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27 Cards in this Set

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Therapeutic Applications of Alpha1 activation
-Vasoconstriction
- Mydriasis (pupil dilation)
Vasoconstriction can cause
-Hemostasis- stopping bleeding
-Nasal decongestion
-Adjunct to Lacal Anesthetics to delay absorption by reducing blood flow to the site of administration prolonging anesthesia
-Elevates blood pressure
Clinical consequences of Alpha2 activation
inhibits norepinephrine release- no clinical applications related to the activation of Alpha2
Therapeutic applications of Beta1 activation
-Increases the force of contraction in heart failure and improves cardiac performance
-Increases heart rate and force of contraction and improve tissue perfusion in shock
-Enhances impulse conduction through the AV node helping overcome atrioventricular heart block (only temporary)
-Initiate contraction in a heart that has stopped beating in cardiac arrest (not the drug of choice)
Adverse effects of Beta1 activation
- tachycardia from overstimulation
-Dysrhythmias from overstimulation
- Angina Pectoris, pain in the chest from not enough oxygen to meet demands
Therapeutic Applications of Beta2 activation
-Asthma- promotes bronchodilation to help relieve or prevent asthma attacks
-Delay of preterm labor- relaxes uterine smooth muscle
Adverse effects of Beta2 activation
-Hyperglycemia-promotes breakdown of glycogen into glucose in patients with diabetes
-Tremor- most common side effect due to enhanced muscle contraction
Treatment of Anaphylactic Shock
Epinephrine injected IM
-activates 3 types of adrenergic receptors alpha1, beta1, and beta2
-increases cardiac output, increases bp, dilates bronchioles
Therapeutic uses of epinephrine
-Delays absorption of local anesthetics
-Controls superficial bleeding
-Elevates BP
-Overcomes AV heart block
-Restores cardiac function in cardiac arrest
-Promotes bronchodilation
-Treatment of choice for anaphylactic shock
Epinephrine cannot be given __________________

Inactivation of epinephine
-Orally

-Has a short half life because of enzymatic inactivation and uptake into adrenergic nerves
Adverse effects of Epinephrine
-Hypertensive crisis (need continuous cardiac monitoring)
-Dysrhythmias due to excessive activation of beta1 receptors
-Angina Pectoris
-Necrosis Following extravasation of IV line
-Hyperglycemia in diabetic patients
Epinephrine Drug Interactions
-MAO inhibitors- prolong and intensify epinephrine
-Tricyclic Antidepressants- intensify and prolong epinephrine
-General Anesthetics- can cause tachydysrhythmias
-Alpha-Adrenergic Blocking agents- prevent receptor activation by epinephrine
-Beta-Adrenergic Blocking Agents- prevent receptor activation by epinephrine
How does Norepinephrine and Epinephrine Differ?
NE does not activate beta2 receptors

NE has limited clinical applications only ones are:
--hypotensive states
--cardiac arrest
Isoproterenol (activates beta receptors) Therapeutic uses
Cardiovascular
-AV heart block
-Cardiac arrest
-Shock

Prevents bronchospasm during anesthesia
Adverse effects of Isoproterenol
-tachydysrhythmias
-angina pectoris
-hyperglycemia in diabetics
Drug interactions of Isoprotenerenol
Same as Epinephrine
-Effects are enhanced by MAO inhibitors and tricyclic antidepressants and reduced by beta-adrenergic blocking agents
Dopamine therapeutic uses
-Shock
-Heart failure
-Acute Renal failure
Adverse effects of Dopamine
-tachycardia
-dysrhythmias
-anginal pain
-necrosis from extravasation of IV
Drug interactions of Dopamine
-MAO inhibitors can intensify the effects of dopamine so if taking an MAO inhibitor dopamine dose must be reduced by 90%
-Tricyclic antidepressants can also intensify dopamine's actions
-Diuretics can complement the effects of dopamine on the kidney
Why are adrenergic agonists known as sympathomimetics?
Their effects mimic those caused by the sympathetic nervous system
What do you do if an IV delivering epinephrine or dopamine becomes extravasated?
-Stop the infusion and infiltrate the region with PHENTOLAMINE to minimize injury
Baseline data needed for dopamine preadministration assessment?
FULL ASSESSMENT OF:
Cardiac status
Hemodynamic status
Renal Status
How can you minimize adverse effects from dopamine and epinephrine?
Cardiovascular effects-- reduce with a beta-adrenergic blocking agent (e.g. propranolol)
Dobutamine therapeutic uses
Improvement of hemodynamic status in Heart failure
Adverse effects of dobutamine?
tachycardia
monitor BP and ECG closely
Drug interactions of dobutamine
-Same as Dopamine
MAO increases effects (decrease dobutamine dose at least 90%)
-Tricyclic antidepressants may cause a moderate increase in effects
Evaluating therapeutic effects of dobutamine
-Monitor heart rate, ECG, blood pressure and urine output
-Monitor central venous pressure and pulmonary wedge pressure when possible