The degree and rate are based on:

age

health status

underlying disease

hydration status

GI disorders

route of administration

gastric acidity

emptying

motility

decreased enzyme levels

intestinal flora

gastric pH is alkaline at birth

reaches adult acidity between 1-3 years

May lead to an exaggerated absorption of drugs that would normally be inactivated by the acid.

• Varing transit times through the GI system may hinder/enhance absorption of drugs; which depends on the usual site of absorption.
• Feeding methods may impact infant absorption, ie: breastfeeding leads to longer GI transit times.
• Irregular peristalsis decreases absorption time available.
• Increased GI surface area in kids vs. adults so there is a more absorptive area.

• neonates/infants- 70% of body is H2O; means a greater volume of fluid for distribution.
• ~2 years: requires higher doses of water soluable meds to achieve therapeutic levels.
• Higher levels of ECFs can lead to dehydration and can change the distribution of water soluble meds.
• Rapid dehydration can elevate serum drug levels.
  

IM/subQ- absorption occurs at tissue level; peripheral perfusion and effectiveness of circulation impacts absorption. dehydration, cold, cardiac status.

Topical: skin is thin and more porous. May get systemic effects.

As children grow and develop the absorption of meds generally becomes more effective.

infants/neonates: have less albumin and fewer protein receptor sites available for binding with meds; creates more free drug and potential for toxicity; need then for reduced dose to produce the same therapeutic effect.

Bilirubin can bind with plasma protein; therefore high bilirubin levels in neonates may result in increased free drug.

Primarily in Kidneys

Less than 9 months of age: decreased renal blood flow

• decreased glomerular filtration rate
• reduced renal tubular function
• slower excretion may lead to accumulation and toxicity
• water is needed for effective excretion

Pediatric medication dosing/monitoring

Client identification

Developmental and cognitive differences

• developmental vs. chronic age

Maintain safety with minimal restraint

Pediatric medication administration

• adaptations for administration to infants/children
• routes of administration

Age-appropriate approaches

• developmental care
• atraumatic care

Assessment

• Age, weight, height, developmental age
• Health status and history of drug use
• Nutritional/hydration status
• Cognitive level
• Family/child understanding

Use appropriate references

Monitor child closely

Communicate w/health care provider

Correctly calculate dosage based on appropriate parameters

Client teaching

• Use of OTC products; report side effects immediately
• Advise breastfeeding mothers that a portion of most drugs is excreted in breast milk
• Keep meds out of reach of children
• Use child-resistant containers for meds

Determine family member's knowledge concerning drug, drug dose, schedule for administration, and side effects

Determine child's physiologic and psychologic response; determine therapeutic and adverse effects of drug(s).

Increase pH gastric secretions

Decrease peristalsis w/delayed emptying time

Decrease motility

Decrease first-pass effect

Decrease cardiac output

Decrease blood flow

Decrease enzyme function

Decrease blood flow by 40-50% (decrease cardiac output)

Decrease in liver size

Decrease ability to heal from injury

Decrease drug clearance (affects males > females)

Decrease blood flow

Decrease functioning of nephrons

Decrease glomerular filtration rate (GFR)

What is polypharmacy and why is it important with the older adults?

The administration of many drugs at once.

Older adults take meds for chronic and multiple illnesses.

• may have multiple health-care providers
• take pain, sleep, and laxative OTC drugs more frequently that the general population

Doses need to be adjusted according to the older adult's weight, adipose tissue, lab results

Must closely monitor effects of drugs because of declining organ functioning

• adverse reactions and drug interactions 3-7x's > those for middle age and younger adults
• drug doses are within safe range yet w/multiple drugs, herbal and OTCs, self medicating issues, altered physiologic processes

• Increased gastric pH (alkaline) alters absorption of weak acid drugs ie:aspirin
• Decrease in blood flow to GI tract caused by decrease in cardiac output slows absorption
• Reduced GI motility rate (peristalsis) slows gastric emptying time; drugs remain in GI tract longer
• Iron and calcium tabs may not be absorbed as readily

