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Adrenergic Agonists (Sympathomimetics) Nursing Considerations & Management

Notes

The autonomic fraught regularity (ANS) works to haunt the assemblage’s homeostasis abutting interior and manifest changes in the environment which substitute the assemblage’s interior governments (e.g., order hurry method, urinary perspiration, breathe-into neutralize, and digestive governments). Adrenergic agonists are autonomic fraught regularity offals that intensify the adrenergic receptors of the grateful fraught regularity (SNS), either immediately (by reacting behind a timeliness receptor places) or inimmediately (by increasing norepinephrine planes). An adrenergic agonist is as-well-behaved designated a sympathomimetic consequently it intensifys the goods of SNS. Adrenergic agonists are prefer disposeified into three: alpha- and beta-adrenergic agonists, alpha-unfair adrenergic agonists, and beta-unfair adrenergic agonists.

Table of Common Drugs and Common Names

Here is a board of uniformly encountered adrenergic agonists, their common indicates, and disgrace indicates:
Classification Generic Name Brand Name
Alpha- and Beta- Adrenergic Drugs dobutamine Dobutrex
dopamine Intropin
ephedrine (generic)
epinephrine Adrenalin, Sus-Phrine
norepinephrine Levophed
Alpha-Specific Adrenergic Agonists clonidine Catapress
phenylephrine Neo-Synephrine
Beta-Specific Adrenergic Agonists albuterol Proventil, Ventolin
arformoterol Brovana
isoproterenol Isuprel
levalbuterol Xopenex
metaproterenol Alupent
pirbuterol Maxair Autohaler
salmetrol Serevent Diskus
terbutaline Brethine

Disease Spotlight: Glaucoma, Shock, and Asthma

  • These agents are uniformly used for matter of glaucoma, asthma, and appall or appall-like provisions.
  • Glaucoma is an eye proviso characterized by acceptiond in intravisible hurry. Alpha adrenergic agonists acceleration stretch the scholars, abate the secretion of aqueous drollery, and acception the uveoscleral outflow. This mechanisms aid the eyes of too abundant hurry.
  • Shock is a perplexity most uniformly agentd by intelligent order mislaying that can markificantly substitute the governments of the organs and edifices. The goods of these agents to cardiovascular regularity grasp hurry acception, vasoconstriction, and acception order advancement to the muscles.
  • Asthma is a hypersensitivity reoperation to unfair triggers characterized by exaggerative reactions and bronchospasm. Beta agonists are generally used for matter of bronchospasm and other redundant respiratory provisions.

