4.16 Alpha and Beta Receptor Agonists (Catecholamines)

Catecholamines

Epinephrine and norepinephrine (NE) are adrenergics that stimulate the beta and alpha receptors on the target cell. Dopamine has dose-dependent effects on targeted arteries in the kidneys, heart, and brain.

Epinephrine (Alpha and Beta Receptor Agonist):  Epinephrine acts on both alpha- and beta-adrenergic receptors and is used in several routes including intravenously (IV), subcutaneously, intramuscularly, and via inhalation. Epinephrine decreases vasodilation and increases vascular permeability through its alpha-adrenergic receptor action, which can lead to loss of intravascular fluid volume and hypotension. Through its action on beta-adrenergic receptors, epinephrine causes bronchial smooth muscle relaxation and helps alleviate bronchospasm, wheezing, and dyspnea that may occur during anaphylaxis.

Indications for Use: Epinephrine is used for severe allergic reactions (anaphylaxis), acute bronchospasm during asthma attacks, cardiac resuscitation, hypotension in severe shock, or for local injection to control superficial bleeding.

Nursing Considerations Across the Lifespan: Epinephrine is contraindicated for use in fingers, toes, ears, nose, or genitalia when used with local anaesthetic due to the vasoconstrictive action. Contraindicated in clients with narrow-angle glaucoma. Administer with caution to the elderly and those with pre-existing cardiovascular disease. When administering IV, monitor vitals (blood pressure, heart rate and respiratory rate) and cardiovascular and respiratory systems closely; if blood pressure increases sharply, give rapid-acting vasodilators. Monitor IV site for extravasation. Discard IV solution if discoloured.

Epinephrine can be used across the lifespan. It can also be given to pregnant women in the case of anaphylaxis.

Patient Teaching & Education with EpiPen:  Epinephrine formulated in a pen for injection is known as EpiPen.  EpiPen is used for severe allergic reactions after exposure to an allergen like a bee sting. Check expiration date, store at room temperature, and protect from light. Effects fade after 15-20 minutes, so seek medical care immediately.^[1]

Norepinephrine is another catecholamine, and is used as a peripheral vasoconstrictor (due to alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries (due to beta-adrenergic action) in clients with critically low blood pressure.

Now let’s take a closer look at the medication grid on epinephrine and norepinephrine in Table 4.16a.^[2][3] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.

Table 4.16a  Epinephrine and Norepinephrine Medication Card

Dopamine is another type of catecholamine specifically used to improve perfusion of organs, improve cardiac output, and increase blood pressure.

Mechanism of Action: In low doses, dopamine mainly stimulates dopamine receptors and dilates the renal vasculature. Moderate doses of dopamine stimulate beta receptors for a positive inotropic effect. Higher doses also stimulate alpha receptors, constricting blood vessels and increasing blood pressure.

Indications for Use:  Dopamine is used to treat shock, improve perfusion to vital organs, increase cardiac output, and correct hypotension.

Nursing Considerations Across the Lifespan: During infusion, frequently monitor blood pressure, cardiac output, urine output, and colour and temperature of limbs. If urine flow decreases without hypotension, notify prescriber because dosage may need to be reduced. Concurrent alpha or beta-blockers can antagonize dopamine. Adverse effects include hypotension, tachycardia, palpitations, and decreased blood flow to the extremities.

Dopamine is safe to adminster to pediatric and older adults.

Patient Teaching & Education: Clients should contact their health care provider immediately if experiencing unusual sweating, dizziness, heart palpitations, or chest pain.

Now let’s take a closer look at the medication grid on dopamine in Table 4.16b.^[4][5] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.

Table 4.16b Dopamine Medication Card