Nonselective Alpha & Beta Agonists
- promote glycogenolysis (breakdown of glycogen)
- dilate pupils, inc sweating
Indications
- Tx hypotensive shock (esp dopamine)
- bronchospasm & some types of asthma
Contraindications
- Pheochromocytoma (adrenal tumor —> inc catecholamine secretion —> major inc HR & BP)
- Tachy-arrhythmias or V-Fib
- Hypovolemia
- Halogenated hydrocarbon general anesthetics
Cautions
- PVD – could be exacerbated by systemic vasoconstriction
- pregnancy & lactation
Adverse Effects
- Arrhythmias, hypertension, palpitations, angina
- dyspnea
- N/V
- Headache, sweating
Kinetics
- Rapidly absorbed after injection or passage through mucous membranes
- Metabolized in the liver and excreted in the urine
Drugs
1. Dobutamine (Dobutrex)
- preference for B1 receptors –> therefore indicated for CHF
- it can inc myocardial contractility (+ inotrope) w/o much change to rate; does not inc O2 demand of the heart, while most other sympathomimetics do
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2. Epinephrine (Adrenaline, Sus-Phrine)- indicated for shock, glaucoma, asthma/COPD, anaphylactic reactions
- can also prolong effects of local anesthetics
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3. Norepinephrine (Levophed)- indicated for shock
- used during cardiac arrest (V-fib) to get sympathetic activity
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4. Metaraminol (Aramine)- synthetic agent similar to norepinephrine
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Big Guns:1. Dopamine (Intropin)
- Tx hypotensive shock
- ↑ HR, ↑ BP
- maintains renal perfusion (maintains UO / ↑ Na & fluid output)
Nursing Considerations for Dopamine:
- monitor BP, HR, peripheral pulses, UO
- precise measurement essential for accurate titration of dosage
- report the following to physician:
- ascending tachy, dysrhythmias, disproportionate rising diastolic (marked dec in Pulse Pressure), S&S peripheral ischemia (pallor, cyanosis, coldness, pain, numbness/burning, mottling)
- monitor for extravasions
- monitor for effectiveness -
- (loss of pallor, inc toe tmp, good cap refill, reversal of confusion)
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2. Ephedrine (pretz-D)- Tx seasonal rhinitis, hypotensive episodes, (recreational use)
- causes cardiac stimulation, vasoconstriction, bronchodilartion
- stimulates Norepinephrine release
- crosses blood brain barrier (BBB) –> CNS stimulation –> used for narcolepsy & depression, (used illegally as sports performance enhancer)
- form of the drug (Pseudoephedrine) used as nasal decongestant
Nursing Considerations for Ephedrine
- find out pt's OTC med use / education about inadvertent overdose
- monitor AE:
- CNS: anxiety restlessness
- CV: tachy, palpitations
- GU: difficult/painful urination, acute urinary retention (esp. older men w/ prostatitis)
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Drug Interactions
- inc effects Tricyclic antidepressants (TCAs) and MAOI’s
- MAOI inhibits monoamine oxidase which is needed to break down Epi & NE
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Nursing Mgmt for All A&B Agonists- Monitor kidney/liver function, serum electrolytes, I&O, VS, ECG
- Herbs to avoid: Ma Huang, guarana, caffeine (↑ BP, stroke death)
- ask bout OTC cold, allergy, & diet pills use (↑ BP, stroke death)
- Avoid extravasation
- Aseptic technique when administering ophthalmic & nasal agents
- Monitor light exposure to prevent sensitivity to light from pupil dilation
- Encourage voiding prior to med admin to prevent urinary retention due to sphincter contraction
- Encourage relaxation to alleviate feelings of tension and anxiety
- Usually administered systemically for hypovolemic – hypotensive shock in an ICU (esp Dopamine) so pt needs constant monitoring
- monitor systemic effect of nose drops due to excessive dosage due to rapid absorption through nasal mucosa
joshmrivera
6:16 PM
alpha agonists
,
alpha and beta agonists
,
ANS
,
dobutamine
,
ephedrine
,
epinephrine
,
icu
,
metaraminol
,
norepinephrine
,
pharmacology
,
SNS
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