Alpha- and Beta-Adrenergic Agonists

Description
  • Alpha- and beta- agonists are offals that are generally sympathomimetic. These agonists intensify all of the adrenergic receptors so they intesecurity twain alpha- and beta-receptors.
  • Popular examples of offals under this dispose grasp dopamine, dobutamine, and epinephrine.
Therapeutic Action
The desired and salubrious operations of alpha- and beta-agonists are as follows:
  • Acting on the adrenergic receptors of the target organs, (i.e., acceptiond life objurgate and myocardial contractility behind a timeliness the life, bronchodilation behind a timeliness lungs, abate intravisible hurry behind a timeliness eyes).
  • Other goods grasp: perspiration, pupil dilation, acception in objurgate and profoundness of respirations
  • Facilitating the breakdown of glucose stores (glycogenolysis) so it can be used as ghost.
Indications
Alpha- and beta-agonists are implicated for the subjoined medical provisions:
  • Sympathomimetic of valuable for appall is dopamine, a naturally occurring catecholamineAintesecurity from stimulating the life to acception the objurgate and soundness of its contractions, it as-well-behaved agents dilation of the renal and splanchnic arterioles increasing order advancement to the kidneys. This way, renal shutdown is impedemateed.
  • Dobutamine and ephedrine are synthetic catecholamines implicated for matter of life want. They acception cardiac contractility behind a timelinessout causing acception in oxygen ask-for.
  • Ephedrine stimulates extricate of norepinephrine from strength endings. Its use is depressed consequently of availability of offals behind a timeliness aggravate predicboard aggression and operation. Multifarious OTC composed products emmatter this.
Here are some material aspects to mind for prognostic of adrenergic agonists in unanalogous age collections: Children
  • They are at dignified agent for GI and CV perplexitys. Dosage should be equitable and should be validated.
  •  NOTE  Phenylephrine is continually set-up in OTC allergy and composed preparations so bringing eagernessfulnessgivers should be instructed to hinder labels for ingredients and not couple offals behind a timeliness alike ingredients.
Adults
  • Constant dosage combinations fired on acceptance in resigneds behind a timeliness appall or appall-like states is insufficiencyed, specially those on acceptiond agent for cardiac perplexitys.
  • Most of these are necessity offals and can be used in resigneds who are fraught and/or lactating. Timeliness tless are no sufficient studies entailing their goods, use of these offals is justified when advantages plainly outbalance the agents.
Older adults
  • Dose combination is insufficiencyed as this age collection is as-well-behaved aggravate capable to offal intesecurity goods.
  • They are aggravate scapricious to keep toxic planes of the offal consequently of renal or hepatic inconclusivenesss.
  • Both adults and older adults must be forethoughted abutting using OTC offals and complementary therapies.
Pharmacokinetics
Here are the idiosyncrasy interactions of alpha- and beta-adrenergic agonists and the assemblage in provisos of parching, disposement, metabolism, and perspiration:
Route Onset Peak Duration IV 1-2 min 10 min Length of document T1/2: 2 min Metabolism: liver Excretion: urine
Contraindications and Cautions
The subjoined are contraindications and shy for the use of alpha- and beta-agonists:
  • Allergy to any element of the offal. To impedemate hypersensitivity reactions.
  • Pheochromocytoma. Systemic surfeit of catecholamines could be lethal.
  • Pulmonary hypertension. Exacerbated by the issue of the offal.
  • Tachyarrhythmias and ventricular fibrillation. Increased life objurgate and oxygen decline agentd by offals can exacerbate these provisions.
  • Hypovolemia. Fluid replacement is the preferred matter associated behind a timeliness hypotension.
  • Halogenated hydrocarbon general anesthetics. This sensitizes the myocardium to catecholamines and could agent eagernessfulnessful cardiac goods.
  • Peripheral cardiovascular illness. Caution should be used as this can be exacerbated by regularityic vasoconstriction issue of the offal.
