Adrenergic agents

Question 1

Alpha 1 receptors

Answer 1

Eyes, BV, Urinary bladder, Nerve ends, Pancreas

Question 2

α1 Eyes

Answer 2

m. Dilatator p. Contraction - mydriasis

Question 3

α1 Blood vessels

skin, visceral

Answer 3

Arterioles
Venules

Contraction - ↑diastol.pressure,↑heart afterload
Contraction - ↑heart preload

Question 4

α1 Urinary bladder

Answer 4

Sphincters ↑ Muscular tone

Question 5

α2 Nerve ends

autoreceptors

Answer 5

Presynaptic pole ↓ NE release adn synthesis

Question 6

α2 Pancreas

Answer 6

Beta cells ↓ Secretion of insulin

Question 7

ß1 Eyes

Answer 7

Ciliar epithelium ↑ Secretion of intraocular fluid

Question 8

ß1>ß2

Heart

Answer 8

SA node
AV node
Atria/ventricules
His-Purkinje fibers
↑ Heart rate- «+» chronotropic e.
↑ Conduction velocity - «+» dromotropic e.;
↑Automatism
↑Contractility- «+» inotropic e.
↑Automatism

Question 9

ß2 Blood vessels
(except skin, mucosa,
cerebral b/v)

Answer 9

Arterioles
Venules
Relaxation- ↓diastol.pressure (skeletal mm.),
↓heart afterload
↓heart preload

Question 10

ß2 Lungs Bronchioles

Answer 10

↓ Muscle tone

Question 11

α1,ß2 Liver

Answer 11

↑glycogenolysis ↑glyconeogenesis

Question 12

ß2

Pancreas

Answer 12

Beta cells ↑ Secretion of insulin

Question 13

ß2, ß3 Urinary

bladder

Answer 13

m.Detrusor ↓Muscle tone

Question 14

ß1 Kidney

Answer 14

↑Release of renin

Question 15

ß2 Uterus

Answer 15

Myometrium ↓ Muscle tone

Question 16

ß2 Skeletal

muscles

Answer 16

↑ Muscle tone
↑ glycogenolysis,
↑K uptake in cells

Question 17

EPINEPHRINE

Answer 17

Vasoconstrictive / vasodilatory, cardiotonic
(«+» inotropic effect), «+» Chrono-,
dromotropic effect, bronchodilatory,
mydriatic action

Receptor affinity low doses B1 & B2
high doses A1, B1 & B2

=>Anaphylactic shock
=>Asystolia
=>Topically - in combination with local anesthetics

i.m, i/v

Question 18

NOREPINEPHRINE

Answer 18

Vasoconstrictive, cardiotonic («+» inotropic effect), mydriatic effect, Reflector bradycardia

Receptor affinity A1,A2 & B1

Norepinephrine doesn’t cause bronchodilation but causes increase myocardial oxygen demand

=>Acute hypotension - collapse SBP < 70 mm Hg

Question 19

PHENYLEPHRINE

Answer 19

α1 adrenomimetic agents
Local action vasoconstrictors - nasal decongestants

Systemic vasoconstrictive effect → hypertensive effect (↑ BP),
Causes reflector (indirect effect) «-» chronotropic effect
Mydriatic effect

=> Acute rhinnitis, nose bleeding
=>Acute hypotension
=>Paroxysmal ventricular tahycardia

Question 20

CLONIDINE

Answer 20

α2 adrenomimetic agents

1. hypotensive effects (vasomotor center) of central action
   Stimulation of central postsynaptic α2 receptor…↓SANS impulsation…Peripheral vasodilatation
   In vasculature peripheral presynaptic autoreceptor and
   postsynaptic α2 stimulation

Bradycardizing effect

Rebound effect - BP↑

2. Regulates brain subcortical activity.
   ↓ pain impulse transmission in brain
   => Hypertension, hypertensive crisis

Question 21

SALBUTAMOL

Answer 21

β2 adrenomimetic agents - Bronchodilatators

1. ↓ intracellular calcium concentration,
Relaxation of nrochial smooth muscle →
bronchodilation
=> Bronchial asthma attack
2. Tocolytic effect
(inhibition of uterus contractions)
=>Tocolysis

SE: tremor, tachycardia (β2 heart)
MI: reduces effects of vasoconstrictive agents

Question 22

DOXAZOSINE

Answer 22

α1 selective blockers

1. Vasodilatation of peripheral blood vessels, vein and artery
   ↓peripheral resistance (reduces afterload),
   increases capacity of veins (reduces preload)
   and ↓ BP, hypotensive effect
   =>Hypertension
2. ↓ urethral tone and relaxes prostate muscle
   ↓ urination disorders
   => Symptomatic therapy of prostate
   adenoma

SE: first-dose orthostatichypotension and
syncope, reflector tachycardia

Question 23

BAB

1st gen

Answer 23

Nonselective β1, β2 adrenoblockers
PROPANOLOL

=>Coronary artery disease
=>Tachycardia, thyrotoxicosis, prevention of migraine attacks
=> Atrial fibrilation (Class II antiarrhythmics)

SE: bradycardia, AV block, risk of bronchial obstruction,
sexual dysfunction, Raynaud syndrome
MI: Due to non-selective action, P may affect the effects of adrenopositive agents
For diabetic patients its better to use cardioselective BAB as non selective can mask effects of insulin overdose
Sudden stopping of drug can cause rebound effect!

TIMOLOL
eye drops
↓ intraocular fluid secretion in the ciliary body  reduces IO pressure
=>Glaucoma

Question 24

BAB

2nd gen

Answer 24

Cardioselective β1 adrenoblockers
METOPROLOL

Bisoprolol highly selective β1
=> CAD
=>Hypertension
=>Atrial fibrilation (Class II antiarrhythmics)
=>CHF (chronic heart failure)
=>Prophylaxis of migraine attacks

Cardioselectivity β1…

• less impact on b / v smooth muscle, bronchi, uterus and
• electrolyte balance (risk of hyperkalemia is lower)
• safer for patients with asthma, * DM and Raynaud syndrome.
• β2 blockade reduces insulin secretion and glycogenolysis

Question 25

BAB

3rd gen

Answer 25

α1, β1, β2 adrenoblockers
CARVEDILOL

Cardiodepressant + reduces peripheral vascular resistance
+ antioxidant properties
(cardioprotection, inhibits lipid peroxidation)

=>Chronic heart failure
=>CAD
=>Hypertension

Question 26

RAYNAUD SYNDROME

Answer 26

BAB causes peripheral vasoconstriction…limb freezing.

Raynaud syndrome is a group of peripheral circulatory disorders characterized by episodic stenosis of limb arteries and arterioles.
Usually provoked by cold or stress.
Manifested as sudden paleness or cyanosis of the fingers and toes,
including the earlobe and nose