Section 2b Adrenergic Drugs

Question 1

Epinephrine (adrenaline)

Answer 1

potent vasoconstrictor and cardiac stimulant; increase systolic & decrease diastolic; bronchodilation
Causes decreased blood flow to skin, increased blood flow to skeletal muscle and increased force/rate of cardiac contraction

Question 2

Norepinephrine (noradrenaline)

Answer 2

increase BP (systolic and diastolic)

Question 3

Dopamine

Answer 3

• vasodilator (low dose D1; D2)

- vasoconstrictor (high dose a)

Question 4

Isoproterenol (isoprenaline)

Answer 4

cardiac stimulant, potent vasodilator, lowers BP (diastolic and mean, systolic not changed or increased); bronchodilator

Question 5

Phenylephrine

Answer 5

a1 adrenergic agonist

hypotension; nasal decongestant; glaucoma; and symptomatic relief of eye irritation

Question 6

what are the general therapeutic effects and adverse effects of a1-adrenergic agonists?

Answer 6

Therapeutic = arterial vasoconstriction (local/general) = increase in BP
Adverse = hypertension, headache, bradycardia, cardiac arrhythmia

Question 7

Midodrine

Answer 7

a1 adrenergic agonist
orthostatic hypotension (increases arteriolar and venous tone)

Question 8

Methoxamine

Answer 8

hypotension, shock (systemic admin)

Question 9

Oxymetazoline, Tetrahydrozoline, Naphazoline

Answer 9

mydriatic (opthalmic dilation) and decongestant (nasal, ophthalmic)

Question 10

Clonidine

Answer 10

a2 adrenergic agonist
decrease BP through CNS (decrease sympathetic outflow)
Adverse: drowsiness, dizziness, bradycardia, dry mouth, sedation, fatigue

Question 11

Guanfacine

Answer 11

a2 agonist
decrease BP through CNS
Adverse: drowsiness, dizziness, hypotension, fatigue, dry mouth

Question 12

What drug is used for hypertension in pregnancy?

Answer 12

alpha-Methyldopa (a2 agonist)

Question 13

Brimonidine

Answer 13

a2 agonist

glaucoma; facial erythema (rosacea)

Question 14

Dobutamine

Answer 14

B1 agonist

used to increase cardiac output with less reflex tachycardia (needed with heart failure)

Question 15

Albuterol, Terbutaline, Metaproterenol, Salmeterol (Salmerterol is 12h/long lasting)

Answer 15

B2 agonist
causes bronchodilation and uterine relaxation (Terbutaline)
Adverse: hypertension, tachycardia, dizziness, muscle cramps/tremor, headache, nervousness

Question 16

What are indirect-acting sympathomimetics that inhibit catecholamine storage used for?

Answer 16

ADHD and narcolepsy

Question 17

Examples of indirect-acting sympathomimetics that inhibit catecholamine storage

Answer 17

Methampethamine, Amphetamine, Modafinil, Reserpine, Guanethidine, Tyramine

Question 18

What foods have Tyramine, and what metabolizes Tyramine?

Answer 18

1. cheese, red wine, smoked or pickled fish, sausage

2. MAO in GI tract and liver

Question 19

What is a mixed-acting adrenergic agonist?

Answer 19

ephedrine

Question 20

What drugs inhibit catecholamine reuptake?

Answer 20

amphetamines, atomoxetine (selective NET inhibitor), cocaine, tricyclic antidepressants

Question 21

What drugs inhibit the metabolism of cateholamines? (5)

Answer 21

MAOI = antidepressants
Non-selective MAOIs: Phenelzine, Iproniazid, Tranylcyproine
Selective MAO-A inhib: Moclobemide
Selective MAO-B inhib: Selegiline (anti-Parkinson’s disease)

Question 22

What would you give for acute (emergency) hypotension?

Answer 22

norepinephrine or phenylephrine

Question 23

What would you give for chronic orthostatic hypotension?

Answer 23

midodrine or ephedrine

Question 24

What would you give for cardiogenic shock?

Answer 24

dopamine or dobutamine

Question 25

What would you give for HTN?

Answer 25

clonidine

Question 26

What would you give for heart block?

Answer 26

isoproterenol or epinephrine

Question 27

What does epinephrine do when given with local anesthetics?

Answer 27

produces vasoconstriction and prolongs the action of local anesthetics

Question 28

What are potential ADR when too much stimulation occurs due to a1, B1, and B2 agonists?

Answer 28

a1: hypertensino
B1: tachycardia, arrhythmias
B2: skeletal muscle tremor