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Chapter 30 Adrenergic Agonists

Adrenergic Agonist (Sympathomimetic): mimics the effects of the sympathetic nervous
system
Administering Ophthalmic medications
 Wash hands thoroughly
 Do not touch the dropper to the eye or to any other surfaces
 Have patient tilt their head back or lie down and stare upward
 Gently grasp the lower eyelid and pull the eyelid away from the eyeball
 Instill the prescribed number of drops into the lower conjunctival sac and then release
the lid slowly
 Have patient close the eye and look downward
 Apply gentle pressure to the inside corner of the eye for 3 minutes
 Do not rub eyeball, and do not rinse the dropper
 If more than one type of eyedrop is being used, wait 5 minutes before administering the
next one
Receptors
 Alpha 1: causes vasoconstriction of peripheral blood vessels
 Alpha 2: decrease tone, motility, and secretions of GI tract
 Beta 1: increase heart rate and force or myocardial contraction
 Beta 2: causes bronchodilation (treat and manage bronchial spasm, asthma, wheezing)
Alpha-and Beta-Adrenergic Agonists
 Alpha-agonists (stimulate alpha receptors) and Beta-agonists (stimulate beta receptors)
are generally sympathomimetic
 Indications: treatment of hypotensive states or shock, bronchospasm, and some asthma
 Actions: increases heart rate; dilates bronchi; increase respirations; constricts blood
vessels; intraocular pressure decreases; glycogenolysis (breakdown of glucose) occurs;
pupils dilate; increase sweating
 Contraindications: hypersensitivity; pheochromocytoma; tachyarrhythmias or
ventricular fibrillation; and with halogenated hydrocarbon general anesthetics
 Cautions: any kind of peripheral vascular disease (atherosclerosis, Raynaud disease,
diabetic endarteritis)
 Adverse Effects: arrythmias, hypertension, palpitations, angina, and dyspnea; N/V;
headache, sweating, tension and anxiety
 Nursing Interventions: use extreme caution in calculating and preparing doses of these
drugs; always dilute a parenteral drug before use if it is not prediluted; use proper,
aseptic technique when administering ophthalmic or nasal agents; maintain
phentolamine (used to treat extravasation) on standby in case extravasation occurs.
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Patient Teachings: proper technique for administration; measures to prevent and avoid
adverse effects; need to check with prescriber before taking any OTC medication;
importance of avoiding intake of caffeine-containing products
Drug-Drug Interactions: MAOIs, halogenated hydrocarbon anesthetics, beta-blockers,
tricyclic antidepressants
Dopamine
 Sympathomimetic choice for treatment of shock
 Indications: correction of hemodynamic imbalances present in shock
 Actions: helps increase blood pressure
 Adverse Effects: Tachycardia, ectopic beats, anginal pain, hypotension, dyspnea,
nausea, vomiting, headache.
Dobutamine
 Indications: treatment of congestive heart failure
 Actions: increase myocardial contractility
 Adverse Effects: cardiac arrhythmias (bradycardia and tachycardia)
 Nursing Interventions: use phentolamine to treat extravasation; most important to
monitor compliance with drug regimen
Ephedrine
 Can be used to produce methamphetamine (meth)
 Ephedra: herb that acts like ephedrine. Removed from most weight-loss medications
due to potential legal liability – serious adverse effects (hypertension, irregular
heartbeat)
 Indications: treatment of shock to chronic management of asthma and allergic rhinitis
 Actions: stimulates release of norepinephrine from nerve endings and acts directly on
adrenergic receptor sites
 Adverse Effects: restlessness or shaking; flushing or sweating; heart palpitations;
sensitivity to light
 Patient Teachings: if the drug is in a solution that is pink, brown, or black discard it. If
you have diagnosed prostate problems, it might help to void before taking each dose of
the drug. Do not stop taking this drug suddenly. Avoid OTC medications
