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adrenergicandanti-adrenergicdrugsmoa.pptx
- 4. Sympathomimetic oradrenergic in sympathetic nervous system—neurotransmitters are ____________ Parasympathomimetic or cholinergic are used to describe parasympathetic system— neurotransmitter is _____________
- 5. Fight or flightresponse results in: 1. Increased BP 2. Increased blood flow to brain, heart and skeletal muscles 3. Increased muscle glycogen for energy 4. Increased rate of coagulation 5. Pupil dilation
- 6. Alpha—A1 andA2 Beta—B1, B2, B3 Dopamine—subsets D1-5
- 7. Alpha 1—smoothmuscle contraction Alpha 2-negative feedback causes less norepinephrine to be released so BP is reduced Beta 1—increased heart rate Beta 2—bronchodilation Beta 3—actual site for lipolysis
- 8. Direct adrenergicdrug action Affects postsynaptic alpha 1 and beta receptors on target effector organs Examples: epinephrine, Isuprel, norepinephrine, phenylephrine
- 9. 2. Indirectadrenergic drug action occurs by stimulation of postsynaptic alpha 1, beta 1 and beta 2 receptors.Cause release of norepinephrine into the synapse of nerve endings or prevent reuptake of norepinephrine. Examples include cocaine and TCAs
- 10. 3. mixedaction. Combination of direct and indirect receptor stimulation Examples are ephedrine and pseudoephedrine
- 11. Stimulation ofalpha 2 receptors in CNS is useful in decreasing BP Most body tissues have both alpha and beta receptors Effect occurs 2ndary to receptor activated and number of receptors in the particular body tissue
- 12. Some drugsact on both receptors--dopamine Some are selective--Isuprel
- 13. Emergency drugsin treatment of acute cardiovascular, respiratory and allergic disorders In children, epinephrine may be used to treat bronchospasm due to asthma or allergic reactions Phenylephrine may be used to treat sinus congestion
- 14. Stokes Adams Shock Inhibition of uterine contractions For vasoconstrictive and hemostatic purposes
- 15. Cardiac dysrhythmias,angina pectoris Hypertension Hyperthyroidism Cerebrovascular disease Distal areas with a single blood supply such as fingers, toes, nose and ears Renal impairment use caution
- 16. Epinephrine—prototype Effectsinclude: increased BP, increased heart rate, relaxation of bronchial smooth muscle, vasoconstriction in peripheral blood vessels
- 17. Increased glucose,lactate, and fatty acids in the blood due to metabolic effects Increased leukocyte and increased coagulation Inhibition of insulin secretion
- 18. Affects bothalpha and beta receptors Usual doses, beta adenergic effects on heart and vascular smooth muscle will predominate, high doses, alpha adrenergic effects will predominate Drug of choice for bronchospasm and laryngeal edema of anaphylaxis
- 19. Excellent forcardiac stimulant and vasoconstrictive effects in cardiac arrest Added to local anesthetic May be given IV, inhalation, topically Not PO
- 20. Physiologic antagonistto histamine Those on beta blockers may need larger doses Drug of choice in PEA. Vasopressin has now become drug of choice in ventricular tachycardia Single dose of Vasopressin, 40 units IV
- 21. Ephedrine isa mixed acting adrenergic drug. Stimulates alpha and beta receptors. Longer lasting than epinephrine. See in Primatene mist
- 22. Used forbronchodilating and nasal decongestant effects
- 23. Synthetic catecholaminethat acts on beta 1 and 2 receptors Stimulates heart, dilates blood vessels in skeletal muscle and causes bronchodilation No alpha stimulation Used in heart blocks (when pacemaker not available) and as a bronchodilator
- 24. Pure alpha Decreases CO and renal perfusion No B1 or B2 effects Longer lasting than epinephrine Can cause a reflex bradycardia Useful as a mydriatic
- 25. Affects renalperfusion Can induce cardiac dysrhythmias Increases myocardial oxygen consumption May decrease perfusion of liver Tissue necrosis with extravasation
- 26. Do notgive epinephrine and Isuprel at same time or within 4 hours of each other. Could result in serious dysrhythmias.
- 27. Sympatholytic Blockor decrease the effects of sympathetic nerve stimulation, endogenous catecholamines and adrenergic drugs
- 28. Can occurby blocking alpha 1 receptors postsynaptically Or by stimulation presynaptic alpha 2 receptors. Results in return of norepineprhine to presynaptic site. Activates alpha 2 resulting in negative feedback. Decreases release of additional norepinephrine.
- 29. Alpha 2agonists inhibit release of norepinephrine in brain; thus, decrease effects on entire body Results in decrease of BP Also affects pancreatic islet cells, thus some suppression of insulin secretion
- 30. Act onskin, mucosa, intestines, lungs and kidneys to prevent vasoconstriction Effects: dilation of arterioles and veins, decreased blood pressure, pupillary constriction, and increased motility of GI tract
- 31. May activatereflexes that oppose fall in BP such as fluid retention and increased heart rate Can prevent alpha medicated contraction of smooth muscle in nonvascular tissues Thus, useful in treating BPH as inhibit contraction of muscles in prostate and bladder
- 32. Minipress (prazosin)—prototype. Hytrin (terazosin) and Cardura (doxazosin)— both are longer acting than Minipress.
