ADRENERGIC BLOCKERS

CLASSIFICATION (SEARCH PA Po)

ACTION: Adrenergic Blockers act by binding to adrenergic receptors, causing dilation of peripheral blood
vessels. Lowers peripheral resistance, resulting in decrease B/P.

USES: Adrenergic blockers are used for benign prostatic hyperplasia, pheochromocytoma, prevention of
tissues necrosis and sloughing associated with extravasation of IV vasopressors.

SIDE EFFECTS: The most common side effects are hypotension, tachycardia, nasal stuffiness, nausea,
vomiting and diarrhea.

CONTRAINDICATIONS: Hypersensitive reactions may occur, and allergies should be identifies before
these products are given. Patients with MI, coronary insufficiency, angina or other evidence of CAD
should not use these products.

PHARMACOKINETICS: onset, peak, and duration vary among products.

INTERACTIONS: Vasoconstrictive and hypertensive effects of epinephrine are antagonized by adrenergic

blockers.

Possible Nursing Diagnoses:

 Risk for injury (adverse reactions)

 Sleep deprivation
 Ineffective tissue perfusion
 Impaired Urinary Elimination

Nursing considerations

Assess:

 Electrolytes: K, Na, CL, CO2

 Weight daily, I and O
 B/P lying, Standng before starting treatment, q4hr thereafter
 Nausea, vomiting, diarrhea
 Skin turgor, dryness of muscuos membranes for hydration status

Administer:

 Starting with low dose, gradually increasing to prevent side effects

 With food or milk for GI symptoms

Evaluate:

Therapeutic response: decreasded B/P, increased peripheral pulses

Teach patient/family:

 To avoid alcoholic beverages

 To report dizziness, palpitations,fainting
 To change position slowly of fainting may occur
 To take product exactly as prescribed
 To avoid all OTC products (cough, cold, allergy) unless directed by prescriber

SELECTED GENERIC NAMES

 Phentolamine
 Silodosin
 tamsulosin

PHENTOLAMINE (RX)
Fen-tole’a-meen
Func. Class: Anti-hypertensive
Chem. Class: a-Adrenergic blocker

Do not confuse
Phentolamine / phentermine

Action
a-Adrenergic blocker, binds to a-adrenergic receptors, dilating peripheral blood vessels, lowering
peripheral resistance, lowering blood pressure.

Uses
Hypertension; pheochromocytoma; prevention/treatment of dermal necrosis following extravasation of
norepinephrine, DOPamine, epinephrine

Unbalanced Uses:
Impotence, hypertensive crisis due to MAOIs, symphatomimetic amines, heart failure.

DOSAGE AND ROUTES

Treatment of hypertensive episodes in pheochromocytoma
 adult: IM/IV 5mg, repeat if necessary
 Child: IV 0.05-0.1 mg/kg/dose, repeat if necessary; max 5mg
Diagnosis of pheochromocytoma
 Adult: IV 2.5mg; if negative, repeat with 5 mg IV.
 Child: IV 0.1mg/kg IV
Treatment Necrosis
 Adult: 5-10mg/10ml NS injected into area of norepinephrine extravasation within 12hr
 Child: 0.1-0.2 mg/kg, max 5mg
Prevention of Necrosis
 Adult: 10 mg/L of norepinephrine containing sol.
 Child: IV 0.1-0.2 mg/kg, max 5mg

Left ventricular Heart failure (Unlabelled)

 Adult: IV 0.17-0.4 mg/min
Erectile dysfunction (unlabelled)
 Adult: PO 40-80mg
Hypertensive emergency due to MAOIs, sympathomimetic amines (unlabelled)
 Adult: IV BOL 5-15 mg/ml

Pharmacokinetics:
Metabolized in the liver, excreted in urine
IM: Peak 15-20 min, duration 3-4 hr
IV: Peak 2 min, duration 10-15 min

Adverse effects
CNS: Dizziness, flushing, weakness, cerebrovascular spasm
CV: Hypotension, tachycardia, angina, dysrhythmias, MI
EENT: Nasal congestion
GI: Dry mouth, nausea, vomiting, diarrhea, abdominal pain

Nursing considerations
Assess:
 Weight daily, input and output
 Blood pressure lying, standing before starting treatment, q4hr after
 Nausea, vomiting, diarrhea, edema in feet, legs daily; skin turgor, dryness of mucous
membranes for hydration status, postural hypotension, cardiac system: pulse, ECG
Administer:
 Gum, frequent rinsing of mouth, or hard candy for dry mouth
 With vasopressor available
 After discontinuing all medication for 24 hr
 Treatment during required bed rest, 1 hr after
o IV Route:
 After diluting 5mg/1ml sterile H2O for inj; give 5mg or less/min; patient to remain
recumbent during administration
o Cont IV INF Route
 Dilute 5-10 mg/500 ml D5W, titrate to patient response
 10 mg/L may be added to norepinephrine in IV sol for prevention of dermal necrosis
Evaluate:
 Therapeutic response: decreased BP
Teach patient/family:
 That bed rest is required during treatment, 1 hr after

Nursing Diagnosis Plan of Action Intervention Rationale Evaluation

Fluid volume Monitor and Decrease in
deficit related to document vital circulating blood
diarrhea signs especially BP volume can cause
and HR. hypotension and
tachycardia.
Alteration in HR is
a compensatory
mechanism to
maintain cardiac
output.

Assess skin turgor Signs of

and oral mucous dehydration are
membranes for also detected
signs of through the skin.
dehydration.

Assess and color A normal urine

and amount of output is
urine. Report considered normal
urine output less if not less than
than 30 ml/hr for 30ml/hour.
2 consecutive Concentrated
hours. urine denotes fluid
defiit.

Monitor and Febrile states

document decrease bodily
temperature. fluids by
perspiration and
increased
respiration.

Monitor fluid Most fluid comes

status in relation into the body
to dietary intake. through drinking,
water in food, and
water formed by
oxidation of foods.

Urge the patient Oral fluid

to drink prescribed replacement is
amount of fluid. indicated for mild
fluid deficit and is
a cost-effective
method for
replacement
treatment.

Aid the patient if Dehydrated

he or she is unable patients may be
to eat without weak and unable
assistance, and to meet
encourage the prescribed intake
family or SO to independently.
assist with
feedings, as
necessary.

Emphasize Fluid deficit can

importance of oral cause a dry, sticky
hygiene. mouth. Attention
to mouth care
promotes interest
in drinking and
reduces
discomfort of dry
mucous
membranes.