A patient has been prescribed atenolol (Tenormin). To ensure safe dosing, the nurse teaches the patient to frequently assess what parameter? A. Daily weight B. Heart rate C. Urine output D. Body temperature
C
A patient has been taking metoprolol and tells the home care nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's priority action? A. Refer the patient to the social worker. B. Call the drug company to ask for assistance. C. Assess the patient's blood pressure D. Teach the patient that abrupt medication withdrawal may lead to a rebound hypertensive crisis.
D
A patient is given epinephrine, an adrenergic agonist (sympathomimetic). The nurse should monitor the patient for which condition? A. Decreased pulse B. Pupil constriction C. Bronchial constriction D. Increased blood pressure
A, B
A patient is prescribed metoprolol to treat hypertension. It is important for the nurse to monitor the patient for which condition? (Select all that apply) A. Bradycardia B. Hypotension C. Ankle edema D. Decreased respirations E. Increased respirations
C
A patient is receiving dopamine (Intropin) intravenously. Which drug should the nurse have available to treat extravasation and tissue necrosis? A. Norepinephrine bitartrate (Levophed) B. Nadolol (Corgard) C. Phentolamine mesylate (Regitine) D. Clonidine (Catapres)
A
A patient with cardiac decompensation is receiving dobutamine as a continuous infusion. The patient's blood pressure has increased from 100/80 mm Hg to 130/90 mm Hg. What is the nurse's priority action? A. Assess hourly blood pressure readings. B. Assess the patient's ECG and slow the infusion. C. Assess the patient's respiratory rate and measure ABGs. D. Assess the patient's I&O and decrease IV fluids.
Adrenergic antagonists
Act as antagonists by blocking the alpha- and beta- receptor sites.
Effector cells
Adrenergic agonists act on one or more adrenergic receptor sites located in the ______________ of muscles, such as the heart, bronchiole walls, gastrointestinal tract, urinary bladder, and ciliary muscle of the eye.
Stopped
After the neurotransmitter has performed its function, the action must be __________ to prevent prolonging the effect.
C
Albuterol is a Beta-2 adrenergic agonist. What effect does it have on the bronchioles? A. Constricts the bronchioles B. Increases secretions in the bronchioles C. Relaxes smooth muscle causing bronchodilation D. Decreases inflammation in the lining of the bronchiole
Selective alpha blockers that block alpha 1 and nonselective alpha blockers that block alpha 1 and alpha 2
Alpha-blocking agents are divided into two groups:
C
Nadolol is prescribed for a patient. The nurse realizes that this drug is a beta-adrenergic blocker and that this drug classification is contraindicated for patients with which condition? A. Hypothyroidism B. Angina pectoris C. Bronchial asthma D. Live dysfunction
Inhibiting reuptake or inhibiting degradation by enzyme action
Drugs can prolong the action of the neurotransmitter by either (1) ___________________ or (2) _________________.
Selective
Drugs that affect a specific receptor
Nonselective
Drugs that affect multiple adrenergic receptors
Alpha-adrenergic antagonists, adrenergic blockers, or alpha blockers
Drugs that block or inhibit a response at the alpha-adrenergic receptor sites are called:
Adrenergic neuron blockers
Drugs that block the release of norepinephrine from the sympathetic terminal neurons are called _____________________.
Adrenergic agonists, adrenergics, or sympathomimetics
Drugs that stimulate the sympathetic nervous system are called ______________, ______________, or __________________ because they mimic the sympathetic neurotransmitters norepinephrine and epinephrine.
C
Drugs that stimulate the sympathetic nervous system are called all of these except: A. Adrenergics B. Adrenomimetics C. Adrenergic antagonists D. Sympathomimetics
Alpha 1, beta 1, and beta 2
Many of the adrenergic agonists stimulate more than one of the adrenergic receptor sites. An example is epinephrine, which acts on _______, ________, and _________ adrenergic receptor sites. The responses from these receptor sites include increase in blood pressure, pupil dilation, tachycardia, and bronchodilation
Dopaminergic, dopamine
Other adrenergic receptors are ________________ and located in the renal, mesenteric, coronary, and cerebral arteries. When these receptors are stimulated, the vessels dilate, and blood flow increases. Only __________ can activate these receptors.
B
Stimulation of which adrenergic receptor results in dilation of vessels and decrease in blood pressure? A. Alpha 1 B. Alpha 2 C. Beta 1 D. Beta 2
Direct-acting sympathomimetics, indirect-acting sympathomimetics, and mixed-acting sympathomimetics
Sympathomimetic drugs are classified into three categories according to their effects on organ cells. Categories include (1) _________________________, (2) ___________________, and (3) ____________________.
Alpha 2
The _______ receptors are located in the postganglionic sympathetic nerve endings. When stimulated, they inhibit the release of norepinephrine, leading to a decrease in vasoconstriction.
Beta 2
The _________ receptors are found mostly in smooth muscles of the lung ans GI tract, the liver, and the uterine muscle. Stimulation of these receptors causes (1) relaxation of the smooth muscles of the lungs, (2) a decrease in gastrointestinal tone and motility, (3) activation of glycogenolysis in the liver, (4) relaxation of the uterine muscle.
Beta 1
The _________ receptors are located primarily in the heart but are also found in the kidney. Stimulation of these receptors increases myocardial contractility and heart rate.
Alpha-adrenergic
The ____________ receptors are located in blood vessels, eyes, the bladder, and prostate.