- 33. Flomax (tamsulosin).Used in BPH. Produces smooth muscle relaxation of prostate gland and bladder neck. Minimal orthostatic hypotension. Priscoline (tolaxoline) used for vasospastic disorders. Pulmonary hypertension in newborns. Can be given sub Q, IM or IV.
- 34. Catapres (clonidine).PO or patch. Tenex (guanfacine) Aldomet (methyldopa). Can give IV. Caution in renal and hepatic impairment.
- 35. Prevent receptorsfrom responding to sympathetic nerve impulses, catecholamines and beta adrenergic drugs.
- 36. Decreased heartrate Decreased force of contraction Decreased CO Slow cardiac conduction Decreased automaticity of ectopic pacemakers
- 37. Decreased reninsecretion from kidneys Decreased BP Bronchoconstriction Less effective metabolism of glucose. May result in more pronounced hypoglycemia and early s/s of hypoglycemia may be blocker (tachycardia)
- 38. Decreased productionof aqueous humor in eye May increase VLDL and decrease HDL Diminished portal pressure in clients with cirrhosis
- 39. Alpha 1blocking agents are used for tx of hypertension, BPH, in vasospastic disorders, and in persistent pulmonary hypertension in the newborn May be useful in treating pheochromocytoma May be used in Raynaud’s or frostbite to enhance blood flow
- 40. Used forextravasation of potent vasoconstrictors (dopamine, norepinephrine) into subcutaneous tissues
- 41. Alpha 2agonists are used for hypertension— Catapres Epidural route for severe pain in cancer Investigationally for anger management, alcohol withdrawal, postmenopausal hot flashes, ADHD, in opioid withdrawal and as adjunct in anesthesia
- 42. Mainly forcardiovascular disorders (angina, dysrhythmias, hypertension, MI and glaucoma) In angina, beta blockers decrease myocardial oxygen consumption by decreasing rate, BP and contractility. Slow conduction both in SA node and AV node.
- 43. Possibly workby inhibition of renin, decreasing cardiac output and by decreasing sympathetic stimulation May worsen condition of heart failure as are negative inotropes May reduce risk of “sudden death”
- 44. Decrease remodelingseen in heart failure In glaucoma, reduce intraocular pressur by binding to beta-adrenergic receptors in ciliary body, thus decrease formation of aqueous humor
- 45. Inderal (propranolol)is prototype Useful in treatment of hypertension, dysrhythmias, angina pectoris, MI Useful in pheochromocytoma in conjunction with alpha blockers (counter catecholamine release) migraines
- 46. In cirrhosis,Inderal may decrease the incidence of bleeding esophageal varices Used to be contraindicated in heart failure, now are standard Known to reduce sudden death Often given with ACEIs Indications include: htn, angina, prevention of MI
- 47. Acetutolol, atenolol,betaxolol, esmolol, and metoprolol are relatively cardioselective These agents lose cardioselection at higher doses as most organs have both beta 1 and beta 2 receptors Byetta is new agent that is cardioselective
- 48. Carteolol, levobunolol,metipranolol, nadolol, propranolol, sotalol and timolol are all non- selective Can cause bronchoconstriction, peripheral vasoconstriction and interference with glycogenolysis
- 49. Labetalol andcarvedilol (Coreg) block alpha 1 receptors to cause vasodilation and beta 1 and beta 2 receptors which affect heart and lungs Both alpha and beta properties contribute to antihypertensive effects May cause less bradycardia but more postural hypotension Less reflex tachycardia
- 50. Have chemicalstructure similar to that of catecholamines Block some beta receptors and stimulate others Cause less bradycardia Agents include: Sectral (acebutolol), Cartrol (carteolol), Levatol (penbutolol) and Visken (pindolol)
- 51. In txfor BPH, patient should be evaluated for prostate cancer With alpha 2 agonists, sudden cessation can cause rebound BP elevation With alpha 1 blockers, first dose syncope may occurr from hypotension. Give low starting dose and at hs. May also cause reflex tachycardia and fluid retention.
- 52. With significantbradycardia, may need med with ISA such as pindolol and penbutolol Patient with asthma, cardioselectivity is preferred For MI, start as soon as patient is hemodynamically stable
- 53. Should bediscontinued gradually. Long term blockade results in increase receptor sensitivity to epinephrine and norepinephrine. Can result in severe hypertension. Taper 1-2 weeks.
- 54. Monotherapy inAfrican Americans is less effective than in Caucasians. Trandate (labetalol) with both alpha and beta effects has been shown to be more effective in this population than Inderal, Toprol or timolol.
Editor's Notes
- #5 2. Decreased flow to viscera Also increased rate and depth of respiration, increased blood sugar, increased mental acuity, increased muscle strength
- #6 Alpha 1 receptors are in blood vessels, kidney, liver, pregnant uterus, male sexual organs, intestinal smooth muscle. Causes vasoconstriction, decreased renin secretion , uterine contraction Alpha 2—Inhibits release of norepinephrine. affects vascular smooth muscle, inhibits insulin secretion, platelet aggregation B1—affects heart and kidneys B2—affects lundgs, liver, blood vessel vasodilation, decreased motility and tone Dopamine—blood vessels of kidneys, heart, viscera; brain
- #13 Phenylephrine can cause rebound congestion
- #14 Shock after volume has been restored
- #16 Vasoconstriction shunts blood to heart and brain
- #51 May need diuretics