Sympathomimetics part 1

Question 1

Nurse anesthesia is the practice of __ nervous system nursing

Answer 1

autonomic

Question 2

Name three Naturally occurring catecholamines

Answer 2

epinephrine
NE
dopamine

Question 3

Name two Synthetic catecholamines

Answer 3

isoproterenol

dobutamine

Question 4

Name some Synthetic non-catecholamines

Answer 4

ephedrine 
amphetamines 
phenylephrine 
methoxamine 
mephentermine

Question 5

__ isomers have all the adrenergic power – just remember Levophed

Answer 5

Levorotary

Question 6

Six steps for adrenergic transmission, uses NE instead of ACh

Answer 6

SYNTHESIS
STORAGE
RELEASE via Ca++ mediated exocytosis
BINDING
DEGRADATION
RECYCLING

Question 7

__ and __ are the receptor ligands for α1, α2, or β adrenergic receptors. __ and __ binding to receptors alter the chemical conformation – three dimensional shape of the receptor.

Answer 7

Epi & NE

Epi & NE

Question 8

Sympathomimetics work at __-ganglionic in the SNS at effector organ receptor sites. (Remember, pre-ganglionic adrenergic neurons have Ach for their neurotransmitter)

Answer 8

POST

Question 9

Alpha and beta receptors MUST HAVE __ or __ as the neurotransmitter, NOT dopamine

Answer 9

Epi & NE

Question 10

What do alpha 1 agonists do?

Answer 10

VASOCONSTRICTION, mydriasis, relaxation of GI, contraction of GI sphincters, contraction of bladder sphincters = HIGH BP, NO PEE/POOP, PHENYLEPHRINE, levophed, methoxamine

Question 11

What do alpha 2 agonists do?

Answer 11

inhibition of NE (post-synaptic), platelet aggregation, hyperpolarization of cells in the CNS, sedation = DEXMEDETOMIDINE, CLONIDINE

Question 12

two alpha 1 antagonists you should probably know

Answer 12

phentolamine and phenoxybenzamine - for vasopressor extravasation and in preparation for pheochromocytoma

Question 13

one alpha 2 antagonist you should probably know

Answer 13

yohimbe

Question 14

What do beta 1 agonists do?

Answer 14

positive inotropes

Question 15

Beta 1 agonists

Answer 15

isoproterenol, dobutamine, epi, NE

Question 16

beta 1 antagonists

Answer 16

metoprolol, atenolol

Question 17

What do beta 2 agonists do?

Answer 17

smooth muscle relaxation

Question 18

Beta 2 agonists

Answer 18

albuterol, terbutaline, isoproterenol

Question 19

beta 2 antagonists

Answer 19

propranolol

Question 20

beta 3 antagonists

Answer 20

double cheeseburgers

Question 21

How are catecholamines metabolized?

Answer 21

monoamine oxidase (MAO), and catechol-O-methyltransferase (COMT)

Question 22

Despite metabolism, how are the actions of catecholamines terminated?

Answer 22

reuptake into the postganglionic sympathetic nerve endings

Question 23

Synthetic non-catecolamines not affected by COMT or MAO?

Answer 23

not affected by COMT, depend on MAO

Question 24

Where do direct acting sympathomimetics work?

Answer 24

Direct acting agonists act at post-synaptic receptors.

Question 25

Where do indirect acting sympathomimetics work?

Answer 25

Indirect acting agonists release neurotransmitters from pre-synaptic nerve terminals to produce a sympathomimetic effect.

Question 26

How do Synthetic indirect acting non-catecholamines work?

Answer 26

Synthetic non-catecholamines activate adrenergic receptors by evoking release of NE from post ganglionic sympathetic nerve endings
-ephedrine, cocaine, amphetamine

Question 27

Does your patient need an endogenous storage of NE to have an effect from an indirect acting?

Answer 27

Yes. But not a direct acting such as Epi, NE, or dobutamine, they act directly all by themselves.

Question 28

Two structural classes of alpha1 agonists

Answer 28

phenethylamines - related in structure to epi

imidazolines -related in structure to Afrin

Question 29

how to make epi

Answer 29

Tyrosine –> DOPA –> dopamine –> NE –> epi