ADRENERGICS

These are the drugs that

stimulate the
SYMPATHETIC
NERVOUS SYSTEM.
FOUR MAIN RECEPTORS
ALPHA-ADRENERGICS
– Located in the vascular tissues of
muscles.

– When the alpha 1-receptor is stimulated,

the arterioles and venules constrict,
increasing peripheral resistance and
blood return to the heart. Circulation is
improved and blood pressure is
increased. When there is too much
stimulation, blood flow is decreased to the
vital organs.
ALPHA 2 RECEPTOR

• Located in the postganglionic

sympathetic nerve endings.

• When stimulated it inhibits the

release of norepinephrine, leading
to a decrease in vasoconstriction.
This results in a decrease in blood
pressure.
BETA 1-RECEPTOR

• Located primarily in the

heart.
• Stimulation of the beta 1-
receptor increases
myocardial contractility and
heart rate.
BETA 2-RECEPTOR

• This receptor are mostly

in smooth muscles of the
lung, the arterioles of
skeletal muscles and the
uterine muscle.
Stimulation of the beta 2-
receptor causes :
• 1. relaxation of the smooth muscle
of the lungs, resulting in
brochodilation
• 2. an increase in blood flow to the
skeletal muscles and
• 3. relaxation of the uterine muscle
resulting in a decrease in uterine
contraction.
• Another adrenergic receptor is
dopaminergic and is located in
the renal, mesenteric, coronary,
and cerebral arteries.

• When this receptor is stimulated,

the vessels dilate and blood flow
increases. Only dopamine can
activate the receptor.
EFFECTS OF ADRENERGICS AT
RECEPTORS
RECEPTOR PHYSIOLOGIC
RESPONSES

ALPHA1 Increases force of heart

contraction; vasoconstriction
increases blood pressure;
mydriasis (dilation of pupils)
occurs; salivary glands
decreases secretion; increases
urinary bladder relaxation and
urinary sphincter contraction
RECEPTOR PHYSIOLOGIC
RESPONSES
ALPHA2 Inhibits release of
norepinephrine; dilates
blood vessels; produces
hypotension; decreases
gastrointestinal motility
and tone.

BETA1 Increases heart rate and

force of contraction,
increases renin secretion,
which increases blood
pressure.
RECEPTOR PHYSIOLOGIC
RESPONSES
BETA2 Dilates bronchioles;
promotes gastrointestinal
and uterine relaxation;
promotes increase in
blood sugar through
glycogenolysis in liver;
increases blood flow in
skeletal muscles.
 Inactivation of
Neurotransmitters
• After the transmitter has perform
its function, the action must be
stopped  to prevent prolonging the
effect. Transmitter are activated
by:
• 1.reuptake of the transmitter back
into the neuron
• 2.enzymatic transformation or
degredation
• 3.diffusion away from the
receptors.
•   The mechanism of
norepinephrine reuptake plays a
more important role in inactivation
than the enzymatic action .
Following the reuptake of the
transmitter in the neuron, the
transmitter may be degraded or
reused.  The two enzyme that
inactivate the metabolism of
norepinephrine are
• 1.       monoamine oxidase (MOA)
which is inside the neuron
• 2.       cathecol-O-
methyltransferase  (COMT) which
is outside the neuron
• Drugs can stop the termination of
the neurotransmitter by either:
• 1.       inhibiting the norepinephrine
reuptake, which prolong the
actions of the neurotransmitter.
• 2.        Inhibiting the degredation
of norepinephrine by enzyme
action.
 CLASSIFICATION OF
SYMPATHOMIMETICS/
ADRENOMIMETICS:
 
The sympathomimetic drugs that stimulate
adrenergic receptors are classified into three
categories according to their effects on organ
cells.
 

1. DIRECT-ACTING
SYMPATHOMIMETICS
- stimulate the adrenergic
receptor.
Ex. Epinephrine or
norepinephrine
2. INDIRECT-ACTING
SYMPATHOMIMETICS
- which stimulate the release
of norepinephrine from the
terminal nerve endings.
Ex. Amphetamine
3. MIXED-ACTING
SYMPATHOMIMETICS
- both direct and indirect acting
which stimulate the adrenergic
receptor sites and stimulate the
release of norepinephrine from the
terminal nerve endings.
EPHEDRINE:
• is an example of mixed acting
sympathomimetic.
• it acts directly by stimulating the release of
norepinephrine from the nerve terminals

and acts directly on the alpha1, beta1

and beta2 receptors. Ephedrine-like
epinephrine increases the heart rate and
blood pressure but is not as potent a
vasoconstrictor as epinephrine.
• It is helpful to treat idiopathic orthostatic
hypotension that results from spinal anesthesia.
• It also stimulates beta2 receptors which dilate
bronchial tubes and treat mild forms of asthma.
CATECHOLAMINES:
• are the chemical structures of substances either
endogenous or synthetic that can produce a
response. Ex. Epinephrine, norepinephrine and
dopamine.
• synthetic catecholamines are isoproterenol and
dobutamine.

