Adrenomimetics

Front 1

What is adrenomimetic drugs?

Back 1

Also known as sympathomimetics; mimics stimulation of sympathetic ANS "fight/flight"

Front 2

Direct acting adrenomimetic agents

Back 2

Dopamine
Dipivefrin (dont worry about this drug)

Front 3

Direct acting adrenomimetics

Alpha 1 selective agonists

Back 3

Phenylephrine
Methoxamine
Metaraminol
Xylometazoline
Oxymetazoline
Midodrine

Front 4

Direct acting adrenomimetics

Alpha 2 selective agonist

Back 4

Brimonidine
Apraclonidine

Front 5

Direct acting adrenomimetics

Non-selective B agonists

Back 5

Isoproterenol

Front 6

Direct acting adrenomimetics

B1 selective agonists

Back 6

Dobutamine

Front 7

Direct acting adrenomimetics

B2 selective agonists

Back 7

Metaproterenol
albuterol
Bitolterol
Pirbuterol
Salmeterol
Formoterol
Terbutaline
Ritodrine
**most will end in "ol"

Front 8

Direct acting adrenomimetics

Mechanism of action

Back 8

Directly activate adrenergic receptors--alpha, beta, or both

Front 9

Direct acting adrenomimetics

Therapeutic Uses

Back 9

Epi --> A1 --> vasoconstrict blood vessels in the area

Front 10

Direct acting adrenomimetics

What would be the advantage of vasoconstricting blood vessels in the area where a local anesthetic is applied?

Back 10

Keeps local anesthetic local

Reduces bleeding

Front 11

Direct acting adrenomimetics

Therapeutic Uses

Back 11

Nasal Decongestant
activate A1 receptors --> vasoconstriction --> end result: shrink swollen mucosa

Front 12

Direct acting adrenomimetics

Nasal Decongestant Agents Used

Back 12

Phenylephrine
Xylometazoline
Oxymetazoline

Front 13

Phenylephrine

Back 13

Short duration of action

Front 14

Xylometazoline
Oxymetazoline

Back 14

Long duration of action

Front 15

What is the problem with chronic use of nasal decongestants?

Back 15

Rebound nasal congestion

Front 16

Direct acting adrenomimetics

Therapeutic Uses

Back 16

Allergic Shock or anaphylaxis

Front 17

Effect of EPI on angioedema?

Back 17

A1 --> constrict capillary beds --> counteracts dilation and increased vascular permeability of capillaries

Front 18

Effect of EPI on bronchoconstriction?

Back 18

B2 --> bronchodilation

Front 19

Effect of EPI on Pruritis/urticaria?

Back 19

B --> suppress release of mediators from mast cells

Front 20

Why is NE not the drug of choice to treat anaphylaxis?

Back 20

Low affinity for B2 receptors

Front 21

Direct acting adrenomimetics

Therapeutic Uses

Back 21

Hypotension

A1 --> vasoconstrict --> increased BP

Front 22

Direct acting adrenomimetics

Therapeutic Uses

Back 22

Shock
--hypovolemic
--cardiogenic/septic

Front 23

How would you treat hypovolemic shock?

Back 23

Volume replacement, Dopamine

Front 24

How would you treat cardiogenic/septic shock?

Back 24

Dopamine, Dobutamine, NE

Front 25

Effect of low dose Dopamine?

Back 25

Dopaminergic receptors on renal vasculature --> vasodilation --> increased renal blood flow

Front 26

Higer dose of Dopamine _________?

Back 26

B1 receptors (heart) --> increased CO and BP

Front 27

Even higher dose of Dopamine _________?

Back 27

A1 --> increased PVR, CO, BP

Front 28

Direct acting adrenomimetics

Therapeutic Uses

Back 28

Heart block

B1 --> increase AV conduction

Front 29

Drugs to treat heart block

Back 29

EPI, Isoproterenol

Front 30

Direct acting adrenomimetics

Therapeutic Uses

Back 30

Ventricular fibrillation/pulseless V Tach

Front 31

Drug of choice for V Fib/Pulseless V Tach?

Back 31

EPI

Front 32

Direct acting adrenomimetics

Therapeutic Uses

Back 32

Congestive heart failure

Front 33

Drug of choice for CHF?

Back 33

B1 --> increase force of contraction
Dobutamine, Dopamine

Front 34

Direct acting adrenomimetics

Therapeutic Uses

Back 34

Asthma/COPD

Front 35

Short acting drugs of choice for asthma/COPD

Back 35

Metaproterenol
Albuterol
Bitolterol
Pirbuterol
Terbutaline
"Four ols and a line"

Front 36

Long acting drugs of choice for asthma/COPD?

Back 36

Salmeterol
Formoterol
"For sal for long time"

Front 37

How does Albuterol work for asthma/COPD?

Back 37

Albuterol --> B2 --> relax bronchial smooth muscle --> bronchodilation --> open airways

Front 38

What is the advantage of giving albuterol vs epinephrine/isoproterenol to treat asthma?

Back 38

Less B1 side effects.

