25.1 Adrenergics and Anticholinergics
3 min read•june 18, 2024
Adrenergic and are key players in respiratory care. They work by targeting different receptors in the airways, helping to open them up and make breathing easier for people with conditions like asthma and COPD.
These medications can be life-changing, but they come with side effects and interactions to watch out for. Nurses play a crucial role in administering these drugs safely, monitoring patients, and teaching them how to use inhalers correctly and manage their condition long-term.
Adrenergic and Anticholinergic Drugs in Respiratory Care
Mechanisms of Action
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- stimulate (α and β) in the respiratory system
- β2-agonists (, ) are most commonly used relax smooth muscles in the airways causing and increase mucociliary clearance
- (ipratropium, ) block (M1, M2, and M3) in the respiratory system inhibit -mediated and reduce mucus secretion improving mucociliary clearance
Indications, Side Effects, and Interactions
- Indications for adrenergic drugs include asthma, chronic obstructive pulmonary disease (COPD), and bronchospasm while anticholinergic drugs are used for COPD and as an add-on therapy for asthma
- Side effects of adrenergic drugs include , tremor, , and whereas anticholinergic drugs may cause , , , and
- Adrenergic drugs interact with (antagonistic effect) and MAO inhibitors (increased risk of hypertensive crisis) while anticholinergic drugs interact with other anticholinergic medications (additive side effects) and beta-blockers (increased anticholinergic effects)
Nursing Considerations
- Assessment involves monitoring respiratory rate, rhythm, and effort, assessing lung sounds for wheezing, crackles, or diminished breath sounds, and evaluating the patient's response to therapy
- Administration requires ensuring correct dosage and route, educating patients on proper inhaler or nebulizer technique, and monitoring for side effects and adverse reactions
- Monitoring includes regularly assessing vital signs (especially heart rate and blood pressure), monitoring serum potassium levels with prolonged adrenergic drug use, and assessing for signs of anticholinergic toxicity (confusion, hallucinations)
Patient Education Plan
- Medication administration
- Teach proper inhaler or nebulizer technique emphasizing the importance of consistent medication use as prescribed
- Instruct patients to rinse their mouth after using inhaled corticosteroids to prevent oral thrush
- Side effects and precautions
- Inform patients of common side effects (tachycardia, dry mouth) and when to seek medical attention
- Advise patients to report any signs of allergic reactions or worsening symptoms and caution about engaging in activities that require alertness if drowsiness occurs
- Lifestyle modifications
- Encourage smoking cessation and avoidance of respiratory irritants (secondhand smoke, air pollution)
- Discuss the importance of regular exercise and pulmonary rehabilitation to improve lung function
- Advise patients to maintain a healthy diet and stay hydrated to support overall respiratory health
- Follow-up care
- Stress the importance of regular check-ups with healthcare providers to monitor treatment effectiveness and adjust medications as needed
- Encourage patients to keep a symptom diary and discuss changes with their doctor to identify potential triggers or worsening of symptoms
- Provide resources for support groups and educational materials on respiratory conditions to empower patients in managing their health
Key Terms to Review (72)
Accuneb: Accuneb is a brand name for albuterol sulfate, a bronchodilator used to treat or prevent bronchospasm in patients with reversible obstructive airway disease. It works by relaxing muscles in the airways and increasing airflow to the lungs.
Acetylcholine: Acetylcholine is a neurotransmitter that plays a crucial role in the functioning of the nervous system, including the transmission of signals between nerve cells and the activation of muscle contractions. It is a key component in understanding various neurological disorders and the mechanisms of drugs used to treat them.
Aclidinium: Aclidinium is a long-acting muscarinic antagonist (LAMA) medication used primarily in the management of chronic obstructive pulmonary disease (COPD). It functions as an anticholinergic agent, blocking the action of the neurotransmitter acetylcholine in the airways, leading to bronchodilation and improved lung function.
Adrenalin: Adrenalin, also known as epinephrine, is a hormone and neurotransmitter involved in the 'fight or flight' response. It is used medically to treat conditions like asthma and anaphylaxis by stimulating adrenergic receptors.
Adrenergic Drugs: Adrenergic drugs are a class of medications that mimic the effects of the neurotransmitter norepinephrine, also known as noradrenaline, which is released by the sympathetic nervous system. These drugs interact with adrenergic receptors, primarily the alpha and beta subtypes, to produce physiological responses that are characteristic of the sympathetic 'fight-or-flight' response.
