Pharm - Autonomic Drugs (Sympathomimetic Basics)

Question 1

What are 7 examples of Direct sympathomimetics?

Answer 1

(1) Epinephrine (2) Norepinephrine (3) Isoproterenol (4) Dopamine (5) Dobutamine (6) Phenylephrine (7) Albuterol, Salmeterol, Terbutaline

Question 2

What is the effect of Epinephrine? In other words, on what receptor(s) does it act, and to what degree?

Answer 2

Beta > Alpha

Question 3

What are 4 clinical applications for Epinephrine?

Answer 3

(1) Anaphylaxis (2) Open angle glaucoma (3) Asthma (4) Hypotension

Question 4

Again, on what receptor(s) does Epinephrine act, and to what degree? What effects predominate at high doses?

Answer 4

Beta > Alpha; Alpha effects predominate at high doses

Question 5

What is the effect of Norepinephrine? In other words, on what receptor(s) does it act, and to what degree?

Answer 5

Alpha 1 > Alpha 2 > Beta 1

Question 6

What is the major clinical application for norepinephrine? What is an important consideration related to its clinical use?

Answer 6

Hypotension (but decreased renal perfusion)

Question 7

What is the effect of Isoproterenol? In other words, on what receptor(s) does it act, and to what degree?

Answer 7

Beta 1 = Beta 2

Question 8

What is the major clinical application for isoproterenol? What is an important consideration related to its clinical use?

Answer 8

Electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemia.

Question 9

What is the effect of Dopamine? In other words, on what receptor(s) does it act, and to what degree?

Answer 9

D1 = D2 > Beta > Alpha

Question 10

What are 3 clinical uses for Dopamine?

Answer 10

(1) Unstable bradycardia, (2) Heart failure, (3) Shock

Question 11

Again, on what receptor(s) does Dopamine act, and to what degree? What effects predominate at high doses?

Answer 11

D1 = D2 > Beta > Alpha; Inotropic and chronotropic Alpha effects predominate at high doses

Question 12

What is the effect of Dobutamine? In other words, on what receptor(s) does it act, and to what degree?

Answer 12

Beta 1 > Beta 2, Alpha

Question 13

What are 2 clinical uses for Dobutamine?

Answer 13

(1) Heart failure (inotropic > chronotropic), (2) Cardiac stress testing

Question 14

What is the effect of Phenylephrine? In other words, on what receptor(s) does it act, and to what degree?

Answer 14

Alpha 1 > Alpha 2

Question 15

What are 3 clinical uses for Phenylephrine, and what is the mechanism behind each of these uses?

Answer 15

(1) Hypotension (vasoconstrictor), (2) Ocular procedures (Mydriatic), (3) Rhinitis (Decongestant)

Question 16

What is the effect of Albuterol? In other words, on what receptor(s) does it act, and to what degree? What are 2 other drugs that share the same mechanism?

Answer 16

Beta 2 > Beta 1; Albuterol, Salmeterol, Terbutaline

Question 17

What is the clinical use for each of the following direct sympathomimetics: (1) Albuterol (2) Salmeterol (3) Terbutaline?

Answer 17

(1) Albuterol for acute asthma; (2) Salmeterol for long-term asthma or COPD control; (3) Terbutaline to reduce premature uterine contractions

Question 18

What are 3 examples of Indirect sympathomimetics?

Answer 18

(1) Amphetamine (2) Ephedrine (3) Cocaine

Question 19

What are the classifications/effects of Amphetamine?

Answer 19

Indirect general agonist (sympathomimetic), reuptake inhibitor, also releases stored catecholamines

Question 20

What are 3 clinical applications for Amphetamine?

Answer 20

(1) Narcolepsy (2) Obesity (3) Attention deficit disorder

Question 21

What are the classifications/effects of Ephedrine?

Answer 21

Indirect general agonist (sympathomimetic), releases stored catecholamines

Question 22

What are 3 clinical applications for Ephedrine?

Answer 22

(1) Nasal decongestion (2) Urinary incontinence (3) Hypotension

Question 23

What are the classifications/effects of Cocaine?

Answer 23

Indirect general agonist (sympathomimetic), reuptake inhibitor

Question 24

What are 2 clinical applications/notes for Cocaine? What is an important consideration related to its clinical applications?

Answer 24

Causes vasoconstriction and local anesthesia; Never give Beta-blockers if cocaine intoxication is suspected (can lead to unopposed alpha 1 activation and extreme hypertension)