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Pharmacology > Sympathomimetics > Flashcards

Sympathomimetics Flashcards

1
Q

What are medical uses of sympathomimetics?

A 
Bronchodilation
Nasal decongestion
Relieve acute hypersensitivity reactions
Raise BP
Relieve adrenergic insufficiency
Stimulate heart
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2
Q

Sympathomimetics as bronchodilators

A

B2 stimulants used to relieve bronchoconstriction in COPD

Receptors involved

  • -B2
  • -alpha 1
  • -B1 action
    • –side effect
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3
Q

Sympathetic bronchodilators can be used to ..

A

diagnose the cause of airway constriction

may be due to inflammation or bronchiolar spasm
B2 stimulants act in seconds

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4
Q

Which adrenergic receptors does epinephrine work on?

A

alpha 1
beta 1
beta 2

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5
Q

Which adrenergic receptors does albuterol work on?

A

beta 2

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6
Q

Which adrenergic receptors does metaprotere nol work on?

A

beta 2

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7
Q

Which adrenergic receptors does almeterol work on?

A

beta 2

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8
Q

Aside from just bronchodilating, what do bronchodilators do?

A

Increase ciliary activity
Inhibit histamine and leukotriene release

(leukotrienes are powerful bronchoconstrictors)

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9
Q

Why are Beta2 agonists drugs of choice?

A
  • Most effective bronchodilators
  • Tolerance with continued use overcome by increasing dose, usually
  • Receptor down-regulation prevented or even partly reversed with corticosteroids
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10
Q

What are precautions for using adrenergic bronchodilators?

A
  • -“benign essential tremor” due to B2 stimulation
  • -feelings of anxiety may limit use
  • -increases blood sugar
    • -a1 and b2 receptors mobilize liver glycogen
  • -dry pharyngeal membranes
    • -problem with epinephrine (vasoconstriction)
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11
Q

Sympathomimetics as nasal decongestants

–MOA

A

alpha 1 agonists constrict dilated blood vessels and relieve nasal stuffiness and headache

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12
Q

Examples of sympathomimetics used as nasal decogestants

A

Phenylephrine
–P.O. as nose drops or nasal spray

Pseudophedrine

  • -Still “widely available”
  • -CNS stimulant

Oxymetazoline
–Long duration

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13
Q

Adverse reactions to nasal decongestants

A

Transient burning
Rebound congestion
Chemical rhinitis
CNS depression, hypotensio (imidazoline effect)

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14
Q

Adrenergics in acute hypersensitivity

A

May involve foods, pollon, drugs, animals

B2 stimulants inhibit antigen-indcued histamine release

Epinephrine used

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15
Q

Sympathomimetics are used in hypotension. Why is this important?

A

Necessity for “pressor” effect

  • -below 40 mm Hg diastolic or 50 mm Hg systolic
    • –critical decrease in flow to heart, brain, and also gut, liver, kidney

Need to bring the pressure back up!

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16
Q

What are some clinical situations in which there is a decrease in blood pressure?

A

General and spinal anesthesia
Drug overdose
Acute renal failure
Shock (sympathomimetics not used)

17
Q

What are two ways to increased blood pressure via drugs?

A
  1. increase CO with beta1

2. increase peripheral resistance with alpha1

18
Q

Which drugs are used to increased BP via increase in peripheral resistance?

A

Norepinephrine
Alpha-1 stimulants - e.g. phenylephrine

These work on alpha 1

19
Q

Which drugs are used to increased BP via increase in CO?

A

Dopamine
Dobutamine

These work on beta1

20
Q

Short acting pressor agents are substrates for…

A

NET and ENT

21
Q

Long acting pressor agents are used for …

A

smoother pressure control

22
Q

Dopamine

A

Some b1

Dilation of renal, coronary, and mesenteric beds (D1 receptors)

23
Q

Dobutamine

A

B1, but little increase in HR

24
Q

Precautions in using “pressor” agents

A
  1. Hyperthyroidism (excess receptors)

2. Necrosis on prolonged vasoconstriction (when used over a long time) – liver and kidney

25
Q

Disease states that show adrenergic deficiency

A

Pure Autonomic Failure (PAF)
–disease of post ganglionic sympathetic nerves

Postural Tachycardia Syndrome (POTS)

Multiple System Atrophy (MSA)
–autoimmune degeneration ANS centrally

26
Q

Adrenergics in sympathetic deficiency

  • what do they do?
  • which do we use?
A

Used to correct postural hypotension, urinary incontience, and retrograde ejaculation

Midodrine

