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27 Cards in this Set
- Front
- Back
Therapeutic Applications of Alpha1 activation
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-Vasoconstriction
- Mydriasis (pupil dilation) |
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Vasoconstriction can cause
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-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 |
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Clinical consequences of Alpha2 activation
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inhibits norepinephrine release- no clinical applications related to the activation of Alpha2
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Therapeutic applications of Beta1 activation
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-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) |
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Adverse effects of Beta1 activation
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- tachycardia from overstimulation
-Dysrhythmias from overstimulation - Angina Pectoris, pain in the chest from not enough oxygen to meet demands |
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Therapeutic Applications of Beta2 activation
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-Asthma- promotes bronchodilation to help relieve or prevent asthma attacks
-Delay of preterm labor- relaxes uterine smooth muscle |
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Adverse effects of Beta2 activation
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-Hyperglycemia-promotes breakdown of glycogen into glucose in patients with diabetes
-Tremor- most common side effect due to enhanced muscle contraction |
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Treatment of Anaphylactic Shock
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Epinephrine injected IM
-activates 3 types of adrenergic receptors alpha1, beta1, and beta2 -increases cardiac output, increases bp, dilates bronchioles |
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Therapeutic uses of epinephrine
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-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 |
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Epinephrine cannot be given __________________
Inactivation of epinephine |
-Orally
-Has a short half life because of enzymatic inactivation and uptake into adrenergic nerves |
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Adverse effects of Epinephrine
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-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 |
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Epinephrine Drug Interactions
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-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 |
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How does Norepinephrine and Epinephrine Differ?
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NE does not activate beta2 receptors
NE has limited clinical applications only ones are: --hypotensive states --cardiac arrest |
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Isoproterenol (activates beta receptors) Therapeutic uses
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Cardiovascular
-AV heart block -Cardiac arrest -Shock Prevents bronchospasm during anesthesia |
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Adverse effects of Isoproterenol
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-tachydysrhythmias
-angina pectoris -hyperglycemia in diabetics |
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Drug interactions of Isoprotenerenol
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Same as Epinephrine
-Effects are enhanced by MAO inhibitors and tricyclic antidepressants and reduced by beta-adrenergic blocking agents |
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Dopamine therapeutic uses
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-Shock
-Heart failure -Acute Renal failure |
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Adverse effects of Dopamine
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-tachycardia
-dysrhythmias -anginal pain -necrosis from extravasation of IV |
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Drug interactions of Dopamine
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-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 |
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Why are adrenergic agonists known as sympathomimetics?
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Their effects mimic those caused by the sympathetic nervous system
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What do you do if an IV delivering epinephrine or dopamine becomes extravasated?
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-Stop the infusion and infiltrate the region with PHENTOLAMINE to minimize injury
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Baseline data needed for dopamine preadministration assessment?
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FULL ASSESSMENT OF:
Cardiac status Hemodynamic status Renal Status |
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How can you minimize adverse effects from dopamine and epinephrine?
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Cardiovascular effects-- reduce with a beta-adrenergic blocking agent (e.g. propranolol)
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Dobutamine therapeutic uses
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Improvement of hemodynamic status in Heart failure
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Adverse effects of dobutamine?
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tachycardia
monitor BP and ECG closely |
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Drug interactions of dobutamine
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-Same as Dopamine
MAO increases effects (decrease dobutamine dose at least 90%) -Tricyclic antidepressants may cause a moderate increase in effects |
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Evaluating therapeutic effects of dobutamine
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-Monitor heart rate, ECG, blood pressure and urine output
-Monitor central venous pressure and pulmonary wedge pressure when possible |