Front 39

Direct acting adrenomimetics

Therapeutic Uses

Back 39

Premataure Labor

Front 40

What direct acting adrenomimetic drug is used for premature labor?

Back 40

Terbutaline

Front 41

How does Terbutaline workon premature labor?

Back 41

Activation of B2 receptors cause uterine smooth muscle relaxation --> stop uterine contractions.

Front 42

Direct acting adrenomimetics

Therapeutic Uses

Back 42

Dilate pupils

Front 43

What direct acting adrenomimetic dilates the pupil?

Back 43

Phenylephrine

Front 44

How does Phenylephrine dilate the eye?

Back 44

PE --> A1 --> iris radial smooth muscle --> pupil dilation without cycloplegia.

Front 45

What is cycloplegia?

Back 45

Ciliary muscle paralysis with blurred vision.

Front 46

Direct acting adrenomimetics

Therapeutic Uses

Back 46

Open angle glaucoma

Front 47

What direct acting adrenomimetics are used for OAG?

Back 47

Epinephrine--A and B

Brimonidine--A2
Apraclonidine--A2

Front 48

Direct acting adrenomimetics

Adverse Effects--alpha adrenergic activation

Back 48

A1 receptors on blood vessels

Front 49

What are the alpha adrenergic adverse effects on blood vessels?

Back 49

Reduce peripheral blood flow
Marked elevation in BP --> increase cardiac work --> precipitate cardiac ischemia, MI, HF

Front 50

Direct acting adrenomimetics

Adverse Effects--alpha adrenergic

Back 50

Excessive contraction of blood vessels at infusion site --> ischemia/necrosis

Front 51

Direct acting adrenomimetics

Adverse Effects--alpha adrenergic

Back 51

Rebound nasal congestion

Front 52

Direct acting adrenomimetics

Adverse Effects--alpha adrenergic

Back 52

Mydriasis --> photophobia, may precipitate attack of NAG

Front 53

Direct acting adrenomimetics

Adverse Effects--beta adrenergic

Back 53

B1 on heart --> increased HR --> palpitations, tachy, cardiac arrh.

Front 54

Direct acting adrenomimetics

Adverse Effects--beta adrenergic

Back 54

B1 on heart--> increased HR, force of contraction --> increased workload --> angina

Front 55

Direct acting adrenomimetics

Adverse Effects--beta adrenergic

Back 55

Hyperglycemia

Front 56

Direct acting adrenomimetics

Adverse Effects--beta adrenergic

Back 56

Tremor
B2 --> skeletal muscle --> tremor

Front 57

Direct acting adrenomimetics

Contraindications

Back 57

Cardiovascular Disease
Hyperthyroidism
Diabetes

Front 58

Indirect Acting Adrenomimetic Agents

Back 58

Tyramine
Amphetamine
Methylphenidate
Atomoxetine

Front 59

What indirect acting adrenomimetic agents are CNS stimulants and/or used for ADHD?

Back 59

Amphetamine
Methylphenidate
Atomoxetine

Front 60

What is Tyramine's mechanism of action?

Back 60

--Not a drug
--Comes from gut bacteria and fermented food.
--Metabolized by MAO
Promotes release of NE from the sympathetic nerve terminal.

Front 61

What happens if Tyramine is not metabolized by the liver?

Back 61

HTN crisis.

Front 62

What may happen if a person is taking a drug that inhibits the activity of MAO and eats a lot of cheese and drinks a lot of beer?

Back 62

Hypertensive crisis

Front 63

Mixed Acting Adrenomimetic Agents

Back 63

Ephedrine
Pseudoephredrine

Front 64

What does Ephedrine do?

Back 64

Releases NE from nerve terminals.

Activates A and B receptors

Front 65

What is Ephedrine approved to be used for?

Back 65

Asthma/COPD
Nasal congestion

Front 66

How would ephedrine be useful for treating nasal congestion?

Back 66

Ephedrine --> Release NE --> A1 in blood vessels of nasal mucosa --> decrease nasal congestion

Front 67

What other class of drugs is used for nasal congestion?

Back 67

alpha agonists

Front 68

How would ephedrine be useful for treating asthma?

Back 68

Ephedrine --> B2 on bronchiol smooth muscle --> bronchodilation

Front 69

Ephedrine is seldom used to treat asthma. Why?

Back 69

Side effects and development of B2 agonists (fewer SE)

Front 70

What are adverse effects of Ephedrine?

Back 70

Cardiovascular
--excessive stimulation of heart (B1) --> stroke, MI, sudden death

Front 71

What are the CNS side effects of Ephedrine

Back 71

Insomnia
Nervousness
Anxiety

Front 72

What does psuedoephedrine activate?

Back 72

Directly activates alpha, and to a lesser extent, B; and releases NE from nerve terminal

Front 73

What is psuedoephedrine used for?

Back 73

Nasal decongestant and has fewer CNS side effects than ephedrine.

Front 74

What is the big problem with pseudoephedrine?

Back 74

Difficult to find due to the manufacture of meth.

Front 75

Phenylpropanolamine does what?

Back 75

Releases NE from nerver terminal and is used as a nasal decongestant and weight reduction (Dexatrim)