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Assessment and monitoring - norepinephrine
Sympathomimetics are medications that mimic the effect of endogenous catecholamines, like norepinephrine and epinephrine. As a result, these medications activate the sympathetic nervous system, which in turn triggers the fight or flight response, ultimately increasing the heart rate and blood pressure, as well as slowing down digestion. This response maximizes blood flow to the muscles and brain.
Now, sympathomimetic medications include dobutamine, dopamine, norepinephrine, epinephrine, and isoproterenol. All of them are administered intravenously, while isoproterenol can also be given intramuscularly, and epinephrine can also be administered intramuscularly, as well as through endotracheal tube or inhalation.
Once administered, sympathomimetic medications act by stimulating adrenergic receptors. Now, there are two main groups of adrenergic receptors: the alpha receptors, and beta receptors. Alpha adrenergic receptors are mainly located on the walls of blood vessels of the skin, as well as the gastrointestinal and genitourinary systems, and when stimulated, they cause vasoconstriction and decreased blood flow to these tissues.
On the other hand, beta receptors have two main subtypes: beta-1 and beta-2. Beta-1 adrenergic receptors are mainly located in the heart, and when activated, they increase the heart rate and contractility, which helps pump out more blood. On the other hand, beta-2 adrenergic receptors are found on smooth muscle cells in the walls of blood vessels supplying skeletal muscles and the brain, so their activation leads to vasodilation and increased blood flow to these tissues; and in the lungs, they cause bronchodilation.
Sympathomimetic medications are drugs that mimic the effects of the sympathetic nervous system. They work by mimicking the effect of endogenous catecholamines, like norepinephrine and epinephrine, and can be used to treat conditions such as cardiac decompensation, shock, anaphylaxis, bronchospasm, and bradycardia post-cardiac arrest. Some common examples of sympathomimetic medications include dobutamine, dopamine, norepinephrine, epinephrine, and isoproterenol.
Once administered, these medications stimulate two types of adrenergic receptors, alpha, and beta. With alpha-adrenergic receptor stimulation, vasoconstriction occurs, whereas stimulation of beta-1 adrenergic receptors causes increased heart rate and contractility, and stimulation of beta-2 adrenergic receptors causes vasodilation and bronchodilation.
Common side effects of sympathomimetics include gastrointestinal disturbances, hypertension, and arrhythmias. Nursing considerations for clients receiving sympathomimetics include monitoring their hemodynamic status; titrating doses as needed; monitoring for side effects; and assessing for the desired therapeutic response. Client education is focused on what to expect during treatment.
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