Nursing Pharmacology Respiratory System Drugs Respiratory System Drugs Analgesic Drugs Cardiac System Drugs Cardiac System Drugs Anti-Microbial Drugs Neurologic System Drugs Neurologic System Drugs Endocrine System Drugs Endocrine System Drugs Gastrointestina l System Drugs Gastrointestina l System Drugs Allergies Asthma Angina, MI Heart Failure HTN Fungal Bacterial Inflammation Nursing Process Pharmacokinetics Pharmacodynamics Nursing Process Pharmacokinetics Pharmacodynamics Dysrhythmias Coags Diuretics Viral Pain Anxiety Seizures Psychoses Diabetes Pituitary GI PUD
Learning Outcomes 1. Identify the basic functions of the nervous system. 2. Identify divisions of the peripheral nervous system. 3. Compare and contrast the actions of the sympathetic and parasympathetic divisions of the autonomic nervous system. 4. Compare and contrast the types of responses that occur when drugs activate (or block) alpha 1 -, alpha 2 -, beta 1 -, or beta 2 -adrenergic receptors, and nicotinic or muscarinic receptors. 5. Discuss the classification and naming of autonomic drugs based on four possible actions. 6. Describe the nurse’s role in the pharmacological management of patients receiving drugs affecting the autonomic nervous system. 7. Use the nursing process to care for patients receiving adrenergic agents, adrenergic-blocking agents, cholinergic agents, and cholinergic-blocking agents. 4 (cholinergic receptors)
Drugs that stimulate the sympathetic nervous system (SNS) Also known as: Adrenergic agonists Sympathomimetics Adrenergic Drugs 6
7 The Nervous System Central Peripheral BrainSpinal Cord Somatic (skeletal muscle) Autonomic Parasympathetic (cholinergic) ACh Sympathetic (adrenergic) NE AlphaBeta zzzzzzzzzzzzzz
Mimic the effects of SNS neurotransmitters (catecholamines) Norepinephrine (NE) Epinephrine (EPI) Dopamine Characteristics of Adrenergic Drugs 8
Located throughout the body Are receptors for the sympathetic neurotransmitters Alpha-adrenergic receptors Beta-adrenergic receptors Dopaminergic receptors: respond only to dopamine Adrenergic Receptors 9
Divided into alpha 1 and alpha 2 receptors Differentiated by their location on nerves Alpha-Adrenergic Receptors 10
Alpha 1 -adrenergic receptors Located on postsynaptic effector cells (the cell, muscle, or organ that the nerve stimulates) Alpha 2 -adrenergic receptors Located on presynaptic nerve terminals (the nerve that stimulates the effector cells) Control the release of neurotransmitters Alpha-Adrenergic Receptors (cont’d) 11
All are located on postsynaptic effector cells Beta 1 -adrenergic receptors—located primarily in the heart Beta 2 -adrenergic receptors—located in smooth muscle of the bronchioles, arterioles, and visceral organs Beta-Adrenergic Receptors 13 B1
An additional adrenergic receptor Stimulated by dopamine Causes dilation of the following blood vessels, resulting in increased blood flow Renal Mesenteric Coronary Cerebral Dopaminergic Receptors 15
Substances that can produce a sympathomimetic response Endogenous Epinephrine, norepinephrine, dopamine Synthetic Dobutamine, phenylephrine “Catecholamines” 17
Stimulation of alpha-adrenergic receptors on smooth muscles results in Vasoconstriction of blood vessels Relaxation of GI smooth muscles (decreased motility) Constriction of bladder sphincter Contraction of uterus Male ejaculation Contraction of pupillary muscles of the eye (dilated pupils) Drug Effects 18
Stimulation of beta 1 -adrenergic receptors on the myocardium, atrioventricular (AV) node, and sinoatrial (SA) node results in cardiac stimulation (+chronotrope + inotrope) Increased force of contraction (positive inotropic effect) Increased heart rate (positive chronotropic effect) Increased conduction through AV node (positive dromotropic effect) Drug Effects (cont’d) 19
Stimulation of beta 2 -adrenergic receptors on the airways results in Bronchodilation (relaxation of the bronchi) Other effects of beta 2 -adrenergic stimulation Uterine relaxation Glycogenolysis in the liver Increased renin secretion in the kidneys Relaxation of GI smooth muscles (decreased motility) Drug Effects (cont’d) 20
Treatment of asthma and bronchitis Bronchodilators: drugs that stimulate beta 2 -adrenergic receptors of bronchial smooth muscles, causing relaxation, resulting in bronchodilation Examples: albuterol, ephedrine, epinephrine, formoterol, levalbuterol, metaproterenol, pirbuterol, salmeterol, and terbutaline* * Used to stop premature labor—causes relaxation of uterine smooth muscle Indications 21
Treatment of nasal congestion Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion Alpha 1 -adrenergic receptors Examples: ephedrine, naphazoline, oxymetazoline, phenylephrine, and tetrahydrozoline Indications (cont’d) 22
Thyroid preparations Adrenergic antagonists Will directly antagonize each other, resulting in reduced effects Includes some antihypertensives Interactions (cont’d) 30
