1. Autonomic Nervous System
Adrenergic Drugs

2. ANS - Adrenergic Drugs
Describe the adrenergic drug effects on major body systems.
Discuss the nursing process related to the care of patients receiving adrenergic drugs for cardiovascular, respiratory, gastrointestinal, and genitourinary systems.

3. Mimic the effects of the SNS neurotransmitters:
ANS - Adrenergic Drugs
Drugs that stimulate the sympathetic nervous system (SNS)
Adrenergic agonists
Sympathomimetics
Mimic the effects of the SNS neurotransmitters:
norepinephrine (NE)
epinephrine (EPI)
dopamine

4. ANS - Adrenergic Drugs

5. ANS - Adrenergic Drugs Adrenergic Receptors
Located throughout the body
Are receptors for the sympathetic neurotransmitters
 (alpha)-adrenergic receptors
 (beta)-adrenergic receptors
Dopaminergic receptors: respond only to dopamine

6. ANS - Adrenergic Drugs -Adrenergic Receptors
Divided into 1 and 2 receptors
Differentiated by their location on nerves
1-Adrenergic Receptors
Located on postsynaptic effector cells (the cell, muscle, or organ that the nerve stimulates)
2-Adrenergic Receptors
Located on presynaptic nerve terminals (the nerve that stimulates the effector cells)
Control the release of neurotransmitters
Predominant -Adrenergic Agonist Responses
Vasoconstriction
CNS stimulation

7. ANS - Adrenergic Drugs -Adrenergic Receptors
All are located on postsynaptic effector cells
1-adrenergic receptors—located primarily in the heart
2-adrenergic receptors—located in smooth muscle of the bronchioles, arterioles, and visceral organs
-Adrenergic Agonist Response
Results in:
Bronchial, GI, and uterine smooth muscle relaxation
Glycogenolysis
Cardiac stimulation

8. ANS - Adrenergic Drugs Dopaminergic Receptors
An additional adrenergic receptor
Stimulated by dopamine
Causes dilation of the following blood vessels, resulting in increased blood flow
Renal
Mesenteric
Coronary
Cerebral

9. ANS - Adrenergic Drugs Responses to Stimulation
Location Receptor Response
Cardiovascular:
Blood vessels 1 Constriction 2 Dilation
Cardiac muscle 1 Increased contractility
AV Node 1 Increased heart rate
SA Node 1 Increased heart rate
Gastrointestinal:
Muscle: 2 Decreased motility
Sphincters: 1 Constriction

10. ANS - Adrenergic Drugs Responses to Stimulation (cont’d)
Location Receptor Response
Genitourinary:
Bladder sphincter 1 Constriction
Penis 1 Ejaculation
Uterus 1 Contraction 2 Relaxation
Respiratory:
Bronchial muscles  Dilation
Liver 2 Glycogenolysis
Pupils 1 Dilation

11. ANS - Adrenergic Drugs Catecholamines
Substances that can produce a sympathomimetic response
Endogenous
epinephrine, norepinephrine, dopamine
Synthetic
dobutamine, phenylephrine
Mechanism of Action:
Direct-acting sympathomimetic
Binds directly to the receptor and causes a physiologic response

12. ANS - Adrenergic Drugs Response to Direct-Acting Sympathomimetics

13. ANS - Adrenergic Drugs Indirect-acting sympathomimetic
Causes the release of catecholamine from the storage sites (vesicles) in the nerve endings
The catecholamine then binds to the receptors and causes a physiologic response

14. ANS - Adrenergic Drugs Indirect-acting sympathomimetic

15. ANS - Adrenergic Drugs – Stimulation of -adrenergic receptors
Stimulation of -adrenergic receptors on smooth muscles results in:
Vasoconstriction of blood vessels
Relaxation of GI smooth muscles
Contraction of the uterus and bladder
Male ejaculation
Decreased insulin release
Contraction of the ciliary muscles of the eye (dilated pupils)

16. ANS - Adrenergic Drugs Stimulation of 1-adrenergic receptors
Stimulation of 1-adrenergic receptors on the myocardium, AV node, and SA node results in cardiac stimulation
Increased force of contraction (positive inotropic effect)
Increased heart rate (positive chronotropic effect)
Increased conduction through the AV node (positive dromotropic effect)

