Exam #2

• Therapeutic: Antihypotensive, nasal decongestant
• Pharmacological: Alpha-adrenergic agonist

prevent or reverse acute hypotension, slow HR, dilate pupils without causing significant cycloplegia, reduces nasal congestion

• stinging of the nasal mucosa, sneezing, rebound congestion, anxiety, restlessness, tremor
• serious: reflex bradycardia, reduced blood flow to peripheral tissue

severe HTN, preexisting bradycardia, angina, narrow-angle glaucoma, hyperthyroidism, diabetes

• Route(s): UM, subcut, IV, intranasal, ophthalmic
• Absorption: Not absorbed in the GI tract; well absorbed when given IM or subcut
• Distribution: Unknown
• Metabolism: Hepatic by MAO
• Excretion: Unknown

• directly activates alpha1-adrenergic receptor in the peripheral nervous system
• it has weak beta-adrenergic activity at high doses

• antihypertenives, MAOIs, ergot alkaloids and tricyclic antidepressants, adrenergic agnoists, including amphetamines or cocaine, halothane, digoxin
• Herbal.Food: St. John's Wort, caffeine

antidysrhythmic agents

• Determine the reason the pt is taking med
• assess the pt for preexisting conditions
• establish baseline VS, and monitor frequently
• examine IV sites
• advise the pt to remove contacts before ophthalmic admin
• advise pt to wear dark eye protection after ophthalmic admin

• carefully read and follow the instructions
• do not give to children or infants
• do not use OTC products containing this drug
• do not share nasal spray
• do not use decongestant nasal sprays for longer than three days
• report symptoms of excessive use to this drug such as rapid, irregular, or pounding heartbeat, nervousness, or insomnia
• limit or eliminate the use of caffeine

Category C

• Therapeutic: Bronchodilator
• Pharmacologic: Nonselective beta-adrenergic agonist

increase the strngth of myocardial contraction, improve cardiac output, cardiogenic or bacteremic shock, cardiac arrest, Adams-Stokes syndrome, and certain types of ventricular dysrhythmias

potent activator of both beta1 and beta2 adrenergic receptors throughout the body

• Route(s): IV
• Absorption: N/A
• Distribution: to most of the tissues; it is unknown if it crosses the placenta or is secreted in breast milk
• Metabolism: Hepatic by COMT and MAO
• Excretion: Renal: (40-50% unchanged)

• headache, nausea, vomiting, tremors, anxiety, insomnia
• serious: serious dysrhythmias

severe cardiac disease, dysrhythmias, HTN, hyperthyroidism, diabetes

beta-adrenergic blockers, bronchodilators or adrenergic agonist such as epi or dopamine, MAOIs, tricyclic antidepressants, potassium wasting diuretics, digoxin, dysrhythmias

Category C

due to the relatively short t1/2 of the drug, discontinuing the infusion is often enough to reverse symptoms, although supportive cardiac drugs may be necessary

• determine reason why pt is taking med
• assess the pt for preexisiting conditions
• assess for therapeutic effectiveness
• establish baseline VS
• check the pulse before and during IV infusion
• monitor for drug tolerance

• notify PCP of asthma, diabetes, mellitus, overactive thyroid, and pheochromocytoma
• Report adverse effects (palpitations, marked decrease in BP, decrease in urine output, ischemia)
• do not breast feed
• immediately report pregnancy

• Therapeutic: Antihypertensive
• Pharmacologic: Selective alpha1-adrenergic antagonist

• reduces BP
• off label: symptomatic BPH, prevention of Raynaud's disease, hypertensive emergencies associated with pheochromocytoma

• competes with NE at alpha-adrenergic on vascular smooth muscles in arterioles and veins.
• it is selective for alpha1-adrenergic receptors and has no activity at alpha2

• Route(s): PO
• Absorption: Well absorbed
• Distribution: Completely; small amounts secreted in breast milk
• Metabolism: Hepatic
• Excretion: Primarily bile and feces, with small amounts by the kidneys

prior sensitivity to the drug

• antihypertensives, diuretics, alcohol, erectile dysfunction agents
• Herbal/Food: Hawthorn

Category C

• vasopressors such as levarterenol or dopamine may be necessary to increase BP
• fluid expanders may be administered to raise BP, and renal function should be monitored

• establish baseline VS
• assess for HTN, Raynaud's disease, or BPH
• Admin the first dose at bedtime
• monitor for drug-related adverse effects
• give meds with food
• monitor BP
• assess for full therapeutic effect

