Sympatholytics (Alpha & Beta Blockers)

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Outline

Overview

   I.         Overview

A.    Autonomic nervous system = PNS & SNS

B.    Sympathetic neurotransmitters all over body

1.     Adrenergic 1 / 2

a.     Varying location and nerves, all over body

2.     Beta 1 = Heart (cardio-selective)

3.     Beta 2 = BV, bronchioles, smooth muscle

     II.         Mechanism of Action

A.    Inhibit stimulation of SNS (flight or fight)

B.    Think inhibit stress response

1.     Decrease HR

2.     Decrease BP

3.     Arterial / Venous dilation

4.     Smooth muscle relaxation

   III.         Types

A.    Alpha-Blockers

1.     Doxazosin

2.     Prazosin

3.     Terazosin

4.     Tamsulosin

B.    Cardio-selective Beta-Blockers (B1)

1.     Atenolol

2.     Esmlol

3.     Metoprolol

4.     Bisprplol

C.     Non-selective Beta-Blockers (B2)

1.     Carvedilol

2.     Labetalol

3.     Propranolol

4.     Sotalol

   IV.         Indications

A.    Alpha-Blockers

1.     HTN

2.     Migraines

3.     Pheochromocytoma

4.     BPH

5.     Urinary flow obstruction

6.     Raynaud’s disease

B.    Beta-Blockers

1.     HTN

2.     Angina

3.     Heart failure

4.     Cardiac-protective (after MI)

5.     Dysrhythmias

6.     Migraines

7.     Glaucoma

    V.         Contraindications

A.    Alpha-Blockers

1.     PVD

2.     Hepatic / renal disease

3.     Coronary artery disease

B.    Beta-Blockers

1.     Uncompensated heart failure

2.     Cardiogenic shock

3.     Heart block or bradycardia

4.     Severe pulmonary disease

   VI.         Side Effects

A.    Cardiovascular

1.     Palpitations

2.     Hypotension

3.     Bradycardia

4.     Chest pain

B.    CNS

1.     Headache

2.     Dizziness

3.     Anxiety

4.     Vertigo

C.     GI

1.     N / V / D

D.    * Beta-Blockers

1.     Hypoglycemia

2.     Bronchospasms

3.     Rebound tachycardia (if stopped abruptly)

4.     Hypotension

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Transcript

Welcome back and today we are doing to discuss sympatholytics.

Sympatholytics work on the autonomic nervous system, mainly the SNS and their neurotransmitters – Adrenergic (which is various locations, think adrenergic = all over) and beta1 (heart) and beta 2 (BV, bronchioles, and smooth muscles).

Now sympatholytic work by inhibiting SNS, so the flight to fight response are inhibited… resulting in lower heart rate, blood pressure, dilation and relaxation. Think the opposite of stress. When you are stressed, you are tachycardic and HTN and generally not relaxed, haha.

Let’s review alpha types, they all tend to end in -OSIN. Do focus on memorization, focus on the ending here.

Next we have beta-blockers. The first section is cardioselective (works mainly within the heart). Non-selective is below and focuses on BV, bronchioles and smooth muscles. Regardless, the ending is -LOL.

Indication for alphas include the following. I want you to focus on what the drug does… inhibit stress responses. So therefore, we are attempting to relax SM, decrease HR and decrease BP. Each indication focuses on those three principles.

Indications for betas focus on the same concept. We are attempting to inhibit the stress response. Angina, HTN, heart failure all stress the heart. Beta-blockers will assist in slowing things down and improving cardiac output.

Contraindications focus on high risk patients populations. in PVD (these drugs cause intermittent claudication, which isn’t good), heart block will be exacerbated with the use of these drugs. The goal here is to assist the heart and vasculature NOT cause more harm.

Cardiac side effects include palpitations, hypotension, bradycardia and chest pain. All of which result from the drug working too well. When the heart beats too slow, my impairs oxygen to the heart, which can cause chest pain. Too low BP = hypotension.

Next we have CNS side effects which can include headache, dizziness, anxiety and vertigo. Again, if you are dilating, previously constricted  areas, dizziness and headaches are common. Focus more on the drug’s action and less of memorization.

Lastly, let’s review unique side effects of beta blockers which include hypoglycemia, bronchospasm, round bound tachycardia and hypotension. If you patient has COPD or is a brittle diabetic, this drug class will be a tough one to manage. Again we are trying to assist not harm so keep these in mind. If a patient for example is admitted with sepsis and has an admitting BP of 80/60, you wouldn’t want to administer their beta-blocker as it will cause more profound hypotension. This is why sympatholytics tend to have BP parameters for administration. You want to check your patient’s BP and HR before administering any sympatholytics, in general.

Priority nursing concepts for a patient receiving sympatholytics include anatomy, perfusion and pharmacology.

Alright let’s review the key points: The how: Inhibition of SNS (flight to fight response). Second, we have the different types -OSIN and -LOL. Indications vary but include HTN, migraines, heart failures, among other things. Contraindications include PVD, heart block and pulm disease. Lastly, we reviewed side effects which included cardiac, CNS, GI and special mentions regarding beta-blockers.

Now you know all you need to know about sympatholytics. Now go out and be your best self and happy nursing!