• Water soluble drugs are more concentrated because of a decrease in the total body water

• Fat soluble drugs are stored & likely to accumulate because of an increase in the fat to water ration

• Decrease in circulating serum protein create fewer protein binding sites w/drugs competing for these sites

• Drug interactions likely to result because of lack of protein sites & increase in free drugs available to body tissue @ receptor sites

• Reduced lean body mass

Decrease in hepatic enzyme production, hepatic blood flow & total liver function causing a reduction in drug metabolism

• leads to an increased 1/2life of drug(s)
• can result in drug accumulation & even toxicity

Decrease in renal blood flow & decrease in GFR of 40-50%

• decrease in renal function leads to decrease in drug excretion
• drug accumulation results; can lead to toxicity

Slower absorption of oral drugs
Impaired circulation can delay transportation of drugs to the tissues
Drugs metabolized more slowly & less completely
Alterations in receptor properties may underlie altered sensitivity to some drugs

• reduction in # of beta receptors
• reduction in affinity of beta receptors

Drugs excreted less completely
1/2life of drug is prolonged (but not as much in really small 1/2life)
Toxicity is more probable

• Taking too many medications @ different times
• Failure to understand purpose or reason for drug
• Impaired memory
• Decreased mobility & dexterity
• Visual & hearing disturbances
• Side effects or adverse reactions from drug

• Lack of affinity to receptor sites throughout the body

• Age related changes in CNS in the # of drug receptors & in the affinity of receptors to drugs may make clients more or less sensitive to drug action

• Compensatory response to physiologic changes is decreased in the geriatric person

Based on what the drug does clinically.

ie: anticoagulants, antidepressants, diurectics

Based on how the drug produces its effects at the molecular, tissue, or body-system level

Requires deeper understanding of biochemistry & physiology

ie:calcium-channel blockers, angiotension-converting enzyme inhibors, proton-pump inhibitors

2nd most common group of drugs prescribed or taken OTC

Need low doses w/short or intermediate 1/2 life drugs

Watch for ataxia, motor impairment, sensory alterations

BP tends to increase w/age; especially in women

Monitor for electrolyte imbalances, hyperglycemia, hyperuricemia, postural hypotension, dizziness

ie: warfarin (Coumadin)

99% protein bound

Frequent labs ie: prothrombin (PT), internation normalized ration (INR)

Monitor for bleeding

May have decreased host defenses

May need reduced dose if renal drug clearance is decreased &/or has a prolonged 1/2 life

May use H2 (histamine) blockers ie: ranitidine, famotidine

Laxatives: monitor fluids & electrolytes; may decrease other drugs absorption because of increased GI motility

Normal dose should be 30-50% of middle-age adult; may gradually increase according to tolerance & desired therapeutic effect

Requires very close monitoring

• Have client's senses as sharp as possible (clean glasses, etc.)
• Speak in tones client can hear; face client when speaking
• Treat client w/respect; expect that pt can learn
• Use large print, bright colors
• Review all meds @ each visit
• Encourage simple dosing schedule
• With onset of confusion or disorientation, suspect recently prescribed medications
• Encourage client to report if the new drug is not improving the condition for which it was prescribed

Client teaching

• General
• Self administration
• Diet
• Side effects
• Cultural consideration

Evaluation

Necessary for normal metabolic functions

Promote tissue growth and healing

Maintain health

Cannot be produced by human cells (except Vit D)

Deficiency will result in disease

Needed in those experiencing periods of rapid growth:

• children, adolescents, some geriatrics

May be needed for certain conditions:

• poor nutritional intake
• pregnancy
• chronic-disease states

By their solubility

Fat soluble: A, D, E, and K

Water soluble: B complex and C

The recommended dietary allowance (RDA): the daily dose required

Minimum amount of a vitamin needed to prevent symptoms of a deficiency

Need for vitamins & minerals varies amoung individuals

Supplements should never be a substitute for a healthy diet

• precursor of retinol; needed for normal vision
• maintenance & treatment of skin disorders (acne)
• hair health
• protects integrity of mucosal & epithelial tissues
• aids in formation of visual pigment needed for night vision
• essential for bone growth & development
• protection of immune cells to fight bacteria/viruses/parasites
• Stored in the liver (up to 2 years), kidneys, fat; released slowly as needed