Questions t o ALWAYS Ask Yourself When Monitoring the effect of any Drug: 1. Why am I giving it? (Expected Effect) 2. How do I monitor / evaluate the Effect of the Drug? 3. Is it working? 4. Is it working “too well?” Assess for allergies, asthma, and history of hypertension, cardiac dysrhythmias, or other cardiovascular disease Assess renal, hepatic, and cardiac function before treatment Nursing Implications 31
Perform baseline assessment of vital signs, peripheral pulses, skin color, temperature, and capillary refill; include postural blood pressure and pulse Follow administration guidelines carefully 32 Nursing Implications
Intravenous administration Check IV site often for infiltration Use clear / crystalloid IV solutions Use an infusion pump Infuse drug slowly to avoid dangerous cardiovascular effects Monitor cardiac rhythm 33 Nursing Implications
With chronic lung disease Instruct patients to avoid factors that exacerbate their condition Encourage fluid intake (up to 3000 mL/day) if permitted Educate patients about proper dosing, use of equipment (metered-dose inhaler [MDI], spacer, nebulizer), and equipment care 34 Nursing Implications
Salmeterol is indicated for prevention of bronchospasms, not management of acute symptoms (“controller” vs “rescue”) Overuse of nasal decongestants may cause rebound nasal congestion or ulcerations Avoid over-the-counter or other medications because of possible interactions 35 Nursing Implications
Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as tachycardia or hypertension 36 Nursing Implications
Monitor for therapeutic effects (cardiovascular uses) Decreased edema Increased urinary output Return to normal vital signs Improved skin color and temperature Increased LOC 37 Nursing Implications
Monitor for therapeutic effects (asthma) Return to normal respiratory rate Improved breath sounds, fewer crackles Increased air exchange Decreased cough Less dyspnea Improved blood gases Increased activity tolerance 38 Nursing Implications
Question 39 A patient is experiencing bronchospasms after running half a mile. He has several inhalers with him. Which one would be appropriate for treatment at this time? A.albuterol B.salmeterol C.fluticasone D.salmeterol and fluticasone combination (Advair Diskus) Rationale: Albuterol is a beta 2 agonist that is used for acute bronchospasms. Salmeterol is appropriate for prevention of bronchospasms. Fluticasone is a corticosteroid that is not effective for acute bronchospasms. Advair Diskus is used for daily maintenance, not acute exacerbations.
Question 40 A patient has two inhalers that are due to be taken at the same time. One is a bronchodilator. The other is a corticosteroid. Which inhaler should the patient take first? A. The bronchodilator B. The corticosteroid C. It does not matter which one is taken first. Rationale: Taking the bronchodilator first will result in a more open airway and thus allow for better penetration by the inhaled corticosteroid.
Question 41 A patient on a dobutamine drip starts to complain that he feels a “tightness” in his chest that he had not felt before. What will the nurse do first? A.Check the infusion site for possible extravasation B.Increase the infusion rate C.Check the patient’s vital signs D.Order an electrocardiogram Rationale: Before anything else is done, the patient’s vital signs should be checked for alterations. The dopamine rate should not be increased. Extravasation rarely causes chest tightness. While an electrocardiogram would be prudent, it's not the priority until after the vital signs demonstrate that the patient is stable.
Question 42 A patient on a dobutamine drip starts to complain that her intravenous line “hurts.” The nurse checks the insertion site and sees that the area is swollen and cool. What will the nurse do first? A.Slow the intravenous infusion B.Stop the intravenous infusion C.Inject the area with phentolamine D.Notify the physician health care provider Rationale: Infiltration of an intravenous solution containing an adrenergic drug may lead to tissue necrosis from excessive vasoconstriction around the intravenous site. Phentolamine is often used for the treatment of infiltration, but the first thing the nurse must do is to stop the infusion of the adrenergic drug. Slowing the medication will not stop further tissue damage. The physician should be notified, but the infusion should be stopped first.
Question 43 A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulizer treatment with albuterol. The nurse’s immediate assessment priority would be to A.determine the time of the child’s last meal. B.monitor Sp O 2 with a pulse oximeter. C.monitor the child’s temperature. D.provide education on asthma management. Rationale: During administration of albuterol, a fast-acting beta 2 agonist, the nurse should monitor the patient’s respiratory status including Sp O 2 (with a pulse oximeter), respiratory rate, and breath sounds to ensure that the medication is having a therapeutic effect. The other items can be handled after her respiratory status is stable.