1. Characteristics of Adrenergic Drugs (p. 291)
Mimic the effects of SNS neurotransmitters (catecholamines)
Norepinephrine (NE)
Epinephrine (EPI)
Dopamine
Also known as andrenergic agonists, sympathomimetics
NURSING APPLICATION:
Ms. Jackson begins to have difficulty breathing. She becomes short of breath and the doctor has ordered albuterol. Why?
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Catecholamines (p. 289)
Substances that can produce a sympathomimetic response
Endogenous
Epinephrine, norepinephrine, dopamine
Synthetic
Dobutamine, phenylephrine
Can be direct-acting, indirect-acting, or mixed-acting sympathomimetic
NURSING APPLICATION:
Ms. Jackson continues to have difficulty breathing, and the physician suspects she is having a reaction to the new antibiotic that was started about 45 minutes ago. Why would he order epinephrine?
Copyright © 2011 by Elsevier Inc. All rights reserved.

3. Copyright © 2011 by Elsevier Inc. All rights reserved.
Drug Effects (p. 291)
Stimulation of alpha-adrenergic receptors on smooth muscles results in:
Vasoconstriction of blood vessels
Relaxation of GI smooth muscles (decreased motility)
Constriction of bladder sphincter
Contraction of uterus
Male ejaculation
Contraction of pupillary muscles of the eye (dilated pupils)
Indications (p. 292)
Treatment of asthma and bronchitis
Bronchodilators: drugs that stimulate beta2-adrenergic receptors of bronchial smooth muscles, causing relaxation, resulting in bronchodilation
Examples: albuterol, ephedrine, epinephrine, formoterol, levalbuterol, metaproterenol, pirbuterol, salmeterol, and terbutaline (used to stop premature labor; causes relaxation of uterine smooth muscle)
NURSING APPLICATION:
Ms. Jackson’s breathing soon becomes more regular, but her blood pressure has become elevated. Why could this happen?
Copyright © 2011 by Elsevier Inc. All rights reserved.

4. Vasoactive Adrenergics (Pressors, Inotropes) (p. 293)
Also called cardioselective sympathomimetics
Used to support the heart during cardiac failure or shock; various alpha and beta receptors affected
Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as tachycardia or hypertension
Potent, quick-acting, injectable drugs.
Nursing Implications (cont’d) (p. 298)
Salmeterol is indicated for prevention of bronchospasms, not management of acute symptoms.
Overuse of nasal decongestants may cause rebound nasal congestion or ulcerations.
Avoid over-the-counter or other medications because of possible interactions.
NURSING APPLICATION:
Ms. Jackson’s blood pressure begins to drop drastically, and the physician has ordered dopamine IV. Why?
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5. Adrenergic Blockers (cont’d) (p. 301)
Classified by the type of adrenergic receptor they block
Alpha1 and alpha2 receptors
Beta1 and beta2 receptors
Alpha-blockers work either by direct competition with norepinephrine or by a noncompetitive process.
NURSING APPLICATION:
Ms. Jackson’s 65-year-old son was in the room when his mother had the problem with her respirations and breathing. He says that he has high blood pressure but has forgotten to take his blood pressure medicine. Why would an adrenergic blocking drug be effective to lower his blood pressure?
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6. Drug Effects and Indications: Alpha-Blockers (p. 303)
Cause both arterial and venous dilation, reducing peripheral vascular resistance and BP
Used to treat hypertension
Effect on receptors on prostate gland and bladder decreases resistance to urinary outflow, thus reducing urinary obstruction and relieving effects of BPH
Also used to control and prevent hypertension in patients with pheochromocytoma
NURSING APPLICATION:
How do alpha-blockers assist to lower blood pressure?
Copyright © 2011 by Elsevier Inc. All rights reserved.

7. Copyright © 2011 by Elsevier Inc. All rights reserved.
Beta-Blockers (p. 304)
Block stimulation of beta receptors in the SNS
Compete with norepinephrine and epinephrine
Can be selective or nonselective
Nonselective beta-blockers block both beta1 and beta2 receptors
The blocking of beta 2 receptors in the bronchioles may cause shortness of breath.
NURSING APPLICATION:
How could a beta blocker cause dizziness?
Copyright © 2011 by Elsevier Inc. All rights reserved.

8. Adrenergic-Blocking Drugs: Nursing Implications (p. xxx )
Assess for allergies and history of:
COPD
Hypotension
Cardiac dysrhythmias
Bradycardia
Heart failure
Other cardiovascular problems
Remember that alpha-blockers may precipitate hypotension.
NURSING APPLICATION:
Why would these condition be problematic?
Copyright © 2011 by Elsevier Inc. All rights reserved.

9. Adrenergic-Blocking Drugs: Nursing Implications (cont’d) (p. 305)
Avoid over-the-counter medications because of possible interactions
Possible drug interactions may occur with:
Antacids (aluminum hydroxide type)
Antimuscarinics/anticholinergics
Diuretics and cardiovascular drugs
Neuromuscular blocking drugs
Oral hypoglycemic drugs
Remember that some beta-blockers may precipitate bradycardia, hypotension, heart block, heart failure, and bronchoconstriction.
NURSING APPLICATION:
Explain to Ms. Jackson's son why he should avoid specific over-the-counter medications.
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10. Beta-Blocking Drugs: Nursing Implications (p. 307)
Rebound hypertension or chest pain may occur if this medication is discontinued abruptly
Instruct patients to notify their physician if they become ill and unable to take medication
Inform patients that they may notice a decrease in tolerance for exercise (dizziness and fainting may occur with increased activity), and have patients notify the physician if these problems occur
Patients should report weight gain, edema, shortness of breath, fatigue, or dizziness.
NURSING APPLICATION:
Explain to Ms. Jackson's son why he may be experiencing chest pain as a result of skipping his blood pressure medication today.
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