Less is able to be stored with liver disease

Absorption is decreased with mineral oil, alcohol, and antilipemic drugs

Adverse reactions/Toxicity: teratogenic effect, leukopenia, aplastic anemai, hypervitaminosis A

RDA: 5000iu

Foods: carotenes, fruits, yellow and green veggies, fish, dairy

A group of chemicals sharing similar activity. The natural form, calciferol, is made in the skin by sunlight; influenced by UV sunlight

Regulates calcium and phosphorus metabolism; needed for calcium absorption from intestines.

Converted to califediol in liver, then converted to the active form calcitriol in kidney.

if serum levels are too low, more is activated

Adverse reaction: hypervitaminosis D

Absorption: When PO absorbed in small intestine & required bile salts

Excretion: primarily in bile

Foods: dairy, fish, yeast, 'fortified w/vit D'

Antioxidant propertied which prevent cellular components from being oxidized, and RBC's from hemolysis

May aid in prevention of macular degeneration by blocking free radicals

Absorption depends on bile salts, pancreatic secretion and fats

Stored in all tissues; especially liver, muscle and fatty tissue

RDA: 400-800 iu

Drug/lab interactions: may prolong PT (prothrombin time: clotting time)

Drug-Drug interactions: iron can interfere w/Vit E absorption

75% is excreted in bile

Foods: oils, nonhydrogenated margarine, milk, grains, meat

Four forms w/ K1 being the most active

1/2 comes from diet the rest from intestinal flora

Foods: green leafy veggies, meats, eggs, dairy

Uses: needed to produce prothrombin and the clotting factors VII, IX and X; newborns need immediately after delivery via aquaMEPHYTON

An antidote for oral anticoagulant overdose; prevents hemorrhage

Adverse issues: Spontaneous hemorrhage may occur w/deficiency

Stored primarily in liver

A, D, E, K

Must be ingested w/lipids to be absorbed int he small intestines

Metabolized slowly; excreted in urine @ a slow rate

Excess stored in liver, adipose, and some muscle

Can be removed from storage areas in body and used as needed

Excessive intake can lead to dangerously high levels

Absorbed w/water in digestive tract

Easily dissolved in blood and body fluids

Excess can not be stored

Readily excreted in urine

Must be ingested daily

Minimal protein-binding occurs

Not usually toxic unless taken in extreme amounts

A group of vitamins that act as coenzymes. Organic chemicals that must combine with an enzyme in order for enzymes to function

B₁, B₂, B₃, B₆, B₉, and B₁₂.

Thiamine: precursor of an enzyme needed for oxidation of carbohydrates (CHO) and alcohol (ETOH) metabolism

• Foods: whole-grains, dried beans, peanuts
• Deficiency: beriberi, paresthesia, neuralgia, decreasing reflexes
• Alcoholics frequently have thiamine deficiency- heavy consumption of ETOH interferes with body's ability to absorb B₁ from food

Riboflavin: important for metabolism of fats, CHo, and proteins; manage dermatologic problems, migraines

Foods: meats, wheat germ, eggs, cheese, fish, nuts, leafy veggies

Deficiency: anemia, corneal vascularization, dermatitis, cheilosis

Niacin: Treatment of nutritional deficiency in chronic alcoholism; may lower cholesterol, triglycerides and free fatty acids

Foods: synthesized from tryptophan; beans, wheat germ, meats, nuts, whole great breads

Deficiency may be seen with alcoholics: fatigue, anorexia, drying of the skin

Pyridoxine: essential building block of nucleic acids, RBC formation and synthesis of hemoglobin (hgb); can prevent or alleviate neuritis

Absorbed rapidly from jejunum; stored in liver, muscle and brain

Deficiency can result from alcoholism, uremia, hypothyroidism, heart failure; certain drugs: INH, oral contraceptives, Apresoline