Epinephrine
 Indications: relief of anaphylactic shock; primary treatment for bronchospasm
 Actions: increases vasoconstrictive effects of local anesthetics to prolong effects;
stimulates electrical and mechanical activity
 Nursing Interventions: immediately report to the health care provider a fall in systolic
blood pressure below 100 mm Hg
Norepinephrine
 Indications: treatment of shock; used during cardiac arrest to get sympathetic activity
Blue Highlight: Medications
Pink Highlight: Drug Categories
Yellow Highlight: Subheads
Purple: Symptoms
Red: Important
Orange: Stated in Class
Alpha-Specific Adrenergic Agonists
 Indications: hypovolemic shock, cardiac arrest, respiratory distress, allergic reactions
Contraindications: hypersensitivity; severe hypertension or tachycardia; narrow-angle
glaucoma
 Cautions: CV disease or vasomotor spasm; thyrotoxicosis or diabetes; renal or hepatic
impairment
 Adverse Effects: anxiety, restlessness, depression, fatigue, blurred vision; ECG
changes; arrhythmias; BP changes; N/V; decreased urinary output
 Nursing Interventions: signs and symptoms of shock include cyanosis; cold, clammy
skin; diaphoresis; disorientation; tachypnea; urine output less than 20 mL/hr
 Patient Teachings: should not be stopped suddenly – can lead to tachycardia,
hypertension, arrythmias, flushing, and even death. To avoid withdrawal effects; taper
the drug over 2-4 days when it is being discontinued. DO not discontinue the drug
before surgery
Phenylephrine
 Indications: cold and allergies; shock and shock-like states; supraventricular
tachycardias; glaucoma; allergic rhinitis; otitis media; maintain BP
 Actions: causes vasoconstriction and raising systolic and diastolic blood pressure
 Cautions: thyroid or CV disease (should not take medication)
 Adverse Effects: fear, anxiety, restlessness, headache, nausea, decreased urine
formation, pallor
 Nursing Interventions: when giving intravenously, ensure that an alpha-blocking agent
is readily available to counteract the effects
 Patient Teachings: often found in OTC allergy and cold preparations, and parents need
to be instructed to be careful with the use of these drugs – patients should be alert for
cardiac arrhythmias and difficulty urinating
Clonidine
 Indications: treatment of essential hypertension; chronic pain; to ease opiate
withdrawal; used only for adults
 Actions: stimulates CNS alpha2-receptors
 Adverse Effects: associated with many more CNS effects: bad dreams, sedation,
drowsiness, fatigue, headache; photophobia (sensitivity to light); extreme
hypotension, heart failure, bradycardia
Midodrine
 Indications: treatment of orthostatic hypotension
 Actions: activates alpha1-adrenergic receptors
 Adverse Effects: serious supine hypertension
 Nursing Interventions: monitor patient’s BP in different positions (standing, sitting, and
supine)
Blue Highlight: Medications
Pink Highlight: Drug Categories
Yellow Highlight: Subheads
Purple: Symptoms
Red: Important
Orange: Stated in Class
Beta-Specific Adrenergic Agonists
Isoproterenol
 Indications: treatment of shock, cardiac arrest, cardiac standstill, heart block in
transplanted hearts, acute hyperkalemia; prevention of bronchospasm
 Contraindications: hypersensitivity; pulmonary hypertension; during anesthesia with
halogenated hydrocarbons; eclampsia, uterine hemorrhage, and intrauterine death
 Cautions: diabetes, thyroid disease, vasomotor problems, degenerative heart disease,
history of stroke, severe renal impairment
 Adverse Effects: Restlessness, anxiety, feat; tachycardia, angina, MI, and palpitations;
difficulty breathing, cough, and bronchospasm; N/V, anorexia
 Nursing Interventions: ensure that a beta-adrenergic blocker is readily available when
giving drug parenterally; use minimal doses needed to achieve desired effects. Report
any changes in pulse rate or rhythm immediately. Desired effects include improved
contractility and conductivity, increased heart rate, bronchodilation.
