Adrenopositive Drugs

Question 0

Epinephrine/adrenaline

Answer 0

A= adrenopositive drug, alpha and beta agonist, direct acting sympathomimetics 
B= binds to and activates alpha1-2 and beta 1-2 receptors non-selectively --> evokes sympathetic effects(positive ino-batmo-dromo-chronotrophic effects on heart, systemic vasoconstriction, GIT relaxation, dilates bronchi and cerebral vessels).
C= cardiopulmonary resuscitation, acute anaphylaxis, angioedema, cardiac arrest, acute asthmatic effects, stokes-Adams syndrome

Question 1

Norepinephrine/Noradrenaline

Answer 1

A= adrenopositive drug, alpha and beta agonist, direct acting sympathomimetics
B= stimulates alpha1, alpha2, beta1 receptors(latter to a lesser degree) and therefore acts as an peripheral vasoconstrictor and positive inotrophic effect on heart and dilator of coronary arteries as a result of its beta-adrenergic activity
C= acute hypotension, cardiac arrest, septic shock, neurogenic shock

Question 2

Phenylephrine

Answer 2

A= adrenopositive drug, direct acting selective alpha1 agonist 
B= binds to and activates alpha1 receptors (mainly located on peripheral blood vessels), increases peripheral arterial resistance (contraction) and decreases venous capacitance
C= acute hypotension, shock, addition with anaesthetics, glaucoma, used as a nasal decongestant

Question 3

Xylometazoline (trade name otrivin) only topically(spray)

Answer 3

A= adrenopositive drug, selective alpha2 post synaptic receptor agonist, direct acting
B= binds to and activates post synaptic alpha2 receptors located on SMC of bv--> vasoconstriction--> decrease edema and inflammatory reactions and increases drainage into paranasal sinuses --> decrease mucous and plasma leakage 
C= rhinitis, nasal congestion and bleeding, conjunctivitis, sinusitis

Question 4

Clonidine (centrally acting, can be used during pregnancy)

Answer 4

A= adrenopositive drug, selective alpha2 presynaptic receptor agonist
B= binds to and activates presynaptic alpha2 receptors --> located on cardiovascular control centers--> decreasing impulsation among sympathetic nerves from CNS--> decreasing of bp. Blood vessels--> decreased release of NE and decreasing of bp
C= hypertension, hypertensive crisis when immideate effects are not necessary. Differential diagnosis of pheochromocytoma in hypertensive patients, prophylaxis of vascular migraine headaches, ADHD. Painkiller properties, reliefs withdrawal symptoms of opioids or alcohol abuse

Question 5

Methyldopa

Answer 5

A= adrenopositive drug, selective presynaptic alpha2 receptor agonist
B= binds to and activates alpha2 presynaptic receptors in CNS--> reduction of sympathetic tone, total peripheral resistance and bp + reduction in plasma renin activity, inhibition of both central and peripheral NE and SER production may also contribute to the antihypertensive effect. 
C= antihypertensive treatment, mainly in pregnant women

Question 6

Dopamine

Answer 6

A= adrenopositive drug, alpha and beta agonist
B= activates alpha1 and beta1 receptors--> causes positive chronotropic and inotrophic effects on myocaridum --> increased HR and contractility--> due to directly activating beta adrenergic receptors and indirectly due to causing release of NE from storage sites of sympathetic neurons. In the brain dopamin acts as an agonist to be 5 receptor subtypes (d1-5)
C= cardiogenic shock in infarction or cardiac surgery. Hemorrhagic shock, shock due to renal failure

Question 7

Dobutamine

Answer 7

A= adrenopositive drug, selective beta1 receptor agonist
B= activates mainly beta1 receptors of heart--> increases contractility with little effect on heart rate and beta2 receptors--> increases CO. Does not Cause release of NE as dopamine
C= used in case of inotrophic support in cardiomyopathies, septic shock, cardiogenic shock

Question 8

Salbutamol/Albutamol

Answer 8

A= adrenopositive drug drug, selective Beta2 receptor agonist 
B= binds to and activates beta2 receptors mainly located on SMC of airways --> cause bronchodilatation. (Increases cAMP by activating adenylyl Cyclase, which increases activity of protein kinase A which inhibits phosphorylation of myosin and lowers I/c levels of ca2+.) 
C= used as a bronchodilator in case of asthma or reversible airway obstructions, COPD, asthma prophylaxis

Question 9

Ephedrine

Answer 9

A= adrenopositive drug, indirect sympathomimetics 
B= acts through the release of stored catecholamines (incl dopamine and serotonin) 
C= stimulate, have a stimulant effect on mood and alertness and a depressant effect on appetite. Ephedrine is utilized when prolonged duration of effect is desired, particularly after oral administration in case of nasal congestion, sinusitin and also urinary incontincence and asthma

Question 10

Pseudoephedrine

Answer 10

A= adrenopositive drug, indirect sympathomimetics (little direct activity)
B= through direct action on adrenergic receptors in respiratory tract causes vasoconstriction and bronchodilatation (beta2) and also acts through the release of NE in synaptic clefts 
C= nasal congestion, sinus congestion, Eustachian tube congestion and vasomotor rhinitis, croup, otitis media, tracheobronchitis. Also used as a first line therapy of priapism