Foods: whole grains, cereals, breads, lean meats, fish, soybeans

Symptoms: skin abnormalities, cheilosis, fatigue, irritability

• Folic Acid: (Folate) essential for body growth, needed for DNA synthesis and to prevent disruption in cellular division
• Absorbed from the small intestin: circulated to all tissues; most is excreted in bile
• Deficiency during pregnancy serious: can affect development of the CNS in fetus; neural tube defects, spinal bifida, anecephaly
• Malabsorption syndrome, phytoin, barbituartes, folic acid antagonists (chemotherapy) may also cause deficiency
• Symptoms: (after 2-4 mos) anorexia, nausea, diarrhea, stomatitis, fatigue, blood dyscrasias
• RDA: 400 mcg
• Foods: green leafy veggies, citrus fruits

Choline: essential for DNA synthesis, converting folic acid to its active form, a structural component of cell metabolism, ACh, promotes cellular division, normal *hematopoiesis (RBC formation), nervous system integrity (myelin synthesis)

Storage: mostly in the liver, slowly excreted

Foods: lean meats, seafood, liver, milk

Deficiency: pernicious anemia, crohn's disease, gasrectomy, malabsorption syndromes

S/S: numbness, tingling in lower extremities, weakness, fatigue, anorexia, loss of taste, diarrhea, memory loss, mood changes, dementia, psychosis

Asorbic acid

Absorbed from the small intestine

Potent antioxident; CHO metabolism and protein/lipid synthesis

Building and maintaining strong tissues (wound healing)

Aids in absorption of iron * conversion of folic acid

Promotes calcium absorption

Functions: collagen synthesis, would/tissue healing, maintenance of bones/teeth, epithelial tissue, and may create resistance to infection

megadoses:

• may decrease the effect of oralanticoagulants
• may cause a false negative occult (blood) stool result
• reduce high dose gradually; abrupt removal can cause rebound deficiency

Deficiency: fatigue, bleeding gums, gingivitis, poor wound healing

RDA: 50-100mg

Smoking decreases serum Vit C levels

Foods: citrus, green veggies

Purpose: vital for hgb regeneration & general metabolism. 60% of Fe is in hgb

Absorption: absorbed by intestines, enter plasma as heme. Food/antacids slow the absorption of Fe, but may need to take w/food to lessen GI discomfort

RDA: 300-325 mg

Foods: lean meats, egg yolks, green vegies, dried fruits, cereals

Fe deficient anemia: may result from inadequate daily intake, excessive blood loss, inadequate gastric HCl to liberate iron for absorption.

• s/s: fatigue weakness, shortness of breath, pallor, GI bleeding

Toxicity: nausea, vomiting, diarrhea

• Uses: needed for the formation of RBCs and connective tissues, cofactor of many enzymes.
• Function: in the production of NE and Dopamine
• RDA: 1.5-3mg/daily
• Foods: organ meat (liver), seafood, nuts, seeds, legumes and grains
• Toxicity: liver & nerve damage; Wilson's disease where copper accumulates in liver, brain, corneas, & kidneys

Purpose: important to many enzyme reactions; essential for normal growth & tissue repair, wound healing, taste/smell,

• important during growth periods: pregnancy, lactation, infancy, childhood, & adulthood

Deficiency: causes poor wound healing, hair loss, diarrhea, skin irritation

Precautions: do not take w/antibiotics as they inhibit tetracycline absorption. Wait 2 hours between

Foods: meat, seafood (oysters)

Toxicity: nausea, vomiting, decreased immune function

Uses: helpful in control of type 2 diabetes

helps to normalize blood glucose by increasing the effects of insulin on the cells