Adrenergic receptors: Adrenergic receptors are a class of G protein-coupled receptors targeted by catecholamines like adrenaline and noradrenaline. They play a crucial role in the sympathetic nervous system by modulating physiological responses such as heart rate, blood pressure, and bronchodilation.
Adrenergic Receptors: Adrenergic receptors are a class of G protein-coupled receptors that bind to the neurotransmitters epinephrine (adrenaline) and norepinephrine (noradrenaline). These receptors play a crucial role in the body's sympathetic nervous system, mediating the physiological responses to these neurotransmitters.
Albuterol: Albuterol is a bronchodilator medication that works by relaxing and opening the airways in the lungs, making it easier to breathe. It is commonly used to treat and prevent symptoms of asthma, chronic obstructive pulmonary disease (COPD), and other respiratory conditions.
Alpha- and beta-adrenergic agonists: Alpha- and beta-adrenergic agonists are drugs that stimulate alpha and beta receptors in the sympathetic nervous system, leading to various physiological responses. These agents are commonly used to manage conditions such as asthma, COPD, and other lower respiratory disorders by promoting bronchodilation.
Anticholinergic drugs: Anticholinergic drugs inhibit the action of acetylcholine in the nervous system. They are used to manage respiratory disorders by relaxing bronchial muscles and reducing mucus secretion.
Anticholinergic Drugs: Anticholinergic drugs are a class of medications that block the action of the neurotransmitter acetylcholine, which is responsible for various physiological functions. These drugs have the opposite effect of cholinergic drugs, which enhance the action of acetylcholine. Anticholinergics are commonly used to treat a variety of conditions, including overactive bladder, Parkinson's disease, and certain types of respiratory disorders.
Atrovent: Atrovent is a brand name for ipratropium bromide, an anticholinergic bronchodilator used to treat symptoms of chronic obstructive pulmonary disease (COPD). It works by relaxing muscles in the airways and increasing airflow to the lungs.
Autonomic Nervous System: The autonomic nervous system is the part of the nervous system that controls and regulates the body's internal organs and involuntary functions, such as heart rate, breathing, digestion, and blood pressure, without conscious control. It is a critical component in maintaining homeostasis and ensuring the body's proper functioning.
Auvi-Q: Auvi-Q is an epinephrine auto-injector designed for the emergency treatment of life-threatening allergic reactions or anaphylaxis. Its compact, user-friendly design includes voice instructions to guide users through administration.
Beta-2 adrenergic agonist: Beta-2 adrenergic agonists are medications that stimulate beta-2 receptors in the lungs, leading to bronchodilation. They are commonly used to treat conditions like asthma and chronic obstructive pulmonary disease (COPD).
Beta-2 Receptors: Beta-2 receptors are a subtype of beta-adrenergic receptors that are primarily located in the smooth muscle cells of the lungs, blood vessels, and other organs. They play a crucial role in the regulation of various physiological processes, particularly in the context of nervous system disorders, beta-adrenergic blockers, and the interplay between adrenergics and anticholinergics.
Beta-adrenergic: Beta-adrenergic receptors are a class of G-protein-coupled receptors that are targets for catecholamines, especially norepinephrine and epinephrine. They play a critical role in the regulation of cardiovascular and respiratory functions.
Beta-Blockers: Beta-blockers are a class of medications that work by blocking the effects of the hormone epinephrine (adrenaline) on the body. They are primarily used to treat various cardiovascular conditions, such as hypertension, angina, and heart failure, by reducing the heart's workload and oxygen demand.
Blurred Vision: Blurred vision is a common symptom characterized by the inability to see objects or text clearly, resulting in a loss of visual sharpness and focus. This term is particularly relevant in the context of adrenergics, anticholinergics, urinary antispasmodics, antimuscarinics, and ocular anesthetics and lubricants, as these drug classes can potentially cause or contribute to this visual disturbance.
Bronchial Smooth Muscle: Bronchial smooth muscle is the layer of smooth muscle tissue that lines the airways, specifically the bronchi and bronchioles, within the respiratory system. This smooth muscle plays a crucial role in regulating airway diameter and resistance, which in turn affects airflow and breathing dynamics.
