ANS: - Nitroprusside (for HTN crisis) o IV Drip o Causes cyanide poisoning (if given for longer than 72 hours) o Increased intracranial pressure o Dilates arteries and increases capacity of veins - Levophed (Norepinephrine) (Shock and HTN) o Used to treat life-threatening hypotension o During cardio-pulmonary resuscitation o Monitor for changes of shin extremities can cause necrosis and sloughing of surrounding tissue - Epinephrine o IM form o AE: nervousness, restlessness, dizziness, and local necrosis of skin o Used to treat of hypovolemic shock, cardiac arrest, and anaphylaxis o Adrenergic agonist - Dobutamine o Hypovolemic shock, cardiac arrest, anaphylaxis; stimulates beta-1 receptor o Monitor EKG, BP, I and O, serum potassium o AE: hypertension, PVCs, asthmatic episodes, and headache - Dopamine o Low doses: dopamine preferentially stimulates D1 and D2 receptors in the renal vasculature, which leads to vasodilation and promotes renal blood flow to preserve glomerular filtration o Used for hypovolemic shock, cardiac arrest, and anaphylaxis Therapeutic effect at renal and systemic dose . See more urine o Adverse effects " Increased ocular pressure, Ectopic beats, Nausea, Tachycardia, Chest pain, and dysrhythmias - Milrinone o Used for hypovolemic shock, cardiac arrest, and anaphylaxis o AE: dysrhythmia, thrombocytopenia, and jaundice o Nursing considerations: positive inotropic agent o Smooth muscle relaxant used to treat severe heart failure - SNS (fight or flight): o Adrenaline (Epinephrine and Norepinephrine) o Pupils dilate, tachycardia (inc HR), vasoconstriction, bronchodilation, urinary and gastrointestinal retention, and uterus constricts o Triggers: stress, anxiety, and illness o Adrenergic Receptors (Alpha 1, Alpha 2, Beta 1, Beta 2) " Alpha 1: Blood vessels, vasoconstriction (increase BP), increase closure/tightens urinary sphincter (retain urine)
" Beta 1: (focuses on the heart), increase HR (tachycardia) and cardiac contractility " Beta 2: (2 lungs/systemic), lungs - bronchodilation, blood vessels - vasoconstriction (increase BP), liver = need energy so break down glucose - PNS (rest/digest): Vagal response O Acetylcholine o Cholinergic Receptors (Muscarinic and Nicotinic) o These are your -ic receptors and ick responses o Pupils relax, HR goes down, vasodilation, RR goes down, GI and urinary work, uterus relaxes o Cholinergic Side Effects ("icky secretions") · Salivation Lacrimation · Urination · Diaphoresis (sweating) · Gl upset (diarrhea) · Emesis (vomiting) o Cholinergic Crisis Diarrhea/diaphoresis Urination " Miosis (pinpoint pupils) · Bradycardia · Emesis (nausea and vomiting) Lacrimation Lethargy · Salivation o Anticholinergic Toxicity Mad as a hatter - confused " Hot as a hare - hyperthermia · Red as a beet - flushed skin " Dry as a bone - dry mouth and urinary retention Blind as a bat - dilated pupils Tachycardia and absent bowel sounds o Cholinergic Drugs · Myasthenia Gravis (chronic muscular disease; autoimmune disease) · Neostigmine · Pyridostigmine · Edrophonium · Symptoms (can't see, can't pee, can't spit, can't shit) · Alzheimer Disease · 3 reversible indirect-acting cholinergic agonists - slow the progression of this disease (not a cure): o Donepezil
o Galantamine o Rivastigmine o Anticholinergic Drugs Atropine · Used for emergent slow HR · Antidote to cholinergic