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NURS 472 Adrenergic
Pharm - adrenergic drugs
Question | Answer |
---|---|
properties of catechols | have neighboring -OH --> not orally absorbed (IV admin), do not cross BBB so no CNS effects |
properties on non-catechols | non-neighboring -OH --> oral absorption, cross BBB to exert CNS effects |
Alpha-1 receptor normal functions | vasoCon, mydriasis, bladder/prostrate sphincter contraction |
Alpha-1 therapeutic uses | to increase BP, hemostasis, releive nasal congestion, local anesthesia adjunct, mydriasis |
ADRs of Alpha-1 activation | HTN (too much of good thing), brady compensatory, necrosis extravasation |
Beta-1 normal functions | cardiac stimulation (force, frequency, AV conduction), kidney --> renin |
Beta-1 therapeutic uses | tx of cardiac arrest, HF, AV heart block, shock |
Beta-1 ADRs | tachy overshoot, dysrhythmias, angina pectoris (bwo increased heart activity exceeding what coronary artery can provide) |
Beta-2 normal functions | bronchoDIL, uterine relaxation, vasoDIL-essential, glycogenolysis, skeletal muscle contraction, HYPERkalemia |
Beta-2 therapeutic uses | asthma, delay tocolysis |
Beta-2 ADRs | hyperglycemia, tremor, HYPOkalemia (intracellular K shunting) |
Dopamine receptor blurb | PNS only in kidney vasculature -->increase RBF--> increase urine output |
All Adrenergic agonists are catechols EXCEPT | terbutaline, ephedrine |
how must chatechols be administered | must be IV admin, not absorbed orally, SHORT ACTING due to peripheral COMT, do NOT pass BBB, no CNS effect |
What catechol activates all 4 receptor types | epinephrine |
epinephrine indications | cardiac stimulation, anaphylactic shock(slanted towards Alpha-1, Beta-1) |
epinephrine ADRs | HTN overshoot, dysrhythmias, angina, necrosis extravasation, HYPERglycemia |
What endogenous substance and 2 drugs activate Alpha-1, Alpha-2 and Beta-1 | Norepinephrine, levarterenol, levophed |
Norepinephrine activates these receptors with this indication | Alpha-1,2 and Beta-1. Indicated for cardiac. CANNOT tx asthma or tocolysis because no Beta-2 |
What is the only drug that acts on Beta-1, Beta-2 nonselectively | isoproterenol |
What is isoproterenol indicated for | cardiac stimulation, bronchoDIL |
ADRs of Isoproterenol (B-1, B-2) | B-1: tachy, dysrhythmias, angina. B-2: hyperglycemia, hypokalemia |
what is therapeutically relevant about norepinephrine, levarterenol and levophed | this class can treat both cardiac and blood pressure bwo A-1, A-2 and B-1 stimulation |
In what order does dopamine 'step up' with increased dosage | dopa receptors, B-1 receptors, A-1 receptors, with respective ADRs at each receptor |
what drug activates Beta-1 selectively | dobutamine |
what is indication of dobutamine | to stimulate heart in CHF |
major ADRs of dobutamine | B-1 ADRs of tachy, dysrhythmias, angina |
what drug activates Beta-2 selectively | terbutaline, which is a NON-catechol, so it can be given oral and it DOES cross BBB |
terbutaline indicated for | asthma, tocolysis |
what NONcatechol activates all 4 receptors | ephedrine - like an oral epinephrine |
what little use does ephedrine have today | pre-tx IV contrast, nasal decongestant, asthma, allergy, postural orthostasis |
besides usual ADRs relevant to receptor type, what other ADR does ephedrine have | because it is a NONcatechol, it can cross BBB and stimulate CNS-->insomnia |
epinephrine | catecholamine activates all 4 receptors |
norepinephrine | catecholamine activates A-1,A-2, B-1 |
levarterenol | catecholamine activates A-1, A-2, B-1 |
levophed | catecholamine activates A-1, A-2, B-1 |
dopamine | activates dopa first, B-1 second, A-1 third |
dobutamine | selective B-1 |
terbutamine | selective B-2 NONCATECHOLAMINE |
ephedrine | activates all 4, NONCATECHOLAMINE |