RDA: no recommendation, but 50-200 mcg suggested

Food: meats, whole grain cereals, brewer's yeast

Uses: acts as cofactor for antioxidant enzyme; protects protein & nucleic acids from oxidative damage

may have an anti-carcinogenic effect: reduces the risk of lung, prostate & colorectal cancer

works with vit E

RDA: 40-75 mcg

Foods: meats, liver, seafood, eggs, dairy

Flourine: beneficial effects on bones and teeth

Manganese: cofactor in some enzymes of lipid, CHO, & protein metabolism

Iodine: neeeded to synthesize thyroid hormone

Cobalt: cofactor for vit B₁₂ and several oxidative enzymes

• used for hydration, replacement & maintenance fluid therapy & to promote urine output
• create osmotic pressure by the movement of dissolved ions
• solutions (free H₂O and elctrolytes) freely cross the semi permeable membrane of the vessel walls into interstitial spaces; they do not cross cellular membranes
• contain electrolytes & other agents that closely mimic the ECF

Dextrose, saline, and lactated Ringer's solutions

• Dextrose₅ in water (D₅W): isotonic, but if used continuously the metabolism of D₅ makes a hypotonic state
• Normal saline solution (0.9% NS): isotonic solution
• D₅/0.45%NS: hypertonic solution

They are Plasma volume expanders

• Used to mobilize third-spaced fluids, correct hypotension, replenish protein depletion, and expand intravascular volume
• Contain proteins, starches, amino acids & other large insoluble molecules that are too large to easily cross capillary membranes so they remain in the plasma for a long time
• Increase osmotic pressure by drawing water molecules from cells and tissues into plasma
• Can cause intravascular fluid overload, decrease platelets and hct

Dextran solutions (Dextran 40)- synthetic

Hetastarch: nonantigenic; isotonic

Plasmanate: commercially prepared protein product

Requires close monitoring of labs and fluid balance

Whole blood: should not be used to correct anemia unless the anemia is severe: one unit increases hgb by 1gm

Packed RBC: w/out plasma therefore decreased chance of causing circulatory overload; smaller risk of reaction to plasma antigens & of transmitting serum hepatitis; one unit can increase hgb by 3gm

Plasma

Albumin

Fat emulsion solution: helps balance patient's nutritional needs

Usually indicated when IV therapy is prolonged

Classifications:

• Crystalloids
• Colloids
• Blood/blood products
• Lipids

Use:

• Replace fluids, electrolytes, calories, or nutrition for clients whose illness has caused a deficit of these substances
• To maintain homeostasis
• Transfuse blood/blood products
• Administer prescribed medications as needed

<240 mOsm/L and cause fluid to move out of the plasma in the capillaries and into the interstitial spaces

Results in cellular swelling

240-340 mOsm/L; can expand the circulating intravascular fluid volume without causing major fluid shifts between compartments.

ie: .9% NS: used w/dehydrated clients who have low BP;

treat fluid loss of vomiting/diarrhea;

during/after surgical procedures

>340 mOsm/L and a higher solute concentration than plasma; cause fluids to be pulled from the cells into vascular compartments

used w/cellular edema to increase vascular volume and dehyrdate the cells causing them to shrink

Potassium: 3.5 - 5.3 mEq/L

Sodium: 135 - 145 mEq/L

Calcium: 4.5 - 5.5 mEq/L

Magnesium: 1.5 - 2.5 mEq/L

Phosphorus: 1.7 - 2.6 mEq/L

Low serum Potassium

Causes: can occur whenever cells are damaged and K+ leaks into intravascular fluid and is excreted

• Strenuous muscular activity;
• loop diurectics- K+ shifts from blood plasma into cells to restore K+ balance;
• Vomiting/Diarrhea;
• Chronic use of laxatives
• Steriods
• Antibiotics

S/S: N/V, dysrhthmias, abd distention, soft flabby muscles

Usually results from renal insufficiency or over administrtaion of K+ ie: dietary supplements

S/S: N, abd cramps, oliguria, dyspnea, tachycardia then bradycardia, fatigue, weakness, numbess, muscle twitching

Hypo treatments:

Oral

Intravenous K+: extremely irritating so use slow ive

Hyper treatments:

kayexalate

Foods: fruits, fruit juices, leafy greens, yams, nuts, p-nut butter, red meats, milk products, coffee