17. ANS - Adrenergic Drugs Stimulation of 2-adrenergic receptors
Stimulation of 2-adrenergic receptors on the airways results in:
Bronchodilation (relaxation of the bronchi)
Other effects of 2-adrenergic stimulation:
Uterine relaxation
Glycogenolysis in the liver
Increased renin secretion in the kidneys

18. ANS - Adrenergic Drugs 2-Adrenergic Drugs
Examples: Tx of acute bronchospasm (Asthma, COPD)
albuterol (Proventil, Ventolin)
epinephrine (Adrenalin)
levalbuterol (Xopenex)
metaproterenol (Alupent, Metaprel)
ephedrine
salmeterol (Serevent)
terbutaline* (Brethine, Brethaire)
* Used to stop premature labor—causes relaxation of uterine smooth muscle

19. ANS - Adrenergic Drugs Reduction of intraocular pressure
Reduction of intraocular pressure and causes mydriasis (pupil dilation): treatment of open-angle glaucoma
 or 2 receptors, or both
– Examples: epinephrine and dipivefrin
Temporary relief of conjunctival congestion (eyes)
-adrenergic receptors
Examples:
– epinephrine (Primatene, Bronkaid)
– phenylephrine (Neo-Synephrine)
– tetrahydrozoline (Tyzine)

20. ANS - Adrenergic Drugs Nasal decongestant
Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion
1-adrenergic stimulation
Topical Nasal Decongestants
tetrahydrozoline (Tyzine)
epinephrine (Adrenalin)
ephedrine
phenylephrine (Neo-Synephrine)

21. ANS - Adrenergic Drugs Vasoactive Sympathomimetics (
Pressors, (Inotropes, cardioselective sympathomimetics)
Used to support the heart during cardiac failure or shock; various  and  receptors affected
Pressors:
dobutamine (Dobutrex)
ephedrine
fenoldopam (Corlopam)
methoxamine
Dopamine (Intropin)
Epinephrine (Adrenalin)
Norepinephrine (Levophed)
Phenylephrine (Neo-Synephrine)

22. ANS - Adrenergic Drugs -Adrenergic Adverse Effects
CNS
Headache, restlessness, excitement, insomnia, euphoria
Cardiovascular
Palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension
Other
Loss of appetite, dry mouth, nausea, vomiting, taste changes (rare)

23. ANS - Adrenergic Drugs -Adrenergic Adverse Effects
CNS
Mild tremors, headache, nervousness, dizziness
Cardiovascular
Increased heart rate, palpitations (dysrhythmias), fluctuations in BP
Other
Sweating, nausea, vomiting, muscle cramps

24. ANS - Adrenergic Drugs Interactions
Anesthetic drugs
Tricyclic antidepressants
MAOIs
Antihistamines
Thyroid preparations
Antihypertensives

25. ANS - Adrenergic Drugs Nursing Implications
Assess for allergies and history of hypertension, cardiac dysrhythmias, or other cardiovascular disease
Assess renal, hepatic, and cardiac function before treatment
Perform baseline assessment of vital signs, peripheral pulses, skin color, temperature; include postural blood pressure and pulse
Follow administration guidelines carefully
Intravenous administration
Check IV site often for infiltration
Use clear IV solutions / Use an infusion pump
Infuse drug slowly to avoid dangerous cardiovascular effects
Monitor cardiac rhythm

26. ANS - Adrenergic Drugs Nursing Implications (cont’d)
With chronic lung disease:
Instruct patients to avoid factors that exacerbate their condition
Encourage fluid intake (up to 3000 mL per day) if permitted
Educate about proper dosing, use of equipment (MDI, spacer, nebulizer), and equipment care

27. ANS - Adrenergic Drugs Nursing Implications (cont’d)
Salmeterol is indicated for prevention of bronchospasms, not management of acute symptoms
Overuse of nasal decongestants may cause rebound nasal congestion or ulcerations
Avoid OTC or other medications because of possible interactions
Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as tachycardia or hypertension

28. ANS - Adrenergic Drugs Nursing Implications (cont’d)
Monitor for therapeutic effects: (cardiovascular uses)
Decreased edema
Increased urinary output
Return to normal vital signs
Improved skin color and temperature
Increased LOC

29. ANS - Adrenergic Drugs Nursing Implications (cont’d)
Monitor for therapeutic effects
(bronchospasm/asthma):
Return to normal respiratory rate
Improved breath sounds, fewer rales
Increased air exchange
Decreased cough
Less dyspnea
Improved blood gases
Increased activity tolerance