Bronchoconstriction: Bronchoconstriction refers to the narrowing or tightening of the bronchial tubes, the airways that carry air to and from the lungs. This process can occur in response to various stimuli and is a key feature in conditions like asthma and chronic obstructive pulmonary disease (COPD).
Bronchodilation: Bronchodilation is the dilation or widening of the bronchi and bronchioles, the airways within the lungs. This process leads to increased airflow and reduced airway resistance, facilitating easier breathing. Bronchodilation is a crucial mechanism in the management of various respiratory conditions, including asthma, chronic obstructive pulmonary disease (COPD), and bronchospasm.
Cholinergic Receptors: Cholinergic receptors are a class of receptors that respond to the neurotransmitter acetylcholine (ACh), which is involved in various physiological processes throughout the body. These receptors play a crucial role in the functioning of the parasympathetic nervous system and are relevant in the context of several pharmacological topics.
Constipation: Constipation is a condition characterized by infrequent bowel movements or difficulty in passing stools. It can be a common side effect of opioid medications.
Constipation: Constipation is a common gastrointestinal condition characterized by infrequent or difficult bowel movements, often accompanied by hard, dry stool. This term is particularly relevant in the context of various medication classes, as certain drugs can either cause or alleviate constipation as a side effect or therapeutic effect.
Corphedra: Corphedra is a pharmaceutical compound used as a bronchodilator in the treatment of lower respiratory disorders. It acts as an adrenergic agonist, stimulating beta-adrenergic receptors to relax smooth muscle in the airways.
Dry Mouth: Dry mouth, also known as xerostomia, is a condition characterized by a decrease in the production and flow of saliva. This can have significant impacts on various aspects of health and daily functioning.
Emerphed: Emerphed is a synthetic adrenergic agonist used primarily as a bronchodilator in the treatment of lower respiratory disorders. It works by stimulating beta-adrenergic receptors, leading to relaxation of bronchial muscles.
Ephedrine: Ephedrine is a sympathomimetic adrenergic drug that stimulates both alpha and beta-adrenergic receptors, used to relieve bronchospasm in conditions like asthma. It also has vasoconstrictive properties, making it useful in treating hypotension.
Epipen: An Epipen is an auto-injector device containing epinephrine, used to manage severe allergic reactions (anaphylaxis). It quickly narrows blood vessels and opens airways in the lungs to improve breathing.
Formoterol: Formoterol is a long-acting beta2-adrenergic agonist (LABA) used as a bronchodilator for the management of asthma and chronic obstructive pulmonary disease (COPD). It works by stimulating beta2-adrenergic receptors in the lungs, leading to smooth muscle relaxation and improved airflow.
Hyperglycemia: Hyperglycemia refers to an abnormally high level of glucose in the bloodstream. It is a key feature in the pathophysiology of various medical conditions, particularly diabetes mellitus, and can have significant implications for fluid and electrolyte balance, inflammatory processes, and overall health.
Hypokalemia: Hypokalemia is a condition characterized by an abnormally low level of potassium in the blood. Potassium is an essential electrolyte that plays a crucial role in maintaining homeostasis, regulating fluid balance, and supporting proper nerve and muscle function throughout the body.
Ipratropium bromide: Ipratropium bromide is an anticholinergic bronchodilator used to relieve bronchospasm in conditions like chronic obstructive pulmonary disease (COPD) and asthma. It works by inhibiting the action of acetylcholine on muscarinic receptors in the airway, leading to bronchodilation.
Ipratropium Bromide: Ipratropium bromide is an anticholinergic medication used to treat respiratory conditions such as chronic obstructive pulmonary disease (COPD) and asthma. It works by blocking the action of acetylcholine, a neurotransmitter that causes the muscles in the airways to constrict, leading to improved breathing and reduced symptoms.
LABAs: LABAs, or long-acting beta-agonists, are a class of medications primarily used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). These drugs work by stimulating beta-2 adrenergic receptors in the lungs, leading to bronchodilation and improved airflow.
LAMAs: LAMAs, or Long-Acting Muscarinic Antagonists, are a class of medications primarily used to treat chronic obstructive pulmonary disease (COPD) by blocking the action of acetylcholine, a neurotransmitter that can cause airway constriction. These drugs work to relax and open the airways, improving breathing and reducing symptoms associated with COPD.
