Pharmacology · chapter 25 · Lower Respiratory Disorder Drugs
Adrenergics and Anticholinergics
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Beta-2 receptors and bronchodilation
One type of beta-adrenergic receptor, beta 2, is predominantly found in the smooth muscles of the lungs, bronchioles, and blood vessels. Stimulating these receptors leads to bronchodilation and vasodilation.
Albuterol is a rescue drug
Albuterol is often used as a rescue medication for acute asthma attacks and as maintenance therapy for COPD (Hsu Bajaj, 2023).
Salmeterol is not for attacks
Salmeterol is used as a maintenance therapy to prevent asthma and should not be used for immediate relief of an asthma attack, whereas levalbuterol is used similarly to albuterol.
Beta adrenergic adverse effects
Common adverse effects include tremors, nervousness, headache, and tachycardia. Cold symptoms, migraine, chest pain, bronchitis, and nausea have also been reported.
Albuterol in severe cardiac disease
Clients with severe cardiac disease should use albuterol only at the direction of their health care provider due to systemic effects on heart rate and blood pressure (DailyMed, Albuterol sulfate, 2023).
Epinephrine in anaphylaxis
Epinephrine is used often as an emergency treatment for allergic reactions and respiratory distress including anaphylaxis. It works by relaxing and opening air passages to allow for easier breathing.
Ephedrine effects and MAOIs
Ephedrine can cause an increase in heart rate and blood pressure, insomnia, and tremors. Clients who have hypersensitivity or who have been taking a monoamine oxidase inhibitor (MAOI) should not use ephedrine (DailyMed, Ephedrine hydrochloride, 2022).
Anticholinergics in older adults
Anticholinergics should be used with caution due to potential side effects, especially in older adults, who may be more susceptible to adverse reactions like cognitive impairment and increased risk of falls.
How ipratropium works
Ipratropium bromide, often administered via inhalation, acts as a bronchodilator by blocking the action of acetylcholine at the muscarinic receptors in the airways.
Tiotropium for long-term COPD
It is primarily used for the long-term maintenance treatment of COPD to reduce symptoms and improve lung function.
Anticholinergic side effects
Side effects of both drugs can include dry mouth, headache, nervousness or dizziness, blurred vision, constipation, and cough.
Glaucoma and urinary retention
Clients with hypersensitivity, narrow-angle glaucoma, and urinary retention should avoid these drugs; they can cause urinary retention and exacerbate symptoms.
Monitor the response to the drug
Monitor the client’s response to the drug, including any changes in breathing effort, rate, and oxygen saturation.
Priming and cleaning the inhaler
Prime the inhaler prior to use by shaking it and spraying into the air for a total of 4 sprays. Clean it after use by rinsing it with water and allowing it to dry.
Terms to know
- Adrenergic drugs
- Adrenergic drugs, also known as sympathomimetic drugs, are a class of medications that that bind to adrenergic receptors throughout the body.
- long-acting beta-2 agonist
- Levalbuterol is a short-acting beta-2 agonist, and salmeterol is a long-acting beta-2 agonist.
- nonselective alpha- and beta-adrenergic agonist
- Ephedrine, a sympathomimetic drug, acts as a nonselective alpha- and beta-adrenergic agonist, meaning it stimulates both types of receptors.
- Anticholinergic drugs
- Anticholinergic drugs block the action of acetylcholine at muscarinic receptors, which are found in numerous organs and tissues throughout the body.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A client with asthma has sudden wheezing and shortness of breath. The client has albuterol and salmeterol inhalers. Which should the nurse tell the client to use now?
- Neither; wait for symptoms to pass
- Both at double the usual dose
- Albuterol
- Salmeterol
Answer: Albuterol
Albuterol is a short-acting rescue medication for acute asthma attacks. Salmeterol is long-acting maintenance therapy and should not be used for immediate relief, and doubling doses exceeds what was prescribed.
A client starts albuterol and reports feeling shaky with a faster heartbeat. How should the nurse interpret this?
- This is a sign of urinary retention.
- These are common adverse effects of beta adrenergics.
- The drug is not working.
- This is an allergic reaction requiring epinephrine.
Answer: These are common adverse effects of beta adrenergics.
Tremors, nervousness, headache, and tachycardia are common adverse effects of beta adrenergics. They do not indicate allergy, drug failure, or urinary retention.
A client with narrow-angle glaucoma has a new order for tiotropium. What should the nurse do?
- Give it; glaucoma is not relevant to inhaled drugs.
- Give it only at night.
- Question the order because clients with narrow-angle glaucoma should avoid these drugs.
- Give it with albuterol to cancel the effect on the eyes.
Answer: Question the order because clients with narrow-angle glaucoma should avoid these drugs.
Clients with hypersensitivity, narrow-angle glaucoma, or urinary retention should avoid ipratropium and tiotropium because they can exacerbate symptoms. Timing or combining drugs does not remove the risk.
A nurse is teaching a client how to use a metered-dose inhaler for an adrenergic drug. Which instructions are correct? Select all that apply.
- Wait at least 15 seconds between inhalations.
- Prime it by shaking it and spraying 4 times into the air.
- Report worsening shortness of breath or wheezing.
- Use extra puffs whenever you feel like it.
- Rinse it with water after use and let it dry.
Answer: Wait at least 15 seconds between inhalations., Prime it by shaking it and spraying 4 times into the air., Report worsening shortness of breath or wheezing., Rinse it with water after use and let it dry.
The client primes the inhaler with 4 sprays, waits at least 15 seconds between inhalations, rinses and dries it, and reports worsening symptoms. Clients should not use more medication than prescribed.
An older adult is starting ipratropium. Which adverse effects should the nurse monitor for? Select all that apply.
- Excess salivation
- Dry mouth
- Blurred vision
- Urinary retention
- Constipation
Answer: Dry mouth, Blurred vision, Urinary retention, Constipation
Ipratropium can cause dry mouth, blurred vision, constipation, and urinary retention, and older adults are more susceptible to anticholinergic reactions. Anticholinergics reduce secretions, so excess salivation is not expected.
A client who takes an MAOI for depression asks whether ephedrine tablets can be used for asthma. What should the nurse say?
- Ephedrine should be taken with the MAOI to boost its effect.
- Ephedrine lowers blood pressure, so it is safe.
- Ephedrine is safe with any antidepressant.
- Clients taking an MAOI should not use ephedrine.
Answer: Clients taking an MAOI should not use ephedrine.
Clients who have been taking an MAOI should not use ephedrine. Ephedrine raises heart rate and blood pressure rather than lowering it.
Where every quote comes from
Section 25.1 Adrenergics and Anticholinergics of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.