ADRENERGICS

ACTIONS AND USES:

Adrenergic amines are drugs that stimulate the sympathetic nervous system. Adrenergics are also called adrenergic agonists, sympathomimetics, or adrenomimetics because they mimic the sympathetic neurotransmitters. The sympathetic nervous system is the part of the autonomic nervous system that originates in the thoracic and lumbar regions of the spinal cord and regulates involuntary reactions to stress. It stimulates the heartbeat, sweating, breathing rate, and other stress-related body processes.
Adrenergic drugs have many uses. They are used to increase the output of the heart, to raise blood pressure, and to increase urine flow as part of the treatment of shock. Adrenergics are also used as heart stimulants. They may be given to a patient to reverse the drop in blood pressure that is sometimes caused by general anesthesia. They may be used to stop bleeding by causing the blood vessels to constrict, and to keep local anesthetics in a small area of the body by closing off the nearby blood vessels that would otherwise spread the anesthetic to other parts of the body. This ability to make blood vessels constrict makes adrenergics useful in reducing nasal stuffiness associated with colds and allergies. They may also be given to open the bronchi for treatment of asthma and chronic obstructive pulmonary disease (COPD).

SIDE EFFECTS AND ADVERSE REACTIONS:

The most common side effects of adrenergic amines are nervousness, agitation, and wakefulness. These side effects do not usually cause problems when the drugs are given during surgery or in combination with local anesthetics.The following side effects sometimes occur when adrenergic amines are used to treat nasal congestion due to allergies or infections:
  • rapid heartbeat
  • increased sweating
  • nervousness
  • hallucinations
  • sleep disturbances
  • paleness
Other rare side effects may occur. Anyone who has unusual symptoms after taking adrenergic amines should contact his or her physician right away.

NURSING IMPLICATIONS:

  • Record client's vital signs. Repoert signs of increasing blood pressure and increasin pulse rate. If client recieves an alpha-adrenergic drug intravenoulsy for shock, the blood pressure should be sheked every three to five minutes or as indicated to avoid sever hypertension.
  • Moniter IV site frequently when administering norepeenephrine bitartrate or dopamine because infiltrationof these drugs causes tissue necrosis. THese drugs should be diluted sufficiently in IV fluids. An antidote for norepinephrine and dopamine is phentolamine mesylate five to ten mg, duluted in ten to fifteen ml of saline infiltrated into the area.


ADRENERGIC BLOCKERS (ANTAGONISTS)

ACTIONS AND USES:

Drugs that block the effects of the adrenergic neurotransmitter are called adrenergic blockers, adrenergic antagonists, or sympatholytics. They act as antagonists to the adrenergic agonists by blocking the alpha- and beta-receptor sites. Most adrenergic blockers block either the alpha- or the beta-receptor. They block the effects of the neurotramsmitter either directly by occupying the alpha- or the beta-receptors or inderectly by inhibiting the release of the neurotransmitters norepinephrine and epinephrine. The three sympatholytic receptors are alpha1, beta1, and beta2.
Alpha-adrenergic blockers
Drugs that block or inhibit a response at the alpha-adrenergic receptor site are called alpha-adrenergic blockers, or alpha-blockers. Alpha-blocking agents are divided into two groups: selective alpha-blockers that block alpha1 and nonselective alpha-blockers that block alpha1 and alpha2. Because alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia, many of these drugs are not as frequently prescribed as the beta-blockers. The alpha blockers are helpful in decreasing symptoms of benign prostatic hypertrophy.
The alpha-blockers promote vasodilation, thus causing a decrease in blood pressure. The alpha-blockers can be used to treat peripheral vascular disease. Vasodilation occurs, permitting more blood flow to the extremities.
Beta-adrenergic blockers
Commonly called beta-blockers, decrease heart rate; a decrease in blood pressure usually follows. Some of the beta-blockers are nonselective, blocking both beta1- and beta2-receptors. Not only does the pulse rate decrease because of beta1-blocking, but bronchoconstriction also occurs. Nonselective beta-blockers should be used with extreme caution in any client who has chronic obstructive pulmonary disease or asthma.

SIDE EFFECTS AND ADEVERSE EFFECTS:

General side effects of alpha-adrenergic blockers include:
  • cardiac dysrhythmias,
  • flush, hypotension,
  • and reflex tachycardia.
The side effects commonly associated with beta-blockers include are:
  • bradycardia
  • dizziness
  • hypotension
  • headache
  • hyperglycemia
  • intensified hypoglycemia
  • and agranulocytosis

NURSING IMPLICATIONS:

  • Report any complaints of a stuffy nose. Vasodialtion results fro the sue of alph-adrenergic blockers, and nasal congestion can occure.
  • Clients who take beta-blockers do not have normal compensatory mechanisms while in states of shock. To resuscitate such clients, clucagon must be given in high doses to counteract the sympatholytic effects of beta-blockers.

REFERENCES:

2007. Adrenergic Drugs.http://www.surgeryencyclopedia.com/A-Ce/Adrenergic-Drugs.html

Kee, Hayes, McCuistion. 2006.Pharmacology: A Nursing Process Approach. St. Louis, MO: Robin Carter.



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