adrenergic drugs (agonists and antagonists)

Question 1

Direct sympathomimetics - drugs and mechanism of action

Answer 1

1. albuterol - β2 more than β1
2. salmoterol - β2 more than β1
3. dobutamine - β1 more than β2, α
4. dopamine - D1=D2 more than β, and β more than α
5. epinephrine - β more than α (but α predominate at high doses)
6. fenodlopam - D1
7. isoproterenol - β1 = β2
8. midodrine - a1
9. norepinephrine - a1 more than α2 more than β1
10. phenylephrine - α1 more than α2

Question 2

Albuterol, slameterol - mechanism of action and clinical use

Answer 2

β2 more than β1
albuterol for acute asthma or COPD
salmeterol for long term asthma or COPD control

Question 3

dobutamine - mechanism of action and clinical use

Answer 3

β1 more than β2, α

1. HF (inotropic more than chronotropic)
2. cardiac stress testing

Question 4

epinephrine - mechanism of action and clinical use

Answer 4

β more than α (but α predominate at high doses)

1. anaphylaxis 2. asthma 3. open-angle glaucoma

Question 5

dopamine - mechanism of action and clinical use

Answer 5

D1=D2 more than β, and β more than α
1. unstable bradycardia
2. HF 3. shock
β predominates at lower doses, α at higher

Question 6

fenoldopam - mechanism of action and clinical use

Answer 6

D1 1. postoperative hypertension 2. hypertensive crisis 3. vasodilatero (coronary, peripheral, renal, splachinc) 4. promotes natriureis

Question 7

fenoldopam - side effects

Answer 7

can cause hypotension and tachycardia

Question 8

isoproterenol - mechanism of action and clinical use

Answer 8

β1=β2

electrophysiologuc evaluation of tachyarrhythimas

Question 9

isoproterenol - side effects

Answer 9

can worsen ischemia

Question 10

Milodrine - mechanism of action and clinical use

Answer 10

α1

autonomic insifficiency and postural hypotension

Question 11

Milodrine - side effects

Answer 11

may exacerbate supine hypertension

Question 12

norepinephrine - mechanism of action and clinical use

Answer 12

a1 more than α2 more than β1
hypotension
spetic shock

Question 13

phenylephrine - mechanism of action and clinical use

Answer 13

α1 more than α2

hypotension (vasoconstriction), ocular procedures (mydriatic), rhinitis (decongestant)

Question 14

Indirect sympathomimetics - drugs

Answer 14

1. amphetamines
2. cocaine
3. ephedrine

Question 15

amphetamine - mechanism of action

Answer 15

1. indirect general agonist
2. reuptake inhibitor
3. releases stored catecholamines

Question 16

cocaine - mechanism of action

Answer 16

1. indirect general agonist

2. reuptake inhibitor

Question 17

ephedrine - mechanism of action

Answer 17

1. indirect general agonist

2. releases stored catecholamines

Question 18

amphetamine - clinical use

Answer 18

1. Narcolepsy
2. obesity
3. ADHD

Question 19

ephedrine - clinical use

Answer 19

1. Nasal congestion
2. urinary incontinence
3. hypotension

Question 20

cocaine - clinical use

Answer 20

vasoconstriction and local anesthesia

Question 21

cocaine - β blockers

Answer 21

never give β-blockers if cocaine intoxication is suspected –> it can lead to unopposed α1 activation –> extreme hypertension

Question 22

epinephrine vs norepinephrine according to effects at β2 receptors

Answer 22

epinephrine has significantly stronger effect at β2 receptor than norepinephrine

Question 23

norepinephrine effects on cardiovascular system

Answer 23

increases systolic and diastolic pressures (α1 mediated) –> increases MAP

Question 24

isoproterenol effects on cardiovascular system

Answer 24

causes β2 mediated vasodilation resulting in decreased MAP and increaed heart rate through β1 and reflex activity

Question 25

norepinephrine vs epinephrine vs isoproterenol according to HR

Answer 25

norepinephrine –> reflex bradycardia
epinephrine –> β1 mediated tachycardia
isoproterenol –> β1 and refelx mediated tachycardia (higher than epinephrine)

Question 26

norepinephrine vs epinephrine vs isoproterenol according to BP

Answer 26

norepinephrine –> increases systolic, diastolic, and MAP
epinephrine –> increases systolic (a1) and decreases diastolic (β2) (slightly increased MAP)
isoproterenol –> increases systolic (heart) and decreases diastolic (more than epinephrine), (slightly decreased MAP)

Question 27

norepinephrine vs epinephrine vs isoproterenol according to peripheral resistance

Answer 27

norepinephrine –> increased (unopposed α1)
epinephrine –> decreased (β2>a1)
isoproterenol –> more decreased (unopposed β2)

Question 28

norepinephrine vs epinephrine vs isoproterenol according to cardiac output

Answer 28

norepinephrine –> unchanged
epinephrine –> increased
isoproterenol –> more increased

Question 29

norepinephrine vs epinephrine vs isoproterenol according to pulse pressure

Answer 29

norepinephrine –> increased
epinephrine –> increased
isoproterenol –> more increased

Question 30

sympatholytics - mechanism of action

Answer 30

α2 agonists

Question 31

sympatholytics (α2 agonists) drugs

Answer 31

1. clonidine
2. guanfacine
3. α-methyldopa
4. Brimonidine

Question 32

clonidine - clinical use

Answer 32

1. hypertensive urgency (limited situations)
2. ADHD
3. Tourette syndrome

Question 33

clonidine - side effects

Answer 33

1. CNS depression
2. bradycardia
3. hypotension
4. respiratory depression
5. miosis

Question 34

α-methyldopa - clinical use

Answer 34

hypertension in pregnancy

Question 35

α-methyldopa - side effects

Answer 35

1. direct coomps + hemolysis

2. SLE-like syndrome

Question 36

guanfacine - clinical use

Answer 36

1. hypertensive urgency (limited situations)
2. ADHD
3. Tourette syndrome

Question 37

guanfacine - side effects

Answer 37

1. CNS depression
2. bradycardia
3. hypotension
4. respiratory depression
5. miosis

Question 38

Brimonidine - clinical use

Answer 38

Glaucoma