Adrenergic Agents Flashcards
Epinephrine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
Direct sympathomimetic
Mechanism?
b-agonist at low doses (BLOW)
a1-agonist at high doses
Net effect?
b1-agonist -> increase HR/contractility (increase CO/BP)
b2-agonist -> bronchodilation
a1-agonist -> vasoconstriction (increased BP)
Clinical Uses?
cardiac arrest and severe hypotension
broncospasm and anaphylaxis
Wide-angle glaucoma (ophthalmic solution)
Side effects?
HTN, cardiac arrhythmias, MI, pulmonary edema, headache, axiety
Similar drugs?
Adrenaline
Contraindications?
propranolol
FYI: Epinephrine is metabolized by COMT, so use if patient requires intervention and is taking MAOi
Norepinephrine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Norepinephrine
Class?
Direct Sympathomimetic
Mechanism?
a1 agonist
a2 agonist
b1 agonist
Net effect?
a1 agonist -> vasoconstriction (increased BP)
b1 agonist -> increase HR/contractility
Clinical Uses?
severe hypotension and shock
Side effects?
angina, MI, cardiac arrhythmias, decrease renal/GI flow
Similar drugs? (1)
Noradrenaline
Contraindications?
use cautiously in patients who use MAO inhibitors, since it is metabolized by both COMT and MAO. Use Epi if patient is on MAOi
Dopamine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
Direct sympathomimetic
Mechanism?
D1-agonist at very low doses
b1 agonist at low doses (B-LOW)
a1 agonist at high doses (a-HIGH)
Net effect?
a1 -> vasoconstriction (increase BP)
b1 -> increase HR/contractility
D1 -> increase renal perfusion due to vasodilaton (maintains adequate perfusion to vital organs in patients with renal failure)
Clinical Uses?
severe hypotension, shock
Side effects?
cardiac arrhythmias, angina, hypertension, nausea
Similar drugs?
Ionotropin
Contraindications?
DOES NOT CROSS BBB - not useful for treating Parkinsons
Dobutamine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
Direct Sympathomimetic
Mechanism? b1 agonist b2 agonist (mild)
Net effect?
b1 -> increase HR, contractility (increase CO)
b2 -> mild vasodilation
Clinical Uses?
cardiogenic shock
Side effects?
cardiac arrhythmias, angina, hypotension, headache
Similar drugs?
none
Contraindications?
none
Cocaine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
Indirect Sympathomimetic
Mechanism?
- blocks Na/K ATPase that is responsible for reuptake of NE, Serotonin, and Dopamine
- block VG Na channels
Net effect?
- potentiate the effects of NE, serotonin, and dopamine
- block repolarziation/anesthetic effect
Clinical Uses?
local anesthetic for ENT surgery
Side effects?
HTN, drug abuse, cardiac ischemia/infarction, cardiac arrhythmias
Similar drugs?
Reserpine - inhibits the neuron’s ability to store NE, Dopamine, and serotonin; used in the past to treat HTN, but is rarely used now because it has been shown to cause serious psychiatric depression
Contraindications?
none
Amphetamine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class? Indirect sympathomimetic
Mechanism? stimulates release of Epi/Dopamine/NE/serotonin
Net effect? Psychostimulant
Clinical Uses? ADHD
Side effects?
Similar drugs? Adderol
Contraindications?
Tyramine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class? Indirect sympathomimetic found in wine/cheese
Mechanism? stimulates NE and dopamine release
Net effect? increase BP with subsequent decrease in HR (due to baroreflex)
Clinical Uses?
Side effects?
Similar drugs?
Contraindications? if a person is taking MAOi, patients would experience severe vasoconstriction due to prolonged appearance of NE; results in HTN crisis
Phenylephrine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
Adrenergic Agonist
Mechanism?
a1 agonist
Net effect?
systemic vasoconstriction
pupil dilation
nasal vasoconstriction (topical) which leads to a decrease in mucosal secretions
Clinical Uses?
hypotension, shock
nasal congestion
mydriasis for retinal examination
Side effects? cardiac arrhythmias (reflex bradycardia), headache
Similar drugs?
none
Contraindications?
none
Midodrine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
Adrenergic agonist
Mechanism?
a1 agonist
Net effect?
systemic vasoconstrction
Clinical Uses?
orthostatic hypotention
Side effects?
supine HTN, headache, urinary retention
Similar drugs?
none
Contraindications?
none
Clonidine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
adrenergic agonist
Mechanism?
a2 agonist in vasomotor centers of medulla –> inhibits release of NE/NT
Net effect?
decreased central adrenergic activity with a resulting decrease in vasoconstriction, CO, and HR
Clinical Uses?
HTN
Sideeffects?