Insufficient sodium levels

Occurs from escessive dilution of the plasma, vomiting/diarrhea, potent diuretics, excessive sweating

S/S: muscular weakness, HA, lethargy, confusion, anxiety, seizures, abd cramps, N/V, tachycardia, hypotension, pale skin, dry mucous membranes

Treatment: NaCl, lactated Ringer's

Excess sodium levels

Occurs from: some drugs; ie: cortisone, cough meds, antibiotics

diarrhea

burns

fever

S/S: dry flushed skin, agitation, elevated temp, hypertension, edema, rough dry tongue, N/V, anorexia, thirst, tachycardia, muscle twitching, hyperreflexia

Low calcium levels

Causes: from inadequate calcium intake, vit D deficiency, hypoparathyroidism, multiple blood transfusions, loop diurectics, steroids, phosphate preps.

S/S: anxiety, irratibility, tetany symptoms, bone deformites, osteomalacia, osteoporosis

Excess calcium levels

Causes: excess Ca++ intake, bone tumors, prolonged immobilization, multiple fractures, thiazide diuretics, N/V.

S/S: flabby muscles, constipation, N/V, pain over bony areas, hypotension, kidney stones, cardiac arrhythmias

Hypo:

• May result from diuretics, some antibiotics, laxatives, steroids
• May potentiate the action of digitalis
• S/S: cardiac dysrhythmias, hyperexcitability, tachycardia, muscle spasms

Hyper:

• Excess intake Mg++; laxatives, MOM/Maalox/Mylanta
• S/S: sedative CNS effect- lethargy, drowsiness, paralysis, may result in loss of DTRs; hypotension, heart block

Hypo:

• May result from diabetes, starvation, alcoholism, Crohn's disease
• S/S: muscle weakness, tremors, paresthesias (numbness), bone pain, anorexia

Hyper:

• Generally caused by kidney disease
• S/S: hyperreflexia, tetany, flaccid paralysis, muscular weakness, tachycardia, N/D, and cramps

Alpha₁

• Blood Vessels: vasoconstriction, increased BP, increased contractibility of the heart
• Eye: mydriasis (pupil dilation)
• Bladder: contraction
• Prostate: contraction

Alpha₂

• Blood Vessels: decreased bp (reduced NE)
• Smooth Muscle (GI tract): decreased GI tone and motility

Beta₁

• Heart: increased heart contraction, increased heart rate
• Kidney: increased renin secretion, increased angiotensin, increased BP

Beta₂

• Smooth Muscle (GI Tract): decreased GI tone and mobility
• Lungs: bronchodilation
• Uterus: relaxation of uterine smooth muscle
• Liver: activation of glycogenolysis, increased blood sugar

It is activated under conditions of stress; helps the body ready for an immediate response or a potential threat

ie: trauma, stress, fear, cold, exercise, hypoglycemia

• Vasoconstriction: increases HR & BP
• Increases resp rate
• Dilates the bronchi
• Shunts blood away from the skin and viscera to skeletal muscles
• Dilates the pupils for better vision
• Mobilizes stores energy from liver

Norepinephrine (NE)

Synthesized nerve terminals; released by most postgaglionic neurons

Stored in vesicles until an action potential triggers its release into the synaptic cleft

Epinephrine (E)

Released by the adrenal medulla directly into bloodstream

Action is terminated through hepatic metabolism (not reuptake)

Also called adrenergic, sympathomimetics, & adrenomimetics

Main functions:Regulation of cardiovascular system

• Maintain blood flow to the brain
• Redistribution of blood
• Compensation for loss of blood

Regulation of body temp

• Regulate blood flow to the skin
• Promote secretion of sweat
• Induces piloerection

Direct-acting: directly stimulate the adrenergic receptor sites

E, NE, & D

Indirect-acting: stimulate the release of NE from the vesicles on the presynaptic terminal nerve endings (amphetamine) or inhibit the reuptake of destruction of NE

Mixed-acting: both direct & indirect; stimulate the adrenergic receptor sites and stimulate release of NE from the terminal nerve endings.