Adverse Effects
Use of alpha- and beta-agonists may consequence to these counteractive goods:
  • Related to grateful stimulation: debauchery, perspiration, feelings of force or anxiety, piloerection
  • CV: arrhythmias, hypertension, palpitations, angina, dyspnea
  • GI: disgust, vomiting, constipation
  •  WARNING   Beagent of vasoconstrictive goods, eagernessfulness must be fascinated to shun extravasation of any infused offals. The vasoconstriction in the area of extravasation can bring to necrosis and cell departure in that area.
Interactions
The subjoined are offal-offal interactions implicated in the use of alpha- and beta-agonists:
  • Tricyclic antidepressant (TCA) and monoamine oxidase inhibitors (MAOI).Increased goods of these offals kindred to acceptiond norepinephrine planes or acceptiond receptor stimulation that occurs behind a timeliness twain offals. TCAs acception sympathomimetic goods behind a timeliness phenylephrine but abated antihypertensive goods behind a timeliness clonidine.
  • Ma huang, guarana, caffeine. Increased agent of hyperforce specially behind a timeliness alpha agonists.
  • Propranolol. Paradoxical hyperforce behind a timeliness clonidine
  • Any other adrenergic rival. Loss of issueiveness of offals.
Nursing Considerations
Here are material nursing considerations when administering alpha- and beta-agonists:
Nursing Assessment
These are the material things the nourish should grasp in conducting reprove, narrative regulative, and test:
  • Assess for contraindications or shy (e.g. narrative of allergy, pheochromocytoma, lethal arrhythmias, etc.) to shun counteractive goods.
  • Establish baseline corporeal reprove to mentor for any implicit counteractive goods.
  • Assess living marks, specially pulse and order hurry to mentor for likely debauchery stimulation of the cardiac regularity.
  • Note respiratory objurgate and auscultate lungs for influenceed sounds to evaluate goods on bronchi and respirations.
  • Monitor urine output to evaluate perfusion of the kidneys and sanative goods.
  • Monitor laboratory experience consequences (e.g. liver and renal government experiences) to indicate insufficiency for likely dose combination, and serum electrolyte planes to evaluate mellifluous mislaying and decorum of therapy.
Nursing Diagnosis and Carefulness Planning
Here are some of the nursing diagnoses that can be formulated in the use of this offal for therapy:
  • Decreased cardiac output kindred to CV goods
  • Ineffective edifice perfusion kindred to CV goods
Implementation behind a timeliness Rationale
These are living nursing interventions executed in resigneds who are regulative alpha- and beta-agonists:
  • Use ultimate forethought in wary and preparing doses of these offals consequently smooth mean errors could keep eagernessfulnessful goods.
  • Use personal, aseptic technique when administering ophthalmic or nasal agents (alpha- and beta- adrenergic agonists) to impedemate insertion and promise the sanative issueiveness of the offal.
  • Monitor resigned acceptance air-tight (living marks, ECG, urine output) to individualize the most advantage behind a timeliness the meanest sum of toxicity.
  • Maintain phentolamine on standby in occurrence extravasation occurs. Hinder the area by infiltrating 10 mL of illustrious embodying 5-10 mg of phentolamine.
  • Provide ease measures (e.g. capricious curb, greeting to lacking, mentoring bowel governments, living and recreation measures) to acceleration resigned struggle behind a timeliness the sympathomimetic goods of the offal.
  • Provide resigned direction encircling offal goods and notice marks to declaration.
Evaluation
Here are aspects of eagernessfulness that should be evaluated to indicate issueiveness of offal therapy:
  • Monitor resigned acceptance to therapy (advancement in order hurry, visible hurry, bronchial airflow).
  • Monitor for counteractive goods (e.g. CV changes, abated urine output, debauchery, GI aggravatethrow).
  • Evaluate resigned understanding on offal therapy by scrutiny resigned to indicate the offal, its prognostic, and counteractive goods to observe for.
  • Monitor resigned acquiescence to offal therapy. 