Rebound HTN if the drug is withdrawn too quickly, bradycardia, sedation
Similar drugs?
Methyldopa
Contraindications?
Patients with heart failure or heart block simply because it would exacerbate the situation.
Isoproterenol
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
Adrenergic agonist
Mechanism?
b1 agonist
b2 agonist
Net effect?
b1 agonist - increase HR/contractility (increase CO, BP)
b2 agonist - increase peripheral vasodilation, decerase MAP, and bronchodilation
Clinical Uses?
Torsades de pointes, cardiac arrest, complete heart block, severe asthma attacks
Side effects?
tachyarrhythmias (b1), anxiety, pulmonary edema
Similar drugs?
none
Contraindications?
none
Albuterol
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (3)
Contraindications?
Class?
adrenergic agonist
Mechanism?
b2 agonist
Net effect?
bronchodilation, K shifts into the cell
Clinical Uses?
asthma, hyperkalemia
Side effects?
tachycardia, tremor, anxiety
Similar drugs?
Pirbuterol, bitolterol, salmeterol (PBS)
Contraindications?
Tertbutaline
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
Adrenergic agonist
Mechanism?
b2 agonist
Net effect?
bronchodilation, uterine vasodilation (contractions)
Clinical Uses?
Delay preterm labor by reducing uterine contractions, reduce bronchospasms
Side effects?
tachycardia, tremor (decreased BP), anxiety, dizziness chest pain
Similar drugs?
none
Contraindications?
none
Methyldopa
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
adrenergic agonist
Mechanism?
agonist of a2 receptors in the vasomotor centers of the medulla to inhibit the release of NE/NTs
Net effect?
decrease in central adrenergic activity with a resulting decrease in vasoconstriction and CO
Clinical Uses?
HTN
Side effects?
orthostatic hypotension, sedation, dizziness, rebound HTN, bradycardia in sinus node disease
Similar drugs?
clonidine
Contraindications?
additive effect with other anti-hypertensives
additive effect with other CNS drugs
Phenoxybenzamine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
adrenergic antagonist
Mechanism?
irreversible a1-receptor antagonist
Net effect?
vasodilation, decrease BP
Clinical Uses?
pheochromocytoma, peripheral vasospasms
Side effects?
orthostatic hypotension, tachycardia, nasal congestion, ejaculation inhibition
Similar drugs?
Phentolamine
Contraindications?
Phentolamine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class? adrenergic antagonist
Mechanism? blocks a1 receptors
Clinical Uses? HTN crisis or when propranolol and epi are accidently given together
Side effects? tachycardia, hypotension
Similar drugs?
Contraindications?
Prazosin
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
adrenergic antagonist
Mechanism?
a1 antagonist
Net effect?
peripheral vasodilation, decrease BP, decrease prostatic and bladder neck contraction. NO REFLEX TACHYCARDIA
Clinical Uses?
HTN, BPH
Side effects?
First-dose syncope (due to severe hypotension), orthostatic hypotension
Similar drugs?
none
Contraindications?
additive effects with other anti-hypertensives, esp. diuretics
Propranolol
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
adrenergic antagonist
Mechanism?
b1 antagonist
b2 antagonist
Net effect?
b1 antagonist - decrease HR/contractility -> decrease CO, MAP
b2 antagonist - bronchoconstriction
Clinical Uses?
HTN, CD, tachycardia associated with hyperthyroidism
migrants
Side effects?
Bronchoconstriction, fasting hypoglycemia, arrhythmias, mild heart block in severe CHD
Similar drugs?
none
Contraindications?
additive effects with other anti-hypertensive drugs, additive AV block with Calcium Entry Blockers (CEBs)
Carvedilol
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
adrenergic antagonist
Mechanism?
a1 antagonist
b antagonist
Net effect?
a1 antagonist - vascular smooth muscle relaxation -> decrease BP
b1 antagonist - decrease HR/contractility -> decrease CO
b2 antagonist - bronchoconstriction
Clinical Uses?
chronic CHF, HTN crisis
Prevents remodeling of the myocardium
can be used for pregnant women.
Side effects?
dizziness, hypotension, bradycardia
Similar drugs?
Contraindications?
patients wiht bradycardia, heartblock, CHF, asthma, shock, cardiomyopathy, pheochromocytoma, decrease dose in patients with impaired liver function
Pregnancy class D
Metoprolol
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
adrenergic antagonist
Mechanism?
b1 antagonist
some b2 antagonism
Net effect?
decreased HR/contractility -> decrease CO
Clinical Uses?
HTN, tachycardia, CAD
Side effects?
bronchoconstriction
mild heart block in severe CHF
Similar drugs?
Atenolol
Contraindications?
Additive effects with other HTN drugs
Additive AV block with CEBs