NONCATECHOLAMINES:
• stimulate the adrenergic receptor.
• They have a longer duration of action than the
endogenous or synthetic catecholamines.
 Many adrenergic drugs stimulate more
than one of adrenergic receptor sites.
An example of epinephrine is
adrenalin.
ADRENALIN:
• acts on alpha1, beta1 and beta2
adrenergic receptor sites.
• The responses from these receptor
sites include an increase in blood
pressure, pupil dilatation, increase in
heart rate and bronchodilation.
• It is use to treat allergic reaction,
anaphylaxis, bronchospasm and
cardiac arrest.
• Side effects are anorexia, nausea,
vomiting, nervousness, tremors,
agitation, headache, pallor,
insomnia and dizziness.
• Adverse reactions are palpitations,
tachycardia and dyspnea.
• In certain types of shock epinephrine
is useful because
– it increases blood pressure,
– heart rate and
– airflow through the lungs through
bronchodilation.
• affects three adrenergic receptors ,it is
NON SELECTIVE. Side effects result
when more responses occur than are
desired.
Epinephrine

• Drug class:
Sympathomimetic
• Trade name:
Adrenalin
Pharmacokinetics
• Epinephrine can be administered
subcutaneously, intravenously,
topically, or by inhalation, intracardiac,
and instillation method. It should not
be given orally, because it is rapidly
metabolized in the GI tract and liver in
which results inadequate serum levels.
Pharmacodynamics
• Epinephrine is frequently used in
emergencies to treat anaphylaxis,
which is a life threatening allergic
response.
• Epinephrine is a potent
inotropic(strengthens myocardial
contraction) drug that increases
cardiac output, promotes
vasoconstriction and systolic blood
pressure elevation, increases heart
rate, and produces bronchodilation.
• High doses can result in
cardiac dysrhythmias ,
therefore the
electrocardiogram (ECG)
should be monitored.
• It can also cause renal
vasoconstriction, thereby
decreasing renal perfusion and
urinary output.
Contraindicated:

• Cardiac dysrhythmias, cerebral

arteriosclerosis, pregnancy, narrow
angle glaucoma, cardiogenic shock.
• Caution: hypertension, prostathic
hypertrophy, hyperthyroidism,
pregnancy, diabetes
mellitus(hyperglycemia could result)
Therapeutic effect:
• To treat allergic reaction, anaphylaxis,
bronchospasm, cardiac arrest.
Side effects: Adverse effects:

Anorexia
Nausea and vomiting Palpitation
Tremors Tachycardia
Headache Dyspnea
Dizziness
Pallor
Agitation Life threatening:
Nervousness ventricular
Insomnia fibrillation,
Syncope pulmonary edema
ALBUTEROL SULFATE (PROVENTIL)

• -is selective for beta2-adrenergic receptors, so

the response is purely bronchodilation.

• -if taken in high doses,it may affect the beta1

receptors,causing an increase in heart rate.

Therapeutic effect:
• To treat bronchospasms, asthma, bronchitis
and other COPD
Route:
PO, Inhal
 
Mode of action:
Stimulates the beta2-adrenergic receptors in
the lungs, which relaxes the bronchial smooth
muscles
 
Side Effect:
Tremor, dizziness, nervousness, restlessness
 
Adverse reactions:
Palpitations, reflex tachycardia, hallucinations
CLONIDINE (CATAPRES) AND
METHYLDOPA (ALDOMET)
-are selective alpha2-adrenergic drugs used
primarily to treat hypertension.
Action:
• 1.Regulate the release of norepinephrine by
inhibiting its release
• 2. produce cardiovascular depression by stimulating
alpha2 receptors in the CNS, leading to a decrease
in BP.