Alpha-Specific Adrenergic Agonists

Description
  • Alpha-unfair adrenergic agonists or alpha-agonists are offals that join largely to alpha-receptors rather than to beta-receptors.
  • Popular examples of offals under this dispose grasp clonidine, midodrine, and phenylephrine.
Therapeutic Action
The desired and salubrious operation of alpha-agonists is:
  • Acting as a strong postsynaptic alpha-adrenergic receptor stimulus causing vasoconstriction and raising systolic and diastolic order hurry behind a timeliness small issue on the beta-receptors of the life.
Indications
Alpha-agonists are implicated for the subjoined medical provisions:
  • Phenylephrine is a strong vasoconstrictor and alpha1-agonist behind a timeliness small or no issue on the life or bronchi and is used in multifarious consortment composed and allergy products. Parenterally, it is used in the subjoined medical provisions: appall or appall-like states and  paroxysmal supraventricular tachycardia. It is as-well-behaved used to continue national anesthesia and to suppress order hurry during spinal anesthesia. Topically, it used for matter of allergic rhinitis and symptoms of otitis resources.
  • Midodrine is an verbal offals used to disrace orthostatic hypotension in resigneds who do not tally to oral therapy. It activates alpha1-adrenergic receptors, bringing to peripheral vasoconstriction and an acception in vascular drift and order hurry.
  • Clonidine specifically intensifys alpha2-receptors of the CNS bringing to abated CNS outadvancement of norepinephrine. Orally and transdermally, it is used to curb hyperforce and as an insertion, it is for epidural document for curbling cancer pain.
Pharmacokinetics
Here are the idiosyncrasy interactions of alpha-agonists and the assemblage in provisos of parching, disposement, metabolism, and perspiration:
Route Onset Peak Duration IV Immediate – 15-20 min IM, subcutaneous 10-15 min – 30-120 min Topically Very small regularityic parching occurs – – T1/2: 47-100 hours Metabolism: edifices Excretion: urine and bile
Contraindications and Cautions
The subjoined are contraindications and shy for the use of alpha-agonists:
  • Allergy to any element of the offal. To impedemate hypersensitivity reactions.
  • Severe hyperforce or tachycardia. Possible comprehensive goods.
  • Narrow-angle glaucoma. Can be exacerbated by arterial constriction.
  • Pregnancy and lactation. No sufficient studies on the goods so use is self-possessed for aspects in which the advantage to the dowager outbalances any implicit agent to the fetus or neonate.
  • CV illness and vasospasm. Caution is used consequently these provisions could be magnify by the vascular goods of the offal
  • Thyrotoxicosis and diabetes. Sympathetic stimulation has thyroid-stimulating and glucose-elevating goods
  • Renal or hepatic inconclusiveness. Can quarrel behind a timeliness metabolism and perspiration of the offal.
Adverse Effects
Use of alpha-agonists may consequence to these counteractive goods:
  • CNS: eagernessfulness, perturbation, depression, fatigue, ungeneral dreams, convertibility changes
  • Sympathetic stimulation: blurred vision, photosensitivity
  • CV: arrhythmias, ECG changes, order hurry changes, peripheral vascular problem
  • GI: disgust, vomiting, anorexia
  • GU: abated urinary output, awkwardness urinating, dysuria, changes in sexual government
  •  WARNING  Sudden behind a timelinessdrawal can bring to: tachycardia, hypertension, arrhythmias, flushing, and smooth departure. Taper offals aggravate 2-4 days.
Interactions
The subjoined are offal-offal interactions implicated in the use of alpha-agonists:
  • MAOIs: cutting hypertension, debauchery, and hyperpyrexia behind a timeliness phenylephrine
  • TCA: acceptiond sympathomimetic goods behind a timeliness phenylephrine; abated antihypertensive goods behind a timeliness clonidine
  • Digoxin, beta-blockers, antipsychotics: acceptiond offal goods behind a timeliness midodrine
  • Adrenergic rivals: mislaying of issueiveness of adrenergic agonists
Nursing Considerations
Here are material nursing considerations when administering alpha-agonists:
Nursing Assessment
These are the material things the nourish should grasp in conducting reprove, narrative regulative, and test:
  • Assess for contraindications or shy (e.g., narrative of allergy, CV illnesss, thyrotoxicosis or diabetes, etc.) to shun counteractive goods.
  • Establish baseline corporeal reprove to mentor for any implicit counteractive goods.
  • Assess plane of orientation, interest, reflexes, and craveing to mentor for CNS changes kindred to offal therapy.
  • Monitor order hurry and pulse, assess peripheral perfusion, and earn electrocardiogram, if implicated, to indicate offal issueiveness and evaluate for counteractive CV goods.
  • Monitor urine output to evaluate perfusion of the kidneys and sanative goods.
  • Evaluate resigned for disgust and constipation to assess counteractive goods of the offal and fir embezzle interventions.
  • Monitor laboratory experience consequences (e.g., liver and renal government experiences) to indicate insufficiency for likely dose combination.
Nursing Diagnosis and Carefulness Planning
Here are some of the nursing diagnoses that can be formulated in the use of this offal for therapy:
  • Decreased cardiac output kindred to order hurry changes, arrhythmias, or vasoconstriction
  • Disturbed sensory cognizance kindred to CNS goods
  • Risk for injury kindred to CNS or CV goods
Implementation behind a timeliness Rationale
These are living nursing interventions executed in resigneds who are regulative alpha-agonists:
  • Do not abolish abruptly to impedemate reverbereprove hypertension.
  • Monitor order hurry, orthostatic order hurry, pulse, rhythm, and cardiac output continually to appoint dose or abolish the offal of CV goods are cutting.
  • Maintain phentolamine on standby when administering phenylephrne in occurrence extravasation occurs. Hinder the area by infiltrating 10 mL of illustrious embodying 5-10 mg of phentolamine behind a timelinessin 12 hours behind extravasation to hinder edifice.
  • Provide ease measures (e.g., security and environmental curb) to acceleration resigned struggle behind a timeliness the offal goods.
  • Provide resigned direction encircling offal goods and notice marks to declaration to excite understanding and acquiescence.
Evaluation
Here are aspects of eagernessfulness that should be evaluated to indicate issueiveness of offal therapy:
  • Monitor resigned acceptance to therapy (advancement in proviso nature discourseed).
  • Monitor for counteractive goods (e.g., GI aggravatethrow, CNS, and CV changes).
  • Evaluate resigned understanding on offal therapy by scrutiny resigned to indicate the offal, its prognostic, and counteractive goods to observe for.
  • Monitor resigned acquiescence to offal therapy.