Intrinsic sympathomimetic activity (ISA)
The ability of certain beta blockers to bind with a beta receptor to prevent strong agonists from binding to that receptor, producing complete activation. These agents may be recommended for patients experiencing bradycardia.
Catecholamines
The chemical structures of a substance that can produce a sympathomimetic response
Decrease blood pressure
The clinical use of neuron blockers is to __________________.
Alpha 1, alpha 2, beta 1, beta 2
The four main receptors are:
A
The nurse assesses a patient receiving an adrenergic (sympathomimetic) agent. Which finding will be of greatest concern to the nurse? A. Weak peripheral pulses and decreased heart rate B. Increased peripheral pulses and increased heart rate. C. Stable blood pressure and increased cardiac output. D. Heart rate of 95 beats per minute and strong peripheral pulses.
D
The nurse assesses the peripheral intravenous infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action? A. Apply a cold pad to the site B. Pull the IV immediately C. Elevate the patient's extremity D. Stop the infusion
B, C
The nurse is administering atenolol to a patient. Which concurrent drugs does the nurse expect to most likely cause an interaction? (Select all that apply) A. Ginseng supplement B. A nonsteroidal antiinflammatory drug, such as aspirin C. Atropine, an anticholinergic D. Haloperidol E. Methyldopa
D
The nurse is caring for a patient diagnosed with heart failure and chronic obstructive pulmonary disease (COPD). The patient is ordered a nonselective beta blocker. What is the nurse's primary intervention? A. Assess the heart rate before administration. B. Maintain the patient on intake and output. C. Make sure the patient is on telemetry monitoring. D. Call the health care provider to request a different medication.
D
The nurse is caring for a patient who has been recently diagnosed with hypertension and is to receive an initial dose of atenolol. What is the nurse's primary intervention? A. Assess the patient's urinary output B. Teach the change position slowly C. Encourage increase in fluid intake D. Assess for history in any respiratory disease
D
The nurse is caring for a patient who is prescribed propranolol. Which assessment finding will reveal if the medication is having a therapeutic effect? A. The patient's lung sounds are clear B. The patient is in sinus rhythm C. The patient has strong peripheral pulses D. The patient's blood pressure is 130/75 mm Hg
A
The nurse is preparing to discharge a patient who is receiving acebutolol HCl. Which instruction will the nurse include in the medication teaching plan for this patient? A. "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." B. "If you become dizzy, do not take your medication for 2 days and then restart on the third day." C. "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." D. "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."
C
The nurse is teaching the patient about the side effects of atenolol (Tenormin). These include: A. Pupillary constriction B. Blood vessel dilation C. Bronchospasms D. Tachycardia
C
The nurse realizes that beta 1 receptor stimulation is differentiated from beta 2 stimulation in that stimulation of beta 1 receptors leads to which condition? A. Increased bronchodilation B. Decreased uterine contractility C. Increased myocardial contractility D. Decreased blood flow to skeletal muscles
A, B, D
The nurse will monitor the patient taking albuterol for which conditions? (Select all that apply) A. Palpitations B. Hypertension C. Hypoglycemia D. Bronchospasm E. Uterine contractions
C
The parasympathetic nervous system primarily utilizes which neurotransmitter? A. Epinephrine B. Adrenaline C. Acetylcholine D. Serotonin
Isoproterenol and dobutamine
The synthetic catecholamines are:
Monoamine oxidase (MAO), catechol-O-methyltransferase (COMT)
The two enzymes that inactivate norepinephrine are (1) ____________________, which is inside the neuron, and (2) _____________________, which is outside the neuron.
Inactivated
Transmitters are __________ by (1) reuptake of the transmitter back into the neuron, (2) enzymatic transformation or degradation, and (3) diffusion away from the receptor.
B
What is the primary neurotransmitter of the sympathetic nervous system? A. Acetylcholine B. Norepinephrine C. Dopamine D. Serotonin
B
When teaching a patient who has been prescribed metoprolol (Lopressor) about side/adverse effects, which is the highest priority teaching point? A. Report any complaints of stuffy nose B. Instruct the patient how to take a pulse C. Check for bladder distention D. Warn of possible impotence and decreased libido
Alpha 1
When the _________ receptors in vascular tissues of muscle are stimulated, the arterioles and venules constrict, increasing peripheral resistance and blood return to the heart.
A
Which finding would indicate to the nurse that a medication has activated alpha 1 receptors? A. Increase in blood pressure B. Pupillary constriction C. Bradycardia D. Increased saliva production
C
Which finding would indicate to the nurse that a medication has activated beta2 receptors? A. Uterine contractions B. Bronchiolar constrictions C. Hyperglycemia D. Increased saliva production
A
Which is the highest priority nursing intervention for a patient who is starting on metoprolol? A. Peripheral pulses B. Respiratory rate C. Urinary retention D. Lung sounds
Sympathetic response
Which response dilates bronchioles?
Sympathetic response
Which response dilates the pupils?
Sympathetic response
Which response increases heart rate?
Parasympathetic response
Which response increases peristalsis?
Parasympathetic response
Which response increases salivation?
Alpha 2
________ drugs are central acting and produce vasodilation by stimulating alpha 2 receptors in the central nervous system, leading to a decrease in blood pressure
Alpha blockers
__________ can be used to treat peripheral vascular disease and are also helpful in decreasing symptoms of benign prostatic hyperplasia
Beta blockers
______________ are useful in treating mild to moderate hypertension, angina pectoris, and myocardial infarction
Beta blockers
_______________ decrease heart rate; a decrease in blood pressure usually follows.
