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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Concepts Covered:

  • Shock
  • Shock
  • Immunological Disorders
  • Cardiac Disorders
  • Emergency Care of the Cardiac Patient
  • Integumentary Disorders
  • Neurological Trauma
  • Musculoskeletal Trauma
  • Liver & Gallbladder Disorders
  • Intraoperative Nursing
  • Neurological Emergencies
  • Oncology Disorders
  • Emergency Care of the Neurological Patient
  • Postoperative Nursing
  • Disorders of the Thyroid & Parathyroid Glands
  • Central Nervous System Disorders – Brain
  • Noninfectious Respiratory Disorder
  • Respiratory Emergencies
  • Hematologic Disorders
  • Vascular Disorders
  • Respiratory System
  • Infectious Respiratory Disorder
  • Urinary Disorders
  • Urinary System
  • Musculoskeletal Disorders
  • Acute & Chronic Renal Disorders
  • Emergency Care of the Trauma Patient
  • Disorders of the Adrenal Gland
  • Documentation and Communication
  • Preoperative Nursing
  • Legal and Ethical Issues
  • Cognitive Disorders
  • Medication Administration
  • Male Reproductive Disorders
  • Sexually Transmitted Infections
  • Disorders of Pancreas
  • Newborn Complications
  • Communication
  • Lower GI Disorders

Study Plan Lessons

Sepsis Concept Map
Shock
Shock Module Intro
Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sinus Bradycardia
Sinus Tachycardia
Skin Cancer
Spinal Cord Injury Case Study (60 min)
Spinal Precautions & Log Rolling
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
Stages of Hepatitis Nursing Mnemonic (PIP)
Sterile Field
Sterile Gloves
Stoke Assessments Nursing Mnemonic (FAST)
Stomach Cancer (Gastric Cancer)
Stroke (CVA) Module Intro
Stroke Assessment (CVA)
Stroke Concept Map
Stroke for Certified Emergency Nursing (CEN)
Stroke Nursing Care (CVA)
Stroke Therapeutic Management (CVA)
Surgical Incisions & Drain Sites
Surgical Prep
Surgical Counts for Certified Perioperative Nurse (CNOR)
Sympatholytics (Alpha & Beta Blockers)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Tension and Cluster Headaches
Tetracycline (Panmycin) Nursing Considerations
The 5-Minute Assessment (Physical assessment)
Thoracentesis
Thrombocytopenia
Thrombolytics
Thromboembolic Disease- Deep Vein Thrombosis (DVT) for Certified Emergency Nursing (CEN)
Thyroxine (T4) Lab Values
Thyroid Stimulating Hormone (TSH) Lab Values
Total Iron Binding Capacity (TIBC) Lab Values
To Clot or Not To Clot – Anticoagulants! – Live Tutoring Archive
Trach Care
Trach Suctioning
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Troponin I (cTNL) Lab Values
Tuberculosis (TB) Case Study (60 min)
Urinary Elimination
Urinary Tract Infection Case Study (45 min)
Vancomycin (Vancocin) Nursing Considerations
Vent Alarms
Ventilator Settings
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)
Vessels & Fluid
Vitamin D Lab Values
Warfarin (Coumadin) Nursing Considerations
Wound Care – Assessment
Wound Care – Selecting a Dressing
Wound Care – Dressing Change
Wound Care – Wound Drains
Wound Infections for Certified Emergency Nursing (CEN)
Wounds (Infectious, Surgical, Trauma) for Progressive Care Certified Nurse (PCCN)
Wound Dressing Maintenance for Certified Perioperative Nurse (CNOR)
Wound Classification for Certified Perioperative Nurse (CNOR)
Who Needs Dialysis Nursing Mnemonic (AEIOU)
Wound Bleeding (Uncontrolled External Hemorrhage) for Certified Emergency Nursing (CEN)
02.14 Shock Stages for CCRN Review
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
ACE (angiotensin-converting enzyme) Inhibitors
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Acute Kidney Injury Case Study (60 min)
Acute Renal (Kidney) Module Intro
Addisons Assessment Nursing Mnemonic (STEROID)
Addisons Disease
Adjunct Neuro Assessments
Admissions, Discharges, and Transfers
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Advance Directives
Adrenal Gland Hormones Nursing Mnemonic (The 3 S’s)
Airway Suctioning
Allergic Reactions and Anaphylaxis for Certified Emergency Nursing (CEN)
Alteplase (tPA, Activase) Nursing Considerations
Altered Mental Status Nursing Mnemonic (AEIOU TIPS)
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Amputation
Amputation Concept Map
Anemia for Progressive Care Certified Nurse (PCCN)
Anesthetic Agents
Anesthetic Agents
Anti-Infective – Sulfonamides
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Anti-Infective – Antitubercular
Anti-Platelet Aggregate
Anticonvulsants
Antidiabetic Agents
Antimetabolites
Antineoplastics
Antinuclear Antibody Lab Values
Aortic Aneurysm – Management Nursing Mnemonic (CRAM)
ASA (Aspirin) Nursing Considerations
Aspiration for Certified Emergency Nursing (CEN)
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
Asthma for Certified Emergency Nursing (CEN)
At Risk for Gout Nursing Mnemonic (MALE)
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Fibrillation (A Fib)
Atrial Flutter
Azithromycin (Zithromax) Nursing Considerations
Barriers to Health Assessment
Blood Flow Through The Heart
Blunt Chest Trauma
Bowel Obstruction Concept Map