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cardiac

Concepts Covered:

  • Cardiac Disorders
  • Cardiovascular
  • Circulatory System
  • Emergency Care of the Cardiac Patient
  • Shock
  • Shock
  • Adult
  • Medication Administration
  • Vascular Disorders
  • Central Nervous System Disorders – Brain
  • Pregnancy Risks
  • Intraoperative Nursing
  • Cardiovascular Disorders
  • Terminology
  • Emergency Care of the Trauma Patient
  • Urinary System
  • Disorders of Thermoregulation
  • Postpartum Complications
  • Oncology Disorders
  • Noninfectious Respiratory Disorder
  • Neurological Emergencies
  • Hematologic Disorders
  • Respiratory Emergencies
  • Immunological Disorders
  • Emergency Care of the Neurological Patient
  • Respiratory Disorders
  • Disorders of the Posterior Pituitary Gland

Study Plan Lessons

02.02 Cardiomyopathy for CCRN Review
02.04 Pulmonary Artery Wedge Pressure (PAWP) for CCRN Review
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.14 Shock Stages for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.17 Septic Shock for CCRN Review
06.05 Wide Complex Tachycardia for CCRN Review
ACE (angiotensin-converting enzyme) Inhibitors
ACLS (Advanced cardiac life support) Drugs
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Adenosine (Adenocard) Nursing Considerations
Advanced Cardiovascular Life Support (ACLS)
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Angiotensin Receptor Blockers
Arterial Pressure Monitoring
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Fibrillation (A Fib)
Atrial Flutter
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
AVPU Mnemonic (The AVPU Scale)
Blood Flow Through The Heart
Blood Pressure (BP) Control
Brain Natriuretic Peptide (BNP) Lab Values
Calcium Channel Blockers
Cardiac (Heart) Disease in Pregnancy
Cardiac (Heart) Enzymes
Cardiac (Heart) Physiology
Cardiac A&P Module Intro
Cardiac Anatomy
Cardiac Arrest Nursing Interventions for Certified Perioperative Nurse (CNOR)
Cardiac Course Introduction
Cardiac Cycle
Cardiac Glycosides
Cardiac Labs – What and When to Use Them – Live Tutoring Archive
Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
Cardiac Stress Test
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Cardiac Terminology
Cardiac Valves Blood Flow Nursing Mnemonic (Toilet Paper my Ass)
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
Cardiopulmonary Arrest
Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
Cardiovascular Trauma for Certified Emergency Nursing (CEN)
Congenital Heart Defects (CHD)
Congestive Heart Failure (CHF) Labs
Congestive Heart Failure Concept Map
Coronary Artery Disease Concept Map
Creatine Phosphokinase (CPK) Lab Values
Defects of Decreased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Digoxin (Lanoxin) Nursing Considerations
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Dobutamine (Dobutrex) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Dysrhythmia Emergencies
Dysrhythmias for Certified Emergency Nursing (CEN)
Dysrhythmias Labs
Echocardiogram (Cardiac Echo)
Electrical A&P of the Heart
Electrical Activity in the Heart
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
Electrolytes Involved in Cardiac (Heart) Conduction
Endocarditis Case Study (45 min)
Endocarditis for Certified Emergency Nursing (CEN)
Epinephrine (EpiPen) Nursing Considerations
Heart (Cardiac) and Great Vessels Assessment
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Heart (Heart) Failure Exacerbation
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Heart Failure Case Study (45 min)
Heart Failure for Certified Emergency Nursing (CEN)
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Hemodynamics
Hemorrhagic Fevers for Certified Emergency Nursing (CEN)
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypovolemic Shock Case Study (OB sim) (60 min)
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Lactate Dehydrogenase (LDH) Lab Values
Mixed (Cardiac) Heart Defects
Minimally-Invasive Cardiac Surgery (Non-Sternal Approach) for Progressive Care Certified Nurse (PCCN)
Myocardial Infarction (MI) Case Study (45 min)
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Norepinephrine (Levophed) Nursing Considerations
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Endocarditis
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Stroke (CVA)
Nursing Care Plan for Coronary Artery Disease (CAD)
Nursing Care Plan for Distributive Shock
Nursing Care Plan for Myocarditis
Nursing Care Plan for Pulmonary Edema
Nursing Case Study for Cardiogenic Shock
Obstructive Heart (Cardiac) Defects
Pacemakers
Performing Cardiac (Heart) Monitoring
Pericardial Tamponade for Certified Emergency Nursing (CEN)
Preload and Afterload
Premature Ventricular Contraction (PVC)
Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Septic Shock (Sepsis) Case Study (45 min)
Sinus Bradycardia
Sinus Tachycardia
Stroke Case Study (45 min)
Stroke for Certified Emergency Nursing (CEN)
Stroke for Progressive Care Certified Nurse (PCCN)
Stroke Therapeutic Management (CVA)
Supraventricular Tachycardia (SVT)
Sympatholytics (Alpha & Beta Blockers)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
The Heart
Thrombolytics
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Transient Ischemic Attack (TIA) for Certified Emergency Nursing (CEN)
Troponin I (cTNL) Lab Values
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Vasopressin
Ventricular Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Ventricular Fibrillation (V Fib)