Pharm CH 13

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Pharm CH 13
2012-09-19 11:08:03

Drugs affecting adrenergic function
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  1. Neurotransmitters of the ANS
    • acetylcholine (ACh)
    • norepinephrine (NE)
    • epinephrine (Epi)
  2. In the SNS preganglionic transmission is mediated by___
  3. In the SNS, postganglionic transmission is mediated by ____
  4. adrenergic receptor types
    • alpha
    • beta
  5. most frequent indication for adrenergic agonist drugs is_____
  6. Adrenergic agonists
    • mimic action of SNS
    • stimulate adrenergic receptors
    • 2 groups - catecholamines & noncatecholamines
    • nonselective agonists stim both alpha & beta receptors
    • prototype drug - EPINEPHRINE
  7. Ephinephrine indications (pharmacotherapeutics)
    asthma, shock
  8. Epi pharmacodynamics
    stim all adrenergic receptors and causes AEs in the cardiovasc syst & CNS
  9. Epi contraindications
    hypersensitivity, sulfite sensitivity, glaucoma & use during labor

    glaucoma b/c increased intraoc P could be made worse by inc BP (sympathetic effect of drug)
  10. Epi drug interactions
    tricyclic antidepressants - when inc NE, dec effectiveness of antidepress

    beta blockers - completely oppose agonist action
  11. which receptors are stim by Epi?
    • alpha 1
    • alpha 2
    • beta 1
    • beta 2

    Epi is nonselective.  the only receptor it does NOT stim is dopamine
  12. Alpha 1 adrenergic agonist
    stimulate alpha-1 receptor directly
  13. Phenylephrine (Allerest)
    A-1 Adrenergic agonist

    • parenterally for vascular failure
    • topically for relief of nasal mucosal congestion

    AE= reflex bradycardia

    Correct blood loss B4 administration
  14. sympathetic NS produces what type of response?
  15. parasympathetic NS produces what type of response?
  16. Alpha 2 adrenergic agonists
    • stim alpha 2 receptors
    • decrease symp outflow by inhib release of NE
  17. Beta adrenergic agonists
    • mimic action of SNS
    • prototype = DOPAMINE (Intropin)
  18. Inotrope drugs affect what?
    muscle contractility
  19. chronotropic drugs affect what?
    heart rate
  20. Dopamine
    beta adrenergic agonist; stim dopaminergic receptors

    corrects hemodynamic imablances in shock

    stim a-1 and b-1 receptors so increases CO (pos inotrope)

    AE= Ectopic beats, tachycardia (expected)

    Tx effective if BP, urine output & CO return to normal

    Only given IV
  21. Dopaminergic agonists
    Stim DA1 & DA2 receptors - mediate responses in adrenergic NS

    stim DA1 &2 results in periph vasodilation

    stim both can have complementary or opposing effects

    prototype= FENOLDOPAM
  22. fenoldopam (Corlopam)
    short-term mgt severe hypotension

    only binds with DA1 receptors

    causes rapid vasodilation

    AE = hypotension, reflex tachycardia

    risk for hypokalemia

    monitor BP to judge efficacy
  23. Alpha Adrenergic antagonists
    block stim of alpha receptors

    mediate prostatic smooth musc contraction

    Prototype = PRAZOSIN
  24. prazosin (Minipress)
    treats CHF, prostatic outflow (males only)

    risk of orthostatic hypotension; monitor wt & check for edema d/t vasodilation
  25. -osin
    alpha blockers
  26. -olol
    beta blockers
  27. beta adrenergic antagonists
    stim of B1 only causes tachycardia

    stim B1 & B2 causes vasodilation, decreased periph resistance and bronchodilation

    prototype = METOPROLOL
  28. metoprolol (Lopressor, Toprol XL)
    contraindicated w/antidepress - blocks NE which Antidepressants try to stim...can actually induce depression

    AEs = hypoglycemia (SNS stim is blocked so pt wont even feel dec gluc effects)

    do not abruptly stop med (have lots of open, sensitized receptors so BP skyrockets)

    monitor BP, HR & edema
  29. Alpha-1 receptor effects
    • inc periph resistance
    • mydriasis
    • vasoconstriction
  30. Alpha 2 receptor effects
    • inhibition of lypolysis
    • dec GI motility
    • inhibition of NE release
    • vasoconstriction
  31. Beta 1 receptor effects
    cardiac effects
  32. Beta 2 receptor effects
    • dec periph resistance
    • vasodilation
    • bronchodilation