Beta-Specific Adrenergic Agonists

Description
  • Beta-unfair adrenergic agonists or beta-agonists are offals that join largely to beta-receptors rather than to alpha-receptors.
  • Popular examples of offals under this dispose grasp albuterol, salmeterol, and terbutaline.
Therapeutic Action
The desired and salubrious operation of beta-agonists is:
  • Acting on beta-adrenergic receptors to fruit acceptiond life objurgate, overbearing inotropic issue, bronchodilation, and vasodilation.
Indications
Beta-agonists are implicated for the subjoined medical provisions:
  • Treatment of bronchial spasm, asthma, and other redundant pulmonary provisions.
Pharmacokinetics
Here are the idiosyncrasy interactions of beta-agonists and the assemblage in provisos of parching, disposement, metabolism, and perspiration:
Route Onset Peak Duration IV Immediate – 1-2 min T1/2: Unknown Metabolism: edifices Excretion: –
Contraindications and Cautions
The subjoined are contraindications and shy for the use of beta-agonists:
  • Allergy to any element of the offal. To impedemate hypersensitivity reactions.
  • Pulmonary hypertension. Can be exacerbated by offal goods
  • Anesthesia behind a timeliness halogenated hydrocarbons. Can sensitize the myocardium to catecholamines and could agent a cutting reaction
  • Eclampsia, uterine hemorrhage, and intrauterine departure. Can be concerned by uterine recreation or acceptiond order hurry
  • Thyrotoxicosis and diabetes. Sympathetic stimulation has thyroid-stimulating and glucose-elevating goods
  • Severe renal inconclusiveness. Can substitute offal perspiration
Adverse Effects
Use of beta-agonists may consequence to these counteractive goods:
  • CNS: eagernessfulness, perturbation, weary, fear, excitement, debauchery
  • CV: tachycardia, angina, myocardial infarction, palpitations
  • Respiratory: awkwardness of living, bronchospasm, cutting pulmonary edema
  • GI: disgust, vomiting, anorexia, GI aggravatethrow
  • Others: perspiration, scholar dilation, overventuresome, muscle cramps
Interactions
The subjoined are offal-offal interactions implicated in the use of beta-agonists:
  • Other sympathomimetic offals: acceptiond sympathomimetic goods
  • Beta-blockers: abated sanative goods
Nursing Considerations
Here are material nursing considerations when administering beta-agonists:
Nursing Assessment
These are the material things the nourish should grasp in conducting reprove, narrative regulative, and test:
  • Assess for contraindications or shy (e.g., narrative of allergy, uterine hemorrhage, thyrotoxicosis or diabetes, etc.) to shun counteractive goods.
  • Establish baseline corporeal reprove to mentor for any implicit counteractive goods.
  • Assess CV standing (pulse objurgate and order hurry) to evaluate for any CV goods associated behind a timeliness SNS stimulation.
  • Assess respiratory standing to mentor offal goods and assess for respiratory counteractive goods.
  • Monitor urine output to evaluate perfusion of the kidneys and sanative goods.
  • Monitor laboratory experience consequences (e.g., liver and renal government experiences) to indicate insufficiency for likely dose combination.
Nursing Diagnosis and Carefulness Planning
Here are some of the nursing diagnoses that can be formulated in the use of this offal for therapy:
  • Acute denial kindred to CV and regularityic goods
  • Decreased cardiac output kindred to CV goods
  • Ineffective edifice perfusion kindred to CV goods
Implementation behind a timeliness Rationale
These are living nursing interventions executed in resigneds who are regulative beta-agonists:
  • Monitor pulse and order hurry eagernessfulnessfully during government to dispose to abolish the offal at any mark of toxicity.
  • Ensure that a beta-blocker is antecedentlyhand beneficial when giving parenteral isoproterenol in occurrence cutting reoperation occurs.
  • Use minimal doses of isoproterenol insufficiencyed to finish desired goods to impedemate counteractive goods and suppress resigned security.
  • Provide ease measures to acceleration resigned struggle behind a timeliness the offal goods.
  • Provide resigned direction encircling offal goods and notice marks to declaration to excite understanding and acquiescence.
Evaluation
Here are aspects of eagernessfulness that should be evaluated to indicate issueiveness of offal therapy:
  • Monitor resigned acceptance to therapy (advancement in proviso nature discourseed, stabilization of order hurry, impedemateion of preterm labor).
  • Monitor for counteractive goods (e.g., GI aggravatethrow, respiratory, and CV changes).
  • Evaluate resigned understanding on offal therapy by scrutiny resigned to indicate the offal, its prognostic, and counteractive goods to observe for.
  • Monitor resigned acquiescence to offal therapy. 

Practice Exam

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