E

Activate adrenergic receptors

Stimulate the SNS through these same receptors

Mimic the sympathetic neurotransmitters NE and E

Act on one or more adrenergic receptor sites located in the cells of muscles

Located in vascular tissues of muscles and blood vessels

Drugs are used to treate hypotension, nasal congestion, dilation of pupils, improves circulation, tissue perfusion

Stimulation/activation of sites:

• blood vessel vascocontriction: Increase cardiac contractility, BP, peripheral resistance, and blood return to heart
• bladder spincter/prostate contraction
• decreases gi motility

Located in presynaptic junction/nerve terminals

Most often used for blood pressure

Stimulation/activation: inhibits NE release which reduces plasma level of NE

Promotes vasodilation of blood vessels

Decreases BP/heart rate and GI tone/mobility

inhibits renin release from kidneys

Adverse effects: hypotension, peripheral edema, dry mouth/eyes, constipation, drowsy, dizzy, pruritis, rash, N/V, depressed, hallucinate

Located primarily in heart, some kidney, GI tract sphincters, and smooth muscle

used to treat circulatory shock, hypotension, cardiac arrest, heart failure

Actions:

Increases cardiac contractitlity, HR, BP

Increases renin secretion & GFR

Decreases digestion & GI motility

Increases lipolysis in adipose

Adverse effects: tachycardia, dysrhythmias, angina pectoris

located mostly in smooth muscles of lung, some arterioles of skeletal muscles, liver cells, blood vessels suppplying brain/heart/kidney/ and uterine muscle

used in patients with COPD, circulatory shock, premature labor, peripheral vascular disease

Actions:

relaxation/vasodilation of smooth muscles of lungs (broncodilation), blood vessels to brain/heart/kidney

Increases blood flow in skeletal muscles & heart

decreases/relaxes uterine tone, digestion, & GI tract

increases rate and contractility of heart

Activates liver glycogenolysis (increase blood glucose)

Adverse effects: hyperglycemia, increase muscle tension, feeling of warmth, flushing, tremor

E: can activate all alpha and beta receptors

NE: can activate alpha₁ and alpha₂ and beta₁ receptors

Dopamine: can activate alpha₁ beta₂ and dopamine receptors

synthetic catecholamines

beta₁ receptor specific

prevents renal failure

watch vital signs for palpitations/BP, headache, confusion

adverse effects: angina, tachydysrhythmias

Synthetic catecholamines

Beta_{1 & 2} receptor specific

Overcome AV heart block, restart heart following cardiac arrest, increase cardiac output during shock

Noncatecholamine

beta₂ receptor selective- promotes bronchodilation

uses: prevent/treat bronchospasm associated w/asthma, bronchitis, COPD

Caution: severe cardiac disease

hypertension/hyperthyroidism

diabetes mellitus, pregnancy

Side effects: tremors, nervousness, dizzy, reflex tachycardia, hallucinate, cardiac dysryhythmias

Drug interactions: may increase effect w/other sympathomimetcs, MAO inhibitors & TCAs

Antagonize effects with beta blockers

mixed acting noncatecholamine

Acts like E: increases HR/BP, but less potent vasoconstrictor

Indirect stimulate release of NE from adrenergic nerve terminals and direct by binding drug to alpha/beta receptors

Uses:

idiopathic orthostatic hypotension and hypotension from spinal anesthesia

stimualtes beta₂receptors- dilates bronchial tubes. useful for asthma, nasal congestion

Adverse effects: hypertension, angina, dysrhythmias

First beta adrenergic blocker

uses: treat angina, cardiac dysrhythmias, hypertension, heart failure, may prevent migraines

Contraindications: COPD

Side effects:

non-selective

bradycardia, palpitations, flushing, hypertension, headache/dizzy/drowsy/fatigue hyperglycemia, impotence

May be additive with another antihypertensive

Monitor hepatic/renal function,HR/rhythm, BP, edema, SOB, cough, weight gain

DO NOT abruptly stop