Side effects:
• Hypertension, tachycardia, palpitations,
dysrhythmias, tremors, dizziness, urinary difficulty,
nausea and vomiting.
Adrenergic Drugs:
  • Epinephrine (Adrenalin Chloride) – treat allergic
reactions, anaphylaxis, bronchospasms,
cardiac arrest.
• Ephedrine HCl, Ephedrine Sulfate (Ephedsol,
Ectasule) –treat hypotensive states,
bronchospasm, nasal congestion, orthostatic
hypotension.
• Norepinephrine bitartrate (Levartrenol,
Levophed) –for shock
• Dopamine HCl (Intropin) – to correct
hypotension
• Midodrine (ProAmatine) - to treat symptomatic
orthostatic hypotension
• Phenylephrine HCl 12-hour
spray/oxymetazoline HCl (Neo-
Synephrine) – to treat nasal
congestion; acts as a decongestant.

• Pseudoephedrine HCl (Sudafed,

Actifed, Co-Tylenol, PediaCare) – to
treat nasal congestion;OTC drug
• Phenylpropanolamine HCl
(Dimetapp,Dristan,Contac 12 hour,
Triaminicol, Triaminic) – To reat nasal
congestion;acts as OTC drugs.
• Dexatrim, Dietac, Control alpha and
beta1 – OTC drug used to control weight
gain.
• Albuterol (Proventil, Ventolin) – to relieve
bronchospasm caused by acute and
COPD.
• Metaproterenol Sulfate (Alupent,
Metaprel) – treatment of bronchospasm,
acute heart block.
• Dobutamine HCl (Dobutrex) – to
treat cardiac decompression
• Isoetharine HCl (Bronkosol) – to
control asthma and COPD
• Terbutaline Sulfate (Brethine,
Breathaire, Bricanyl) – primary
use is to correct bronchospasm.
• Ritodrine HCl (Yutopar) – used to
decrease and/or stop uterine
contraction.
NURSING INTERVENTIONS
• 3RMET
• RECORD CLIENT’S VITAL
SIGNS
• REPORT SIGNS OF
HYPERTENSION AND
TACHYCARDIA
• REPORT SIDE EFFECTS OF
ADRENERGIC DRUGS
• MONITOR IV SITE FREQUENTLY
WHEN ADMINISTERING
NOREPINEPHRINE BITARTRATE or
INTROPIN
• EVALUATE BLOOD GLUCOSE
LEVELS
• TO AVOID NAUSEA AND VOMITING
OFFER FOOD TO CLIENT WHEN
GIVING ADRENERGIC DRUGS
CLIENT TEACHING
• AEIOU
• A- Advise mothers not to take drugs
that contain sympathetic drugs while
nursing infants. These drugs may pass
into breast milk.
• E- Explain to client that continuous use
of nasal sprays or drops that contain
adrenergics may result in nasal
congestion rebound.
• I- Instruct client to read labels on all
OTC drugs for cold symptoms and diet
pills because these drugs should not
be taken with hypertensive,DM and
have cardiac problems client.
• O- Offer food to client when taking up
adrenergic drugs
• U- Unexplain side effects lke
tachycardia should report immediately
to health care provider.
 Practice Question #1
When teaching a patient who has
been prescribed metoprolol about
side/adverse effects, which is the
highest priority teaching point?

A.Report any complaints of stuffy nose.

B.Instruct the patient how to take a
pulse.
C.Check for bladder distention.
D.Warn of possible impotence and
decreased libido.
Copyright © 2018, Elsevier 47
 Practice Question #2
Stimulation of which adrenergic
receptor results in dilation of
vessels and decrease in blood
pressure?

A.Alpha1
B.Alpha2
C.Beta1
D.Beta2
Copyright © 2018, Elsevier 48
 Practice Question #3
The nurse is teaching the
patient about the side effects of
atenolol. These include

A.pupillary constriction.
B.blood vessel dilation.
C.bronchospasm.
D.tachycardia.
Copyright © 2018, Elsevier
Inc. All rights reserved. 49
 Practice Question #4
A nurse is administering
epinephrine to a patient during a
cardiac arrest. The primary desired
action of this medication is to

A.stimulate a heart rate.

B.decrease cerebral blood flow.
C.initiate respirations.
D.increase blood flow to the kidneys.
Copyright © 2018, Elsevier 50
 Practice Question #5
A patient has been prescribed
atenolol. To ensure safe dosing,
the nurse teaches the patient to
frequently assess what parameter?

A.Daily weight
B.Heart rate
C.Urine output
D.Body temperature

Copyright © 2018, Elsevier 51

 Practice Question #6
A patient is receiving dopamine
intravenously. Which drug should
the nurse have available to treat
extravasation and tissue necrosis?

A.Norepinephrine bitartrate
B.Nadolol
C.Phentolamine mesylate
D.Clonidine
Copyright © 2018, Elsevier
Inc. All rights reserved. 52