Chapter 30

Adrenergic Agents

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 Adrenergic Agonists
• Definition
– Called sympathomimetic drugs because they
mimic the effects of the sympathetic nervous
system (SNS)
• Therapeutic and adverse effects
– Related to their stimulation of adrenergic
receptor sites
• Indications
– Vary from ophthalmic preparations for dilating
pupils to systemic preparations for shock
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Physiologic Responses of
Adrenergic Agonists

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Alpha- and Beta-Adrenergic Agonists and
Their Indications
• Epinephrine (Adrenalin, SusPhrine): treats shock, glaucoma;
prolongs effects of regional anesthetic
• Norepinephrine (Levophed): treats shock or is used during
cardiac arrest to stimulate sympathetic activity
• Dopamine (Intropin): treats shock
• Dobutamine (Dobutrex): treats congestive heart failure
• Ephedrine (Pretz-D): treats seasonal rhinitis, hypotensive
episodes
• Metaraminol (Aramine): synthetic agent similar to
norepinephrine; treats shock or induces sympathetic activity
during cardiac arrest
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 Alpha- and Beta-Adrenergic Agonists
• Actions

– The effects of the drug are mediated by the

adrenergic receptors in target organs; heart
rate increases, bronchi dilate, vasoconstriction
occurs, intraocular pressure decreases, and
glycogenolysis occurs throughout the body

• Indications

– Treatment of hypotensive shock,

bronchospasm, and some types of asthma
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 Alpha- and Beta-Adrenergic Agonists
(cont.)
• Pharmacokinetics
– Rapidly absorbed after injection or passage through
mucous membranes
– Metabolized in the liver and excreted in the urine
• Contraindications
– Pheochromocytoma
– Tachyarrhythmias and ventricular fibrillation
– Hypovolemia
– Halogenated hydrocarbon general anesthetics
– Caution should be used with peripheral vascular
disease
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Alpha- and Beta-Adrenergic Agonists
(cont.)
• Caution
– PVD
• Adverse reactions
– Arrhythmias, hypertension, palpitations, angina,
and dyspnea
– Nausea and vomiting
– Headache and sweating
• Drug-to-drug interactions
– Tricyclic antidepressants and MAOIs
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 Alpha-Specific Adrenergic Agonists
(Alpha-Agonists)
• Definition
– Drugs that bind primarily to alpha-receptors
rather than to beta-receptors
• Drugs in the alpha-agonist class
– Phenylephrine (Neo-Synephrine, Allerest,
AK-Dilate, and others)
– Midodrine (ProAmantine)
– Clonidine (Catapres)
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 Alpha-Agonists
• Action
– Therapeutic effects come from the stimulation of
alpha-receptors within the SNS
• Indications
– Hypertension, constriction of topical vessels in nose
• Pharmacokinetics
– Well absorbed; reach peak levels in 20 to 45 minutes
– Widely distributed in the body
– Metabolized in the liver and excreted in the urine

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 Alpha-Agonists (cont.)
• Contraindications
– Allergy to drug
– Severe hypertension or tachycardia
– Narrow angle glaucoma
– Pregnancy
• Cautions
– CVD and vasomotor spasm
– Thyrotoxicosis and diabetes
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 Alpha-Agonists (cont.)
• Adverse reactions
– Anxiety, restlessness, depression, fatigue, and
blurred vision
– ECG changes, arrhythmias, and blood pressure
changes
– Nausea and vomiting
– Decreased urinary output
• Drug-to-drug interactions
– MAOIs and TCAs
– Digoxin and beta-blockers
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Beta-Specific Adrenergic Agonists and
Their Indications
• Isoproterenol (Isuprel)

– Treatment of shock, cardiac standstill, and

heart block in transplanted hearts; prevention
of bronchospasm during anesthesia; inhaled
to treat bronchospasm

• Ritodrine (Yutopar)

– Management of preterm labor

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 Beta-Specific Adrenergic Agonists
• Actions
– Effect is related to stimulation of the beta-adrenergic
receptors
– Increased heart rate, conductivity, and contractility;
bronchodilation; increased blood flow to skeletal
muscles and splanchnic bed; relaxation of uterus
• Pharmacokinetics
– Rapidly distributed after injection
– Metabolized in the liver and excreted in the urine
– T½ less than 1 hour
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Beta-Specific Adrenergic Agonists (cont.)
• Contraindications
– Allergy
– Pulmonary hypertension
– Eclampsia, uterine hemorrhage, and intrauterine
death
– Pregnancy and lactation
• Caution
– Diabetes and thyroid disease
– Vasomotor problems
– Heart disease and stroke
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Beta-Specific Adrenergic Agonists (cont.)
• Adverse reactions
– Restlessness, anxiety, and fear
– Tachycardia, angina, MI, and palpitations
– Difficulty breathing, cough, and bronchospasm
– Nausea, vomiting, and anorexia
• Drug-to-drug interactions
– Increase with other sympathomimetic drugs
– Decrease with beta-adrenergic blockers

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Use of Adrenergic Agents
Across the Lifespan

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Prototype Alpha- and Beta-Adrenergic
Agonists

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Prototype Alpha-Agonists

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Prototype Beta-Specific Adrenergic
Agonists

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Nursing Considerations for Alpha- and
Beta-Adrenergic Agonists

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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 Nursing Considerations for
Alpha-Agonists

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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Nursing Considerations for Beta-Specific
Adrenergic Agonists

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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