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1.26 Sympathetics
Dr. Kapusta
55
Pharmacology
Professional
01/28/2012

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Term
What is the action of EPI when given as a bolus?
Definition
alphas are activated and you have an increased blood pressure with reflexive bradycardia. This is similar to NE given either bolus or infusion
Term
Name the mixed adrenergic agonists and what receptors they bind to?
Definition
NE (alpha1, alpha 2, beta 1); EPI (alpha 1, alpha 2, beta1, beta2); DA (DA, beta1, alpha1)
Term
When do you use NE?
Definition
when you need vascular vasoconstriction like in spinal shock/spinal block or as a topical hemostatic agent
Term
What can you use EPI for?
Definition
asthma, cardiogenic shock, anaphylactic shock, prolong the action of local anesthetics, topical hemostatic agent
Term
What would you use local anesthetic + EPI on a patient taking a beta blocker?
Definition
EPI might diffuse into the vasculature and cause unopposed vasoconstriction
Term
What is low dose dopamine used to treat?
Definition
CHF
Term
Name the alpha 1 agonists?
Definition
phenylephrine, methoxamine, oxymetazoline, tetrahydrozoline, naphazoline, ephedrine/pseudoephedrine
Term
What are teh clinical uses of alpha 1 agonists?
Definition
nasal decongestants; used in eye drops to 'get the red out'; hypotensive states
Term
Name alpha 2 agonists?
Definition
clonidine, guanabenz, guanfacine
Term
Wha are alpha 2 agonists used for?
Definition
hypertension
Term
What is Isoproterenol and what is it used for?
Definition
non selective beta1/beta2 agonist
Term
Name a selective beta 1 agonist.
Definition
dobutamine
Term
What is dobutamine used for?
Definition
used as an ionotropic agent; doesn't affect heart rate too much, just increases force of contraction which makes it useful for heart failure
Term
Name the selective 2 beta agonists?
Definition
albuterol, metaproterenol, terbutaline, isoetharine, bitolterol, ritodrine
Term
What are the selective beta2 agonists used for?
Definition
albuterol, metaproterenol, isoetharine,terbutaline, bitolterol= COPD and Asthma (inhalers)
ritodrine= uterine relaxation
Term
What effect does isoproterenol have on DP, SP, MAP, HR and TPR?
Definition
increases HR, increases SP, decreases DP, decreases TPR. No big change in MAP
Term
What receptors are activated at lower to higher doses of dopamine?
Definition
lower= DA, medium= beta 1, higher= alpha 1
Term
By what mechanism does dopamine treat heart failure?
Definition
natriuretic diuretic
Term
Why do you not want to increase heart rate or TPR in heart failure pts?
Definition
increase in TPR increases the work of the heart. Increases in heart rate could induce arrhythmias
Term
What's another name for low dose dopamine?
Definition
the renal dose
Term
Name a partial alpha 2 agonist?
Definition
methyldopa
Term
How does methyldopa work?
Definition
converted into methylnorepinephrine which acts as a partial agonist at alpha 2 receptors
Term
How do alpha 2 agonists decrease blood pressure?
Definition
works on autoreceptors, and activates alpha 2 receptors in the brain that inhibit downstream sympathetic response
Term
Name non selective alpha 1/2 antagonists?
Definition
phenoxybenzamine, phentolamine,
Term
Compare/contrast phenoxybenzamine and phentolamine.
Definition
phenoxybenzamine is irrefersible; phentolamine is reversible; both are antagonists at alpha 1 and alpha 2 receptors
Term
What is phenoxybenzamine used for?
Definition
nothing; experimental
Term
What is phentolamine used for?
Definition
management of pheochromocytoma, reversal of action of local anesthetic
Term
What are the selective alpha 1 receptor antagonists?
Definition
prazosin, terazosin
Term
What are selective alpha 1 antagonists used for?
Definition
treating blood pressure
Term
Why are alpha1 antagonists preferable over alpha1/2 antagonists for treating blood pressure?
Definition
allows body some control of vasoconstriciton, doesn't block autoreceptors, doesn't affect alpha 2 receptors in the brain
Term
NE released from nerves acts on what lapha receptors?
Definition
alpha 1
Term
Which alpha receptors does circulating EPI bind to?
Definition
alpha 1 and alpha2
Term
What are the nonselective beta 1, beta 2 receptor antagonists?
Definition
propranolol, nadolol, timolol, pindolol, carteolol.
Term
What are the beta 1 blockers?
Definition
atenolol, metropolol, esmolol, acebutolol
Term
What are "cardioselective" beta blockers?
Definition
those that only block beta 1s
Term
Why is it better to block just beta 1s and leave beta 2s alone for people with HTN?
Definition
prevent precipitating an asthma attack
Term
Name the non-selective beta 1, beta 2, alpha 1 antagonists?
Definition
labetalol and carbedilol
Term
What are metropolol and carvedilol used for?
Definition
early stages of heart failure, possibly through a beta arrestin pathway
Term
What are beta blockers used for?
Definition
hypertension, angina, congestive heart failure, myocardial infarction, arrhythmias, anxiety, stage fright, migraines
Term
How does EPI treat cardiogenic shock?
Definition
low dose infusion will activate beta 1s to increase contracility of the heart; low dose will also activate beta 2s which will decrease TPR
Term
How does epinephrine treat anaphylactic shock?
Definition
sudden high dose EPI= 1) beta 1s- increase in CO, 2) alpha 1 and 2- vasoconstriction, 3) beta 2s bronchorelaxation
Term
How does EPI treat neurogenic shock?
Definition
high doses activates alpha 1s increasing vascular tone
Term
name the indirect acting adrenergic agonists?
Definition
Tyramine, ephedrine, speudoephedrine and amphetamines
Term
What is the degredation pathway of NE?
Definition
reuptake 1 into the presyaptic axon terminal (there is also a reuptake 2 on the postsynaptic but its not as important)
Term
What compounds will reuptake 1 bind?
Definition
tyrosin, tyramine, amphetamines, ephedrine, pseudoephedrine, NE
Term
What's the difference between how amphetamines and cocaine work?
Definition
amphetamine- taken up by reputake 1, put in vesicles with NE, triggers release of NE; at high concentrations can block reuptake 1; longer lasting than cocaine
cocaine- blocks reuptake 1
Term
How does reserpine work?
Definition
prevents uptake of dopamine into vesicles
Term
How does guanethadine work?
Definition
inhibits NE release
Term
Name some MAOIs?
Definition
pargyline, tranylcypromine
Term
Which tissues have only sympathetic control?
Definition
blood vessels, sweat glands (sympathetic cholinergic), adrenal glands, pilomotor muscles
Term
Which tissues have only parasympathetic tone?
Definition
bronchioles
Term
What happens to NE taken up by reuptake 2?
Definition
it is degraded by COMT and MAO
Term
What does metyrosine do?
Definition
prevents conversion from tyrosine into DOPA
Term
What are the effects of stimulating adrenergic receptors on the eye?
Definition
iris radial dilator muscle alpha 1= mydriasis
ciliary muscle beta 2 = accomodation for far vision
Term
What adrenergic receptor is responsible for decreased urination and decreased GI motility?
Definition
beta 2
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