Sympathomimetics

Question 1

as bronchodilators

Answer 1

beta-2 stimulants used to relieve bronchoconstriction in chronic obstructive pulmonary disease (COPD)

Question 2

receptors involved in bronchodilators

Answer 2

Beta-2
alpha-1
beta-1 action-> side effect

Question 3

leading cause of death

Answer 3

COPD

Question 4

emphysema

Answer 4

WBC proteolytic destruction of alveolar wall

Question 5

asthma

Answer 5

allergic or intrinsic precipitated by cold, gasoline, fresh paint

Question 6

bronchoeictasis

Answer 6

dilated bronchi due to damage by infection

Question 7

chronic bronchitis

Answer 7

due to infection

Question 8

sympathetic bronchodilators

Answer 8

can be used to diagnose cause of airway constriction

• may be due to inflammation of bronchiolar spasms
• beta-2 stimulants act in seconds

Question 9

epinephrine works on

Answer 9

alpha-1, beta-1, beta-2

Question 10

albuterol

Answer 10

beta-2

Question 11

metaproterenol

Answer 11

beta-2

Question 12

salmeterol

Answer 12

beta-2

-use with steroids

Question 13

what else do bronchodilators do?

Answer 13

increase ciliary activity, inhibit histamine, leukotriene release

Question 14

beta-2 agonist drugs of choice

Answer 14

• tolerance

- receptor-down regulation prevented or even partly revered with steroids

Question 15

precautions for adrenergic bronchodilators

Answer 15

• benign essential tremor (from beta-2 stimulation)
• feelings of anxiety may limit use
• increased blood sugar: alpha1/beta2 receptors mobilize liver glycogen
• dry pharyngeal membranes-> problem with epinephrine (vasoconstriction)

Question 16

nasal decongestants

Answer 16

alpha-1 agonists constrict dilated blood vessels and relieve nasal stiffness and headache

Question 17

nasal decongestant drugs

Answer 17

• phenylephrine
• pseuoephedrine
• oxymetazoline

Question 18

phenylephrine

Answer 18

give p.o, nose drops or spray

-p.o dose advantages

Question 19

pseuoephedrine

Answer 19

still widely available

CNS stimulant

Question 20

oxymetazoline

Answer 20

long duration, 12 hours

Question 21

adverse effects to nasal decongestants

Answer 21

transient burning
rebound congestion
chemical rhinitis
CNS depression, hypotension (imidazoline)

Question 22

uses of sympathomimetisc in eye

Answer 22

Mydriasis
relieve redness, itching
-in allergic hyperemia of conjunctival membrane

Question 23

uses of sympathomimetisc in eye: Mydriasis

Answer 23

phenylephrine

• duration 3 hours, advantage over atropine
• mydriasis without cycloplegia

Question 24

uses of sympathomimetisc in eye: to relieve itching and redness

Answer 24

oxymetazoline

Question 25

adrenergics in acute hypersensitivity

Answer 25

involve foods, pollon, drugs, animals - beta-2 stimulants inhibit antigen-induced histamine release - epinephrine used

Question 26

sympathomimetics in hypotension

Answer 26

``` "pressor" effects -below 40 mmHg diastolic or 50 systolic -critical decrease in flow to heart, brain, gut, liver, kidney -clinical situations showing decrease BP general and spinal anesthesia drug overdose acute renal failure ```

Question 27

what are the two ways to increase blood pressure

Answer 27

1. increased cardiac output (beta-1) | 2. increased peripheral resistance (alpha-1)

Question 28

norepinephrine

Answer 28

lasts about 2 mins does nothing to CO increases PR

Question 29

alpha-1 stimulant: Phenylephrin

Answer 29

20 mins decrease CO increases PR

Question 30

dopamine

Answer 30

lasts about 2 mins increases CO decreases PR

Question 31

dobutamine

Answer 31

lasts about 2 mins increases CO does nothing to PR

Question 32

sympathomimetic pressor agents

Answer 32

- short acting ones are substrates for NET and ENT - long acting-> smoother pressure control - dopamine-> some beta-1, and dilation of renal, coronary and mesenteric beds (D1 receptors) - dobutamine-> beta-1 but little increase in rate

Question 33

precautions in using pressor agents

Answer 33

- hyperthyroidism (excess receptors) | - necrosis on prolonged vasoconstriction: Liver, kidney

Question 34

what are some diseases that show adrenergic deficiency

Answer 34

PAF: pure autonomic failure POTS: postural tachycardia syndrome MSA: multiple systems atrophy

Question 35

PAF

Answer 35

disease of post-ganglionic sympathetic nerves - onset middle age - more common in men

Question 36

POTS

Answer 36

50% antecedent viral illness | -4 times more common in females

Question 37

MSA

Answer 37

autoimmune degeneration ANS centrally | -twice as common in men

Question 38

adrenergics in sympathetic deficiency

Answer 38

- correct postural hypotension, urinary incontinence and retrograde ejaculation mitodrine: alpha-1 agonist, give early in the day avoid nocturnal hypertension

Question 39

sympathomimetics as cardiac stimulants

Answer 39

In A-V block to prevent loss of consciousness -"Stokes Adams" syndrome -some patients alternate between 2nd and 3rd degree block (skipped beats or complete block) -definitive treatment-> pacemaker After bypass surgery -iv epinephrine, isoproterenol, dobutamine, dopamine

Question 40

indirect-acting sympathomimetics

Answer 40

- Tyramine in some cheese and sausage - Dopamine - Pseudoephedrine, ephedrine