Albuterol
 Indications: treatment and prevention of bronchospasm, treatment of acute
bronchospasm and exercise induced bronchospasm when used by inhalation
Arformoterol
 Indications: long-term maintenance treatment of bronchospasm in adults with COPD
Levalbuterol
 Indications: treatment and prevention of bronchial asthma and reversible
bronchospasm in patients 4 years and older
Salmeterol
 Indications: treatment and prevention of bronchial asthma and reversible
bronchospasm, including exercise-induced bronchospasm in patients 4 years and older
Terbutaline
 Indications: treatment and prevention of bronchial asthma and reversible
bronchospasm
Blue Highlight: Medications
Pink Highlight: Drug Categories
Yellow Highlight: Subheads
Purple: Symptoms
Red: Important
Orange: Stated in Class
Chapter 31 Adrenergic Antagonists

Adrenergic Antagonists (Sympatholytic): lyse, or block the effects of the sympathetic
nervous system
Herbal and Alternative Therapies (If combined with adrenergic blocking agents):
 Ginseng, sage: increase antihypertensive effects
 Xuan shen, nightshade: slow heart rate
 Celery, coriander, di huang, fenugreek, goldenseal, Java plum, xuan shen: lower blood
glucose
 Saw palmetto: increase urinary tract complications
Nonselective Adrenergic Blocking Agents
 Indications: treat essential hypertension alone or in combination with diuretics
 Actions: blocks the effects of norepinephrine at alpha- and beta- receptors throughout
the SNS
 Contraindications: hypersensitivity; bradycardia or heart blocks; asthma; shock or heart
failure; lactating
 Cautions: diabetes; bronchospasm
 Adverse Effects: dizziness, N/V/D, anorexia; cardiac arrythmias, hypotension, heart
failure, pulmonary edema, and cerebrovascular accident, stroke; bronchospasm, cough,
rhinitis, and bronchial obstruction
 Nursing Interventions: For clients who reports ceasing all medications because they
began feeling nauseated and started vomiting, a primary step in assessing the severity
of adverse effects (such as cardiovascular incidents) is to perform a bedside
electrocardiogram to assess for any arrhythmias
 Patient Teachings: abruptly stopping these drugs after long-term therapy can result in
MI, stroke, and arrhythmias; taper drug slowly over 2 weeks while monitoring heart rate
and blood pressure
 Evaluation: improvement in blood pressure and heart failure
Labetalol
 Indications: treatment of hypertension, hypertension associated with
pheochromocytoma (tumor of the chromaffin cells of the adrenal medulla that
periodically releases large amounts of norepinephrine and epinephrine into the system
with resultant severe hypertension and tachycardia), and clonidine withdrawal
 Actions: Competitively blocks alpha- and beta-receptor sites in the SNS, leading to lower
blood pressure without reflex tachycardia and decreased renin levels
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects: Dizziness, vertigo, fatigue, gastric pain, flatulence, impotence,
bronchospasm, dyspnea, cough, decreased exercise tolerance
 Nursing Interventions:
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Pink Highlight: Drug Categories
Yellow Highlight: Subheads
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Purple: Symptoms
Red: Important
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Patient Teachings:
Amiodarone
 Indications: treatment of life-threatening ventricular arrhythmias; saved for serious
emergencies and only used an as an antiarrhythmic
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions:
 Patient Teachings:
Carvedilol
 Indications: treatment of hypertension and heart failure in adults
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects: hepatic failure
 Nursing Interventions:
 Patient Teachings:
Nonselective Alpha-Adrenergic Blocking Agents
Phentolamine
 Indications: prevention or control of hypertensive episodes associated with
pheochromocytoma; prevention and treatment of dermal necrosis and sloughing
associated with IV extravasation of norepinephrine or dopamine
 Actions: Competitively blocks postsynaptic alpha1- and presynaptic alpha2-receptors,
causing a vasodilation and lowering of blood pressure, accompanied by increased reflex
tachycardia.
