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Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 19 Adrenergic-Blocking Drugs
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2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic Blockers Bind to adrenergic receptors, but inhibit or block stimulation of the sympathetic nervous system (SNS) Alpha-blockers and beta-blockers
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3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic Blockers (cont’d) Have the opposite effect of adrenergic drugs Inhibit—or lyse—sympathetic stimulation Also known as: Adrenergic antagonists Sympatholytics Alpha-blockers, beta-blockers, or alpha-beta blockers
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4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic Blockers (cont’d) Classified by the type of adrenergic receptor they block Alpha 1 and alpha 2 receptors Beta 1 and beta 2 receptors
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5 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
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6 Drug Effects and Indications: Alpha-Blockers Cause both arterial and venous dilation, reducing peripheral vascular resistance and BP Used to treat hypertension Effect on receptors on prostate gland and bladder decreases resistance to urinary outflow, thus reducing urinary obstruction and relieving effects of BPH
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7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Effects and Indications: Alpha-Blockers (cont’d) Used to control and prevent hypertension in patients with pheochromocytoma Phentolamine Quickly reverses the potent vasoconstrictive effects of extravasated vasopressors such as norepinephrine or epinephrine Restores blood flow and prevents tissue necrosis
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8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Alpha-Blockers: Adverse Effects Body SystemAdverse Effects CardiovascularPalpitations, orthostatic hypotension, tachycardia, edema, dysrhythmias, chest pain CNSDizziness, headache, drowsiness, anxiety, depression, vertigo, weakness, numbness, fatigue
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9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Alpha-Blockers: Adverse Effects (cont’d) Body SystemAdverse Effects GastrointestinalNausea, vomiting, diarrhea, constipation, abdominal pain OtherIncontinence, nosebleed, tinnitus, dry mouth, pharyngitis, rhinitis
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10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Common Alpha-Blockers phenoxybenzamine HCl (Dibenzyline) phentolamine (Regitine) prazosin (Minipress) tolazoline (Priscoline)
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11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Beta-Blockers Block stimulation of beta receptors in the SNS Compete with norepinephrine and epinephrine Can be selective or nonselective Nonselective beta-blockers block both beta 1 and beta 2 receptors
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12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Beta Receptors Beta 1 receptors Located primarily on the heart Beta-blockers selective for these receptors are called cardioselective beta-blockers Beta 2 receptors Located primarily on smooth muscle of bronchioles and blood vessels
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13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mechanism of Action Cardioselective beta-blockers (beta 1 ) Reduce SNS stimulation of the heart Decrease heart rate Prolong SA node recovery Slow conduction rate through the AV node Decrease myocardial contractility, thus reducing myocardial oxygen demand
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14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mechanism of Action (cont’d) Nonselective beta-blockers (beta 1 and beta 2 ) Cause same effects on heart as cardioselective beta-blockers Constrict bronchioles, resulting in narrowing of airways and shortness of breath Produce vasoconstriction of blood vessels Other effects
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15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indications Angina Decreases demand for myocardial oxygen Cardioprotective Inhibits stimulation from circulating catecholamines Dysrhythmias Class II antidysrhythmic Migraine headache Lipophilicity allows entry into CNS
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16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d) Antihypertensive Heart failure Glaucoma (topical use)
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17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects: Beta-Blockers Body SystemAdverse Effects BloodAgranulocytosis, thrombocytopenia CardiovascularAV block, bradycardia, heart failure, peripheral vascular insufficiency CNSDizziness, mental depression, lethargy, hallucinations, unusual dreams
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18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects: Beta-Blockers Body SystemAdverse Effects GastrointestinalNausea, dry mouth, vomiting, diarrhea, cramps, ischemic colitis OtherImpotence, rash, alopecia, bronchospasm
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19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects: Beta-Blockers Nonselective beta-blockers may interfere with normal responses to hypoglycemia (tremor, tachycardia, nervousness) May mask signs and symptoms of hypoglycemia
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20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Beta-Blockers: Examples acebutolol (Sectral) carvedilol (Coreg) labetalol (Normodyne) metoprolol (Lopressor) atenolol (Tenormin) esmolol (Brevibloc) sotalol (Betapace) propranolol (Inderal)
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21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic-Blocking Drugs: Nursing Implications Assess for allergies and history of COPD, hypotension, cardiac dysrhythmias, bradycardia, heart failure, or other cardiovascular problems Any preexisting condition that might be exacerbated by the use of these drugs might be a contraindication to their use
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22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic-Blocking Drugs: Nursing Implications (cont’d) Remember that alpha-blockers may precipitate hypotension Remember that some beta-blockers may precipitate bradycardia, hypotension, heart block, heart failure, and bronchoconstriction
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23 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic-Blocking Drugs: Nursing Implications (cont’d) Avoid over-the-counter medications because of possible interactions Possible drug interactions may occur with: Antacids (aluminum hydroxide type) Antimuscarinics/anticholinergics Diuretics and cardiovascular drugs Neuromuscular blocking drugs Oral hypoglycemic drugs
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24 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic-Blocking Drugs: Nursing Implications (cont’d) Encourage patients to take medications as prescribed Instruct patients that these medications should never be stopped abruptly Inform patients to report constipation or the development of urinary hesitancy or bladder distention
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25 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic-Blocking Drugs: Nursing Implications (cont’d) Teach patients to change positions slowly to prevent or minimize postural hypotension Instruct patients to avoid caffeine (excessive irritability) Instruct patients to avoid alcohol ingestion and hazardous activities until blood levels become stable Instruct patients to notify their physician if palpitations, dyspnea, nausea, or vomiting occurs
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26 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenergic-Blocking Drugs: Nursing Implications (cont’d) Monitor for adverse effects Monitor for therapeutic effects Decreased chest pain in patients with angina Return to normal BP and HR Other specific effects, depending on the use
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27 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Beta-Blocking Drugs: Nursing Implications Rebound hypertension or chest pain may occur if this medication is discontinued abruptly Instruct patients to notify their physician if they become ill and unable to take medication Inform patients that they may notice a decrease in tolerance for exercise (dizziness and fainting may occur with increased activity), and have patients notify the physician if these problems occur
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28 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Beta-Blocking Drugs: Nursing Implications (cont’d) Inform patients to report the following to their physician: Weight gain of more than 2 pounds in 1 day or 5 pounds in 1 week Edema of the feet or ankles Shortness of breath Excessive fatigue or weakness Syncope or dizziness
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