• avoid situations that could result in injury if fainting should occur
• sit or lie down if you feel dizzy, lightheaded, have blurred vision, or feel faint
• make position changes slowly
• do not take the drug at the same time each day
• consult the prescriber before taking OTC meds for cold, cough, allergy remedies
• expect adverse effects to diminished with continued therapy

• Therapeutic: Antipertensive, antidysrhythmic
• Pharmacologic: Nonselective beta-adrenergic blocker

hypertension, angina pectoris, dysrhthmias, migraine prophylaxis, prophylaxis for MI

nonselective beta-adrenergic antagonist, affecting both beta1- and beta2-receptors

• Route(s): Usually PO; IV for severe dysrhythmias
• Absorption: Completely
• Distributed: Widely distributed; including the CNS and placenta; secreted in breast milk; 90% bound to plasma protein
• Metabolism: Hepatic
• Excretion: 90-95% renal

• Nausea, vomiting, and diarrhea, fatigue, insomnia, drowsiness, bradycardia, confusion, impotence, loss of libido
• serious: agranulicytosis, bronchospams, Stevens-Johnson syndrome, anaphylaxis
• if discontinued suddenly: palpitations, rebound HTN, life-threatening dysrhythmias, MI

cardiogenic shock, sinus bradycardia, greater than first-degree heart block, severe heart failure, COPD, asthma, diabetes, reduced renal output

• beta blockers, calcium channel blockers such as verapamil (Calan, and dilitiazem (Cardizem), Phenothiaines, MAOIs, ethanol, antacids containing aluminum hydroxide, beta-adrenergic agonists such as albuterol (Proventil)
• Herbal/Food: large doses of vitamin C, hawthorn

Category C

• Monitor VS
• Obtain thorough medical hx
• evaluate response to therapy
• monitor for drug-related adverse effects
• assess lab tests
• monitor I&Os
• consult prescriber regarding salt restrictions
• examine the pt for impaired circulation

• take radial pulse before each dose
• if you have diabetes, remember that the drug suppresses signs of hypoglycemia
• take med exactly as prescribed
• do not abruptly stop taking med
• make position changes slowly
• avoid prolonged exposure to cold
• do not drive
• to not take any medication, herbals, supplements without consulting your doctor
• inform your dentist, ophthalmologist, surgeon, and other health care providers you are taking a beta blocker
• do not breast feed
• notify doctor if pregnant

• Therapeutic: Antihypertensive
• Pharmacologic: Selective beta1-adrenergic antagonist

• HTN, decreases in HR, cardiac output and BP
• off label: stable, symptomatic HF, essential tremor, migraine prophlylaxis, and the control of HR in pts with atrial dysrhythmias

• selective beta1-adrenergic antagonist that competes with endogenous catecholamines at adrenergic receptors in cardiac muscle.
• at high doses, it may affect beta2 receptors in bronchial smooth muscle

• Route(s): Usually PO; IV for MI
• Absorption: well absorbed
• Distribution: Completely; including CNS and placenta; secreted in breast milk; 12% bound to plasma proteins
• Metabolism: Hepatic
• Excretion: renal

• nausea, vomiting, dizziness, fatigue, insomnia, bradycardia, heartburn, and dyspnea
• serious: agranularcytosis, laryngospasm, compete heart block, thyroid storm in pts with thyrotoxicosis, dysrhythmias, severe HTN, MI, bronchospams, dyspnea

preexisting cardiac disease, cardiogenic shock, severe bradycardia, heart block greater than first degree, severe hepatic disease, asthma, hx of bronchospasms

calcium channel blockers, antihypertensive drugs including cimetidine and oral contraceptives, sympathomimetics, lidocaine

Category C

plasma volume expanders or vasopressors, atropine, isoproterenol

plasma volume expanders, atropine, isoproterenol

• assess VS
• monitor BP
• monitor labs
• max effects seen in 1 week
• monitor pts with CHF for impending HF
• discontinue if pt develops mental depression
• this drug masks hyperthyroidism in pts with thyrotoxicosis
• record I&Os

• take radial pulse before dose
• immediately report changes in vision
• avoid late evening doses
• if you have diabetes, remember that the drug suppresses signs of hypoglycemia
• do not drive
• take med as prescribed
• report cold, painful, or tender feet or hands or other symptoms of Raynaud's disease
• discontinue med slowly over 1-2 weeks
• relieve dry mouth with rinses, hard candies, gum
• relieve dry eyes with OTC drops
• do not breast feed
• report pregnancy