 Contraindications: hypersensitivity; coronary artery disease, MI
 Adverse Effects: hypotension, orthostatic hypotension, angina, MI, tachycardia,
arrhythmias, nausea, flushing
 Nursing Interventions: monitor heart rate and blood pressure; inject directly into the
area of extravasation of epinephrine or dopamine
 Evaluation: improvement in s/s of pheochromocytoma, improvement in tissue
condition after extravasation
Alpha1-Selective Adrenergic Blocking Agents
 Indications: BPH and hypertension
 Actions: blocks alpha 1-receptor sites
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Contraindications: hypersensitivity; lactation
Cautions: heart failure or renal failure; hepatic impairment
Adverse Effects: drowsiness, rrhythmias, hypotension, edema, congestive heart
failure, angina
Patient Teachings: change positions slowly and avoid driving or operating hazardous
machinery
Evaluation: lowering of blood pressure, improved urine flow with BPH
Doxazosin
 Indications: treatment of hypertension and BPH
 Actions: reduces total peripheral resistance through alpha blockade
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects: Headache, fatigue, dizziness, postural dizziness, vertigo, tachycardia,
edema, nausea, dyspepsia, diarrhea, retrograde ejaculation
 Nursing Interventions:
 Patient Teachings:
Alfuzosin
 Indications: treatment of BPH
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions:
 Patient Teachings:
Prazosin
 Indications: treatment of hypertension, alone or in combination with other drugs
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions:
 Patient Teachings:
Tamsulosin
 Indications: treatment of BPH
 Actions:
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Nonselective Beta-Adrenergic Blocking Agents
 Beta-adrenergic blocking agents: used to treat migraine headaches and CV problems
(hypertension, angina) and to prevent reinfarction after MI
 Actions:
 Administration:
 Contraindications: hypersensitivity; bradycardia or heart blocks, shock, or heart failure;
bronchospasm, COPD, or acute asthma
 Cautions: diabetes, hypoglycemia, thyrotoxicosis; renal or hepatic dysfunction
 Adverse Effects: fatigue, dizziness, depression, sleep disturbances; bradycardia, heart
block, hypotension; bronchospasm
 Patient Teachings: do not stop these drugs abruptly after chronic therapy, but taper
gradually over 2 weeks. Avoid OTC medications, including cold and allergy remedies and
diet pills
 Evaluation: lowering of blood pressure, decrease in anginal episodes, improvement in
condition being treated
Propranolol
 Indications: treatment of hypertension, angina pectoris, idiopathic hypertrophic
subaortic stenosis, supraventricular tachycardia, and tremor; prevention of reinfarction
after MI; adjunctive therapy in pheochromocytoma; prophylaxis of migraine headache;
management of situational anxiety, treatment of proliferating infantile hemangioma
 Actions: Competitively blocks beta-adrenergic receptors in the heart and
juxtaglomerular apparatus; reduces vascular tone in the CNS
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects: allergic reaction, bradycardia, heart failure, cardiac arrhythmias,
cerebrovascular accident, pulmonary edema, gastric pain, flatulence, impotence,
decreased exercise tolerance, bronchospasm
 Nursing Interventions:
 Patient Teachings:
Timolol
 Indications: treatment of hypertension; prevention of reinfarction after MI; prophylaxis
for migraine
 Actions:
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Sotalol
 Indications: exclusively for treating life-threatening ventricular arrhythmias;
maintenance of normal sinus rhythm in patient with AFib
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions:
 Patient Teachings:
Nebivolol
 Indications: treatment of hypertension
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions:
 Patient Teachings:
Carteolol
 Indications: treatment of chronic open-angle glaucoma
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions:
 Patient Teachings:
Beta1-Selective Adrenergic Blocking Agents
 Beta1-selective adrenergic blocking agents: specifically block the beta1-receptors in the
SNS while not blocking the beta2-receptors and resultant effects on the respiratory
system
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diabetes, thyroid disease, COPD
Cautions:
Adverse Effects:
Nursing Interventions: do not stop these drugs abruptly after chronic therapy but taper
gradually over 2 weeks. Continuously monitor any patient receiving an IV form of these
drugs
Patient Teachings:
Evaluation: lowered blood pressure, fewer anginal episodes, lowered intraocular
pressure
Acebutolol
 Indications: treatment of hypertension and premature ventricular contractions in adults
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions:
 Patient Teachings:
Atenolol
 Indications: treatment of MI, chronic angina, and hypertension in adults
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions:
 Patient Teachings:
Metoprolol
 Indications: treatment of hypertension; prevention of reinfarction after MI; early acute
MI treatment; treatment of stable and symptomatic heart failure
 Actions:
 Administration:
 Contraindications:
 Cautions:
 Adverse Effects:
 Nursing Interventions: give oral form with food
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Esmolol
 Indications: treatment of supraventricular tachycardias in adults
 Actions:
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 Contraindications:
 Cautions:
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 Nursing Interventions:
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