Sympathomimetics Flashcards
Name the Direct sympathomimetics
Albuterol, salmeterol, terbutaline Dobutamine Dopamine Epinephrine Fenoldopam Isoproterenol Midodrine Mirabegron Norepinephrine Phenylephrine
What receptors are activated by Albuterol, salmeterol, terbutaline?
β2 > β1
What HEMODYNAMIC CHANGES have Albuterol, salmeterol, terbutaline?
↑ HR (little effect)
What clinical APPLICATIONS Albuterol has?
Albuterol for Acute asthma/COPD.
What clinical APPLICATIONS Salmeterol has?
Salmeterol for Serial (long-term) asthma/COPD.
What clinical APPLICATIONS Terbutaline has?
Terbutaline for acute bronchospasm in asthma and tocolysis.
What RECEPTORS are activated by Dobutamine?
β1 > β2, α
What HEMODYNAMIC CHANGES have Dobutamine?
↔︎/↓ BP, ↑HR, ↑CO
What clinical APPLICATIONS Dobutamine has?
Heart failure (HF), cardiogenic shock (inotropic > chronotropic), cardiac stress testing.
What RECEPTORS are activated by Dopamine?
D1 = D2 > β > α
What HEMODYNAMIC CHANGES have Dopamine?
↑BP (high dose), ↑HR, ↑CO
What clinical APPLICATIONS Dopamine has?
Unstable bradycardia, HF, shock; inotropic and chronotropic effects at lower doses due to β effects; vasoconstriction at high doses due to α effects.
What RECEPTORS are activated by Epinephrine?
β > α
What HEMODYNAMIC CHANGES have Epinephrine?
↑BP (high dose), ↑HR, ↑CO
What clinical APPLICATIONS Epinephrine has?
Anaphylaxis, asthma, open-angle glaucoma;
α effects predominate at high doses.
Significantly stronger effect at β2-receptor than norepinephrine.
What RECEPTORS are activated by Fenoldopam?
D1
What HEMODYNAMIC CHANGES have Fenoldopam?
↓BP (vasodilation), ↑HR, ↑CO
What clinical APPLICATIONS Fenoldopam has?
Postoperative hypertension, hypertensive crisis.
Vasodilator (coronary, peripheral, renal, and splanchnic).
Promotes natriuresis.
Can cause hypotension and tachycardia.
What RECEPTORS are activated by Isoproterenol?
β1 = β2
What HEMODYNAMIC CHANGES have Isoproterenol?
↓BP (vasodilation), ↑HR, ↑CO
What clinical APPLICATIONS Isoproterenol has?
Electrophysiologic evaluation of tachyarrhythmias.
Can worsen ischemia.
Has negligible α effect.
What RECEPTORS are activated by Midodrine?
α1
What HEMODYNAMIC CHANGES have Midodrine?
↑BP (vasoconstriction), ↓HR, ↔︎/↑ CO
What clinical APPLICATIONS Midodrine has?
Autonomic insufficiency and postural hypotension.
May exacerbate supine hypertension.
What RECEPTORS are activated by Mirabegron?
β3
What HEMODYNAMIC CHANGES have Mirabegron?
none
What clinical APPLICATIONS Mirabegron has?
Urinary urgency or incontinence or overactive bladder.
Think “mirab3gron.”
What RECEPTORS are activated by Norepinephrine?
α1 > α2 > β1
What HEMODYNAMIC CHANGES have Norepinephrine?
↑BP, ↑HR, ↔︎/↑ CO
What clinical APPLICATIONS Norepinephrine has?
Hypotension, septic shock.
What RECEPTORS are activated by Phenylephrine?
α1 > α2
What HEMODYNAMIC CHANGES have Phenylephrine?
↑BP (vasoconstriction),
↓HR, ↔︎/↓ CO
What clinical APPLICATIONS Phenylephrine has?
Hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant), ischemic priapism.
Name the Indirect sympathomimetics
Amphetamine
Cocaine
Ephedrine
Amphetamine MOA
Indirect general agonist, reuptake inhibitor, also releases stored catecholamines
What Indirect sympathomimetics is use for Narcolepsy, obesity, ADHD?
Amphetamine
Cocaine MOA
Indirect general agonist, reuptake inhibitor
Which Indirect sympathomimetic pharm Causes vasoconstriction and local anesthesia?
Cocaine
Which pharm should be used with Caution when giving β-blockers if intoxication is suspected?
Cocaine
What can cocaine lead to when used with β-blockers?
can lead to unopposed α1 activation → extreme hypertension, coronary vasospasm.
Ephedrine MOA
Indirect general agonist, releases stored catecholamines
Clinical application of Ephedrine
Nasal decongestion (pseudoephedrine), urinary incontinence, hypotension.
