First Aid - Pharm 5

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selectivity for Sympathomimetics - Phenylephrine

α1 >α2

selectivity for Sympathomimetics - Albuterol

β2 >β1

Mechanism/selectivity for Sympathomimetics - terbutaline

β2 >β1

name the Sympathomimetic - α1, α2, β1, β2, low doses selective for β1

Epinephrine

name the Sympathomimetic - α1, α2 >β1

name the Sympathomimetic - β1 =β2

Isoproterenol

name the Sympathomimetic - β1 >β2

Dobutamine

name the Sympathomimetic - D1 = D2 >β >α

Dopamine

name the Sympathomimetic - Indirect general agonist, releases stored catecholamines

Amphetamine - and - Ephedrine

name the Sympathomimetic - α1 >α2

Phenylephrine

name the Sympathomimetic - β2 >β1

Albuterol, - terbutaline

name the Sympathomimetic - Indirect general agonist, uptake inhibitor

Cocaine

name the Sympathomimetic - Centrally acting α-agonist, ↓ central adrenergic outﬂow

Clonidine, α-methyldopa

effect on BP and HR of - Norepinephrine

(α > β), ↑ BP, ↓ HR (reflex bradycardia)

effect on BP and HR of - Epinephrine

nonselective - NC BP( increases systolic, but decreases diastolic)

effect on BP and HR of - Isoproterenol

(β > α), ↓ BP, ↑ HR

Applications of Sympathomimetics - Epinephrine

Anaphylaxis, glaucoma (open;angle), asthma, hypotension

Applications of Sympathomimetics - NE

Hypotension (but ↓ renal ;perfusion)

Applications of Sympathomimetics - Isoproterenol

AV block (rare)

Applications of Sympathomimetics - Dopamine

Shock (↑ renal perfusion), heart failure

Applications of Sympathomimetics - Dobutamine

Shock, heart failure cardiac ;stress testing

Applications of Sympathomimetics - Amphetamine

Narcolepsy, obesity, ADHD

Applications of Sympathomimetics - Ephedrine

Nasal decongestion, urinary incontinence, hypotension

Applications of Sympathomimetics - Phenylephrine

Pupil dilator, vasoconstriction, nasal decongestion

Applications of Sympathomimetics - Albuterol, terbutaline

Asthma

Applications of Sympathomimetics - Cocaine

Causes vasoconstriction and ;local anesthesia

Applications of Sympathomimetics - Clonidine, α-methyldopa

Hypertension, especially with;renal disease (no ↓ in blood ;ﬂow to kidney)

name the Nonselective α-blockers

Phenoxybenzamine - phentolamine

name the α1 selective α-blockers

Prazosin, terazosin, doxazosin

name the α2 selective α-blockers

Mirtazapine

Nonselective α-blockers - Application and Toxicity

Pheochromocytoma - Orthostatic hypotension, reﬂex tachycardia

α1 selective α-blockers - Application and Toxicity

Hypertension, urinary retention in BPH - -1st-dose orthostatic hypotension, dizziness, headache

α2 selective α-blockers - Application and Toxicity

Depression - Sedation, ↑ serum cholesterol, ↑ appetite

Nonselective α-blockers - names and differences

Phenoxybenzamine (irreversible) - phentolamine (reversible)

effects of an α-blocker (e.g., phentolamine) on BP responses to epinephrine and phenylephrine.

The epinephrine response exhibits reversal of the mean blood pressure change, from a net increase (the α response) to a net decrease (the β2 response). The response to phenylephrine is suppressed but not reversed because phenylephrine is a “pure” α-agonis

β-blockers - non selective ones

Nonselective (N or later)(β1 = β2)––propranolol, timolol, nadolol, pindolol (partial agonist), and - labetalol (partial agonist, and exception to the after N rule and the olol rule)

β-blockers - selective ones

Before N - β1 selective (β1 > β2)–– Betaxolol, Esmolol (short acting), Atenolol, Metoprolol - Acebutolol (partial agonist hes and Ass),

β-blocker effect WRT - Hypertension

↓ cardiac output, ↓ renin secretion

β-blocker effect WRT - Angina pectoris

↓ heart rate and contractility, resulting in ↓ O2 consumption

β-blocker effect WRT - MI

β-blockers ↓ mortality

β-blocker effect WRT - SVT

↓ AV conduction velocity

β-blocker effect WRT - CHF

Slows progression of chronic failure