Children are at greater risk for complications associated with the use of adrenergic blocking agents, including bradycardia, difficulty breathing, and changes in glucose metabolism. The safety and efficacy for use of these drugs has not been established for children younger than 18 years of age. If one of these drugs is used the dose for these agents needs to be calculated from the child’s body weight and age. It is good practice to have a second person check the dose calculation before administering the drug to avoid potential toxic effects. Three adrenergic blocking agents have established pediatric doses, and they might be the drugs to consider when one is needed: Prazosin is used to treat hypertension, and phentolamine, which is used during surgery for pheochromocytoma. Children should be carefully monitored and supported when these drugs are given. Propranolol as an oral solution form is used for the treatment of proliferating infantile hemoangioma in children 5 weeks to 5 months of age
Adults being treated with adrenergic blocking agents should be cautioned about the many adverse effects associated with the drugs. Patients with diabetes need to be reeducated about ways to monitor themselves for hyperglycemia and hypoglycemia because the sympathetic reaction (sweating, feeling tense, increased heart rate, rapid breathing) usually alerts patients that there is a problem with their glucose levels. Patients with severe thyroid disease are also at high risk for serious adverse effects when taking these drugs, and if one of them is needed the patient should be monitored very closely. Propranolol and metoprolol are associated with more CNS adverse effects than other adrenergic blockers, and patients who have CNS complications already or who develop CNS problems while taking an adrenergic blocker might do better with a different agent.
In general, there are no adequate studies about the effects of adrenergic blockers during pregnancy and lactation, and they should be used only in those situations in which the benefit to the mother is greater than the risk to the fetus or neonate. Adrenergic blockers can affect labor, and babies born to mothers taking these drugs may exhibit adverse CV, respiratory, and CNS effects. Many of these drugs were teratogenic in animal studies. Because of a similar risk of adverse reactions on the baby, nursing mothers should find another way to feed the baby if an adrenergic blocking drug is needed.
Older patients are more likely to experience the adverse effects associated with these drugs—CNS, CV, GI, and respiratory effects. Because older patients often also have renal or hepatic impairment, they are more likely to have toxic levels of the drug related to changes in metabolism and excretion. The older patient should be started on lower doses of the drugs and should be monitored very closely for potentially serious arrhythmias or blood pressure changes. Bisoprolol is often a drug of choice for older patients who require an adrenergic blocker for hypertension because it is not associated with as many problems in the elderly and regular dosing profiles can be used.
bradycardia – n. 心搏徐缓
glucose – n. 葡萄糖
metabolism – n. 代谢
efficacy – n. 功效，有效性
prazosin – n. 哌唑嗪
phentolamine – n. 酚妥拉明
pheochromocytoma – n. 嗜铬细胞瘤
propranolol – n. 普萘洛尔
proliferating – n. 增殖的
infantile – n. 婴儿的
hemoangioma – n. 血管瘤
sympathetic reaction – 交感反应
metoprolol – n. 美托洛尔
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1. A patient is ordered to start an IV Dopamine drip at 15 mcg/kg/min. The patient weighs 270 lbs. You have a bag of Dopamine that reads 800 mg/500 mL. What will you set the IV pump drip rate (mL/hr) at?
A. 69 mL/hr
B. 1.2 mL/hr
C. 34.5 mL/hr
D. 62 mL/hr
2. Which of the following instructions should be given to the hypertensive patient before taking his first dose of prazosin?
A. Take your medication with a glass of milk.
B. Take your medication on an empty stomach.
C. Take your medication at bedtime.
D. Take your medication in the morning after meals.
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答案 Answer
1. A. 69 mL/hr 2. C. Take the medication at bedtime. Rationale: Prazosin is an alpha-1 adrenergic blocking agent that dilates blood vessels, and can result in the first-dose phenomenon of orthostatic hypotension with dizziness and possibly syncope, and should therefore be taken at bedtime.
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