Sympathetic Rx Flashcards
Albuterol
Direct
B2 > B1
Acute asthma or COPD
Salmeterol
Direct
B2 > B1
Long-term asthma or COPD control
Dobutamine
Direct
B1 > B2 and alpha
Use: heart failure (inotropic > chronotropic), cardiac stress testing
Dopamine
Direct
D1 = D2 > Beta > alpha
Uses: unstable bradycardia, HF, shock
*inotropic and chronotropic effects at lower doses due to beta effects
*vasoconstriction at higher doses due to alpha effects
Epinephrine
Direct
Beta > alpha
Use: anaphylaxis, asthma, open-angle glaucoma
*Alpha effects predominate at higher dose (vasoconstriction)
*Significantly stronger effect at beta2-receptor than norepinephrine (means more vasodilator effects–PVR goes down, PP/CO/HR go up)
Fenoldopam
Direct D1 Use: postop HTN, hypertensive crisis *Vasodilator (coronary, peripheral, renal, splanchnic) *Promotes natriuresis *SE: hypotension and tachycardia
Isoproterenol
Direct
B1 = B2
Use: electrophysiologic evaluation of tachyarrhythmias
*Can worsen ischemia
*B2 vasodilation = decreased MAP = reflex tachycardia
*B1 = increased heart rate
(Very increased heart rate, CO, and PP)
Midodrine
Direct
Alpha1
Use: autonomic insufficiency and postural hypotension
*May exacerbate supine hypertension
Mirabegron
Direct
Beta3
Use: urinary urge incontinence or overactive bladder
Norepinephrine
Direct A1 > A2 > B1 Use: hypotension, septic shock *Increase both SBP and DBP = increased MAP = reflex bradycardia (CO stays the same and PP widens)
Phenylephrine
Direct
A1 > A2
Use: hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)
Amphetamine
Indirect general agonist
Reuptake inhibitor
Releases stored catecholamines
Use: narcolepsy, obesity, ADHD
Cocaine
Indirect general agonist
Reuptake inhibitor
Use: vasoconstriction and local anesthetic
*Never give beta-blockers if cocaine intoxication is suspected (leads to unopposed A1 and extreme hypertension)
Ephedrine
Indirect general agonist
Releases stored catecholamines
Use: nasal decongestion (pseudoephedrine), urinary incontinence, hypotension
Clonidine/guanfacine
Sympatholytics (A2 agonists)
Uses: hypertensive urgency (limited situations), ADHD, Tourette
SE: CNS depression, bradycardia, hypotension, respiratory depression, miosis, rebound hypertension with abrupt cessation
A-methyldopa
Sympatholytic (A2 agonist)
Use: HTN in pregnancy
SE: direct Coombs positive hemolysis, SLE-like syndrome
Phenoxybenzamine
Nonselective A blocker
Irreversible
Use: pheochromocytoma (preop) to prevent catecholamine (HTN) crisis
SE: orthostatic hypotension, reflex tachycardia
Phentolamine
Nonselective A blocker
Reversible
Use: MAOI patients eating tyramine-rich foods
SE: orthostatic hypotension, reflex tachycardia
Prazosin
A1 blocker
Use: urinary symptoms of BPH, PTSD
SE: 1st-dose orthostatic hypoTN, dizziness, HA
Terazosin/doxazosin/tamsulosin
A1 blocker
Use: urinary symptoms of BPH, hypertension (except tamsulosin)
SE: 1st-dose orthostatic hypoTN, dizziness, HA
Mirtazapine
A2 blocker
Use: depression
SE: sedation, increase serum cholesterol, increase appetite
Beta-blockers: angina pectoris
Decrease heart rate and contractility = decreased oxygen consumption
Beta-blockers: MI
Decreased mortality
Beta-blockers: supraventricular tachycardia
Decreased AV conduction velocity (class 2 antiarrhythmic) *Metoprolol and esmolol
Beta-blockers: HTN
Decreased cardiac output, decreased renin secretion (B1 block on JGA cells)
Beta-blockers: HF
Decreased mortality
*Bisoprolol/carvedilol/metoprolol
Beta-blockers: glaucoma
Decreased production of aqueous humor
*Timolol
Beta-blockers: variceal bleeding
Decreased hepatic venous pressure gradient and portal HTN
*Nadolol/propranolol
Beta-blockers: SE
Erectile dysfunction CV SE: bradycardia, AV block, HF CNS SE: seizures, sedation, sleep alterations Dyslipidemia (metoprolol) Asthma/COPD exacerbations *Caution in cocaine users
B1 selective antagonists (B1>B2)
Acebutolol (partial agonist) Atenolol Betaxolol Bisoprolol Esmolol Metoprolol (A-M = 1st half of alphabet)
Nonselective B-antagonists (B1 = B2)
Nadolol Pindolol (partial agonist) Propranolol Timolol (N-Z = 2nd half of alphabet)
Nonselective A and B antagonists
Carvedilol
Labetalol
Nebivolol
Cardiac-selective B1 blockade + stimulation of B3 (activate NOS in vasculature and decrease SVR)
