Adrengergic Agonists

Question 1

Epinephrine (Adrenalin)

Answer 1

B1=B2 A1=A2

• BOTH NT and Hormone
• Endogenous
• Increase HR and Contractility B1
• Renin Release (AGII) B1
• Vasoconstriction (arterioles/mucous/viscera) HIGH DOSE A1
• Vasodilation(liver/SM) LOW DOSE B2
• Increase Sys(A1) Decrease Dia (B2)
• Hyperglycemia
• Gluconeogenesis
• Glycogenolysis (B2)
• Increase Glucagon (B2)
• Decrease Insulin (A2)
• Lypolysis

-IV/IM/SQ/Inhaled (ET)
-Cardiac Arrest
1mg every 2-5min IV
-Bradycardia
2-10ug/min IV
-Anaphylactic Shock
-Bronchospasm/Asthma (B2)
-Local anesthetic ISOLATION (A1)

• Degraded by MAO and COMT (rapid onset/shot duration)
• excreted by kidneys

Question 2

Norepinephrine (Levophed)

Answer 2

A1=A2 B1>B2
-Endogenous
-Increase Contractility(B1)
(Decrease HR from Baroreceptor)
-Increase in Sys/Dia (A1)

• Vasodilatory Shock
• Critical Hypotension
  0. 5-12ug/min

MAO and COMT 1-2 min
excreted by kidneys

THROUGH CENTRAL IV (or cause extravasation)

Question 3

Dopamine

Answer 3

D1=D2»B»A

• Endogenous precursor to NE
• NT and Hormone
• CNS and Adrenal Medulla release
• High Dose A
• Low Dose B
• D (peripheral mesentaric and renal vasc. bed and Presynaptic adrenergic receptor)
• Increase Heart Rate (B2)
• Increase Contractility (B2) (severe Heart failure)
• Vasoconstriction high dose (A1) (hypotension and septic shock)
• Dilation of Renal Arterioles (renal failure)
• Dilates Splanchnic arterioles

LOW D- 1-2ug/kg/min (dilation kidneys/brain/viscera)
MED B1- 2-10ug/kg/min (Increase CO)
HIGH A1->10ug/kg/min vasoconstriction

Question 4

Dobutamine (DOBUTREX)

Answer 4

B1>B2»>A

• Synthetic Direct acting catecholamine
• B1 agonist
• Increase HR (greater than dopamine)
• Increase Contractility (less than dopamine)
• Least O2 demand by catecholamines
• Increase CO for heart failure
• Support for weaning (struggle)

Question 5

Isoproterenol

Answer 5

B1=B2»>A

• 2nd line for cardiac stimulation (heart block and cardiac arrest)
• Treat bronchospasms during anesthesia

Question 6

Phenylephrine (Neo-Synephrine)

Answer 6

A1>A2»>B-+

• A1 agonist
• 20 min duration
• NOT INACTIVATED by COMT
• longer lasting that epi and ephed
• Vasoconstriction (SVR and ART pressure)
• Increase Sys/Dia pressure
• Decrease HR via reflex brady
• TREAT hypotension
• TREAT paroxysmal SVT
• Decongestion topical

IV 50-500ug bolus
IV 10-15ug/250ml = 40-60ug/ml drip

Question 7

Amphetamine

Answer 7

At Synaptic cleft

• Blocks NET no reuptake NE
• Induces release NE
• Reverse Transport
• Diffusion of vescicles

-Treament for performance enhancing/narcolepsy

Question 8

Cocaine

Answer 8

• Binds to and blocks the NE transporter
• Stop nose bleeds
• local anesthetic

Question 9

Ephedrine

Answer 9

Mixed action adrenergic agonist
-Release and stored in NE nerve endings
-Direct stimulation of A and B
-Less potent but longer duration than EPI
-Cardiac stimulation 
-casoconstriction
-Increase Sys/Dia Pressure
Mild CNS stimulation
-TREATS hypotension when epi and neo dont work

Question 10

Pseudoephedrine

Answer 10

Nasal and Sinus congestion

Question 11

Tyramine

Answer 11

Enter the NErve Terminal and displace the NE stored in the vesicle (release)

Question 12

Levodopa

Answer 12

• Dopaminergic Agonist
• Metabolized into dopamine in the brain
• Active transport into CNS
• Dopamine cant cross BBB
• For Parkisons disease (creates more dopamine for brain)