Chapter 17: Adrenergic Drugs (sympathomimetics)

 Stimulate the sympathetic nervous system

 Adrenergic receptors = receptor sites for catecholamines (EPI & NE)
 Divided into α & β receptor sites:

Receptor Location Response

Alpha1 Post synaptic effector cells (tissue, muscle, ***predominant***
organ) vasoconstriction & CNS stimulation
Alpha2 Presynaptic nerve terminal
Βeta1 Primarily the heart ***predominant***
Beta2 Smooth muscle of bronchioles, arterioles, & Smooth muscle relaxation; glycogenolysis; &
visceral organs cardiac stimulation
Dopaminergic Renal, mesenteric, coronary, & cerebral ***predominant***
arteries Dilation
(it’s the only substance that can stimulate
these receptors)

Mechanism of Action Bronchodilators, ophthalmic drugs, nasal decongestants, & vasoactive drugs
Uses Asthma, bronchitis, nasal decongestants,
Contraindications Known drug allergy, severe hypertension
Adverse Effects (General)Headache, restlessness, excitement, insomnia, & euphoria. (α) Chest pain, vasoconstriction,
hypertension, tachycardia, palpitations, anorexia, dry mouth. (β) mild tremors, nervousness, dizziness,
increased HR, sweating, nausea, & muscle cramps
Management of ***aimed at managing S/Sx of the CNS & cardiovascular system***
Toxicity & Overdose Diazepam (for seizures), rapid-acting sympatholytic drug (to lower BP~>prevention of hemorrhage)
Nursing Implications Rinse mouth after each inhalation or use of nebulizer.

Bronchodilators
 Stimulate β-2 adrenergic receptors (causes bronchi to dilate)
 Uses: asthma
 Generic names:
a) albuterol sulfate
b) epinephrine – drug of choice for acute asthma attacks & anaphylaxis. Produces vasoconstriction, increased BP, cardiac
stimulation & dilation of the bronchioles (α & β- drug)
c) salmeterol – long term maintenance tx of asthma, NOT INDICATED FOR ACUTE EXACERBATIONS

Nasal Decongestants
 Causes vasoconstriction in the nasal mucosa
 Uses: reduces nasal secretions & leads to easier breathing. (CAUTION: OVERUSE MAY LEAD TO REBOUND
PHENOMENON ~> GREATER CONGESTION)
 Generic name:
a) pseudoephedrine

Ophthalmic Decongestants
 Results in arteriolar vasoconstriction in the eye
 Uses: reduces red-eye
 Generic names:
a) epinephrine
b) phenylphrine
c) naphazoline
d) tetrahydrozoline (Visine) -- ***most widely used***

Vasoactive Adrenergics
 Very potent, quick-acting, & injectable. Wide range of effects.
 Uses: heart failure, shock, orthostatic hypotension
 Generic names:
a) dobutamine
 b) dopamine – (low-dose)dilate blood vessels & increases blood flow in the brain, heart, kidneys, & mesentery. (high-
dose) improves cardiac contractility and output. Use of the drug is CONTRAINDICATED IN PT’S WHO HAVE A
CATECHOLAMINE-SECRETING TUMOR OF THE ADRENAL GLAND (AKA PHEOCHROMOCYTOMA)
c) epinephrine
d) fenoldopam – short-term tx of severe HTN & increase renal blood flow
e) midodrine – primarily indicated for the tx of ORTHOSTATIC HYPOTENSION. requires careful dosing & monitoring
(keeping track of BP in a journal)
f) norepinephrine – used primarily in tx of hypotension and shock
g) phenylephrine

Review Questions:

The nurse caring for a pt who is rcv’ing β-agonist drug therapy needs to be aware that these drugs cause: increased cardiac contractility.

During a teaching session for a pt who is rcv’ing inhaled salmeterol, the nurse emphasizes that the drug is indicated for: prevention of bronchospasm.

For a pt rcv’ing a vasoactive drug such as IV dopamine, which of the following actions by the nurse is most appropriate? Assess the IV site hourly to
rule out infiltration.

When a drug is characterized as having a negative chronotropic effect, the nurse knows to expect: decreased heart rate.

A pt is rcv’ing doputamine for a worsening of heart failure. The pt is now complaining of “chest tightness”. Which statement is most appropriate
regarding the pt’s symptoms? – the presence of chest pain and the changes in vital signs need to be evaluated immediately by the nurse and physician.