Levalbuterol: Levalbuterol is a short-acting beta2-adrenergic agonist used to treat bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease (COPD). It works by relaxing the muscles around the airways to improve breathing.
Long-acting beta-2 agonist: Long-acting beta-2 agonists (LABAs) are medications used to relax muscles of the airways, improving breathing in conditions like asthma and COPD. They are typically used as maintenance therapy and not for acute relief.
Long-Acting Beta-2 Agonists: Long-acting beta-2 agonists are a class of bronchodilator medications that selectively stimulate beta-2 adrenergic receptors in the lungs, leading to smooth muscle relaxation and airway dilation. These agents have a prolonged duration of action, typically lasting 12 to 24 hours, making them useful for the maintenance treatment of conditions like asthma and chronic obstructive pulmonary disease (COPD).
Long-Acting Muscarinic Antagonists: Long-acting muscarinic antagonists, also known as long-acting anticholinergics, are a class of medications that block the action of the neurotransmitter acetylcholine at muscarinic receptors in the body. This inhibition of muscarinic receptor activity leads to a reduction in the parasympathetic nervous system's effects, which can be beneficial in the management of various medical conditions.
Muscarinic Receptors: Muscarinic receptors are a type of acetylcholine receptor that are primarily found in the parasympathetic nervous system and are responsible for mediating the effects of the neurotransmitter acetylcholine. These receptors play a crucial role in regulating various physiological processes, including cardiac function, gastrointestinal motility, and bladder control, and are the target of both therapeutic drugs and toxins.
Neurotransmitters: Neurotransmitters are chemical messengers that transmit signals between neurons and target cells in the nervous system. They are responsible for the communication and coordination of various physiological and psychological processes in the body, and their imbalance or dysfunction can contribute to the development of various neurological and psychiatric disorders.
Nonselective alpha- and beta-adrenergic agonist: Nonselective alpha- and beta-adrenergic agonists stimulate both alpha and beta adrenergic receptors, leading to widespread effects on the cardiovascular and respiratory systems. They are often used in emergency situations to manage severe asthma attacks or anaphylaxis.
Parasympathetic nervous system: The parasympathetic nervous system (PNS) is a division of the autonomic nervous system that conserves energy by slowing the heart rate and increasing intestinal and gland activity. It is often referred to as the 'rest and digest' system.
Parasympathetic Nervous System: The parasympathetic nervous system is a division of the autonomic nervous system responsible for the body's rest-and-digest functions. It plays a crucial role in maintaining homeostasis and regulating various physiological processes, including digestion, heart rate, and urination.
Parasympatholytics: Parasympatholytics, also known as anticholinergics, are a class of drugs that block the effects of the parasympathetic nervous system by antagonizing the action of the neurotransmitter acetylcholine. They inhibit the parasympathetic functions, which are responsible for rest, digestion, and other involuntary bodily processes.
Pediatric clients: Pediatric clients are children and adolescents who require medical care, including pharmacological treatments. Special considerations must be made for their unique physiological and developmental needs.
Pediatric dosage: Pediatric dosage is the specific amount of medication prescribed to children, taking into account their age, weight, and developmental stage. It ensures both efficacy and safety in treating various pediatric conditions.
Pharmacodynamics: Pharmacodynamics is the study of how drugs affect the body, including mechanisms of action and drug-receptor interactions. It examines the relationship between drug concentration and effect.
Pharmacodynamics: Pharmacodynamics is the study of the biochemical and physiological effects of drugs and their mechanisms of action within the body. It examines how drugs interact with the body's biological systems to produce their desired therapeutic effects or undesired side effects.
Primatene Mist: Primatene Mist is an over-the-counter inhaler containing epinephrine, used for temporary relief of mild symptoms of intermittent asthma. It acts as a bronchodilator to relax muscles in the airways and increase airflow to the lungs.
Proventil: Proventil is a brand name for albuterol, a bronchodilator used to treat or prevent bronchospasm in conditions like asthma and chronic obstructive pulmonary disease (COPD). It works by relaxing muscles in the airways to improve breathing.
SABAs: SABAs, or Short-Acting Beta-Agonists, are a class of medications that act on the beta-2 adrenergic receptors in the body, primarily in the lungs. They are a crucial component in the management of respiratory conditions, particularly asthma and chronic obstructive pulmonary disease (COPD), as they provide rapid relief of symptoms by relaxing and dilating the airways.
Salmeterol: Salmeterol is a long-acting beta-2 adrenergic agonist medication used primarily in the management of asthma and chronic obstructive pulmonary disease (COPD). It works by relaxing and dilating the airways, improving airflow and reducing symptoms associated with these respiratory conditions.
SAMAs: SAMAs, or Selective Alpha-2 Agonist Modulators, are a class of drugs that selectively target and activate the alpha-2 adrenergic receptors in the body. These receptors play a crucial role in regulating various physiological processes, particularly in the context of adrenergic and anticholinergic pharmacology.
Serevent: Serevent is a long-acting beta2-adrenergic agonist used to treat asthma and chronic obstructive pulmonary disease (COPD). It works by relaxing muscles in the airways to improve breathing.
Short-acting beta-2 agonist: Short-acting beta-2 agonists (SABAs) are medications that quickly relax the muscles around the airways, providing rapid relief from asthma symptoms and other respiratory conditions. They are typically used as rescue inhalers.
Short-Acting Beta-2 Agonists: Short-acting beta-2 agonists are a class of medications that act as bronchodilators, rapidly opening the airways by stimulating beta-2 adrenergic receptors in the smooth muscle of the lungs. These agents provide quick relief for symptoms of asthma and chronic obstructive pulmonary disease (COPD) by relaxing and dilating the bronchial tubes, improving airflow and breathing.
Short-Acting Muscarinic Antagonists: Short-acting muscarinic antagonists are a class of medications that work by blocking the action of the neurotransmitter acetylcholine at muscarinic receptors in the body. This helps to counteract the effects of excessive parasympathetic nervous system activity, which can lead to various medical conditions.
Spiriva: Spiriva is a brand name for tiotropium bromide, an anticholinergic medication used in the management of chronic obstructive pulmonary disease (COPD) and asthma. It works by relaxing the muscles around the airways so they open up and make breathing easier.
Sympathetic Nervous System: The sympathetic nervous system is a division of the autonomic nervous system that is responsible for the body's fight-or-flight response. It prepares the body to respond to perceived threats or stressful situations by increasing heart rate, blood pressure, and breathing rate, while also diverting blood flow away from the digestive system and towards the muscles.
Sympathomimetic: Sympathomimetics are drugs that mimic the effects of the sympathetic nervous system by stimulating adrenergic receptors. They are used to treat conditions like asthma, hypotension, and anaphylaxis.
Sympathomimetics: Sympathomimetics are a class of drugs that mimic the effects of the sympathetic nervous system by stimulating adrenergic receptors. They are commonly used to treat a variety of conditions, including asthma, nasal congestion, and weight management.
Tachycardia: Tachycardia refers to a rapid heart rate, typically defined as a resting heart rate exceeding 100 beats per minute. This abnormally fast heart rhythm can have various underlying causes and is an important consideration in several medical conditions and drug therapies.
Tiotropium: Tiotropium is a long-acting anticholinergic bronchodilator used to manage chronic obstructive pulmonary disease (COPD) and asthma. It works by relaxing muscles in the airways and increasing airflow to the lungs.
Tremors: Tremors refer to the involuntary, rhythmic shaking or quivering of a body part, often the hands, head, or limbs. This neurological symptom can be associated with various medical conditions and can have different underlying causes.
Umeclidinium: Umeclidinium is a long-acting muscarinic antagonist (LAMA) used in the management of chronic obstructive pulmonary disease (COPD). It acts by blocking the action of acetylcholine, a neurotransmitter that causes the contraction of smooth muscle in the airways, leading to bronchodilation and improved lung function.
Urinary Retention: Urinary retention is the inability to completely empty the bladder, resulting in a buildup of urine within the bladder. This condition can have various underlying causes and is an important consideration across several medication classes.
Ventolin: Ventolin is a brand name for albuterol, a bronchodilator used to treat or prevent bronchospasm in patients with reversible obstructive airway disease. It works by relaxing muscles in the airways and increasing airflow to the lungs.
Vilanterol: Vilanterol is a long-acting beta2-adrenergic agonist (LABA) used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). It works by relaxing and opening the airways, allowing for easier breathing.
Xopenex: Xopenex (levalbuterol) is a bronchodilator used to treat or prevent bronchospasm in patients with reversible obstructive airway disease. It works by relaxing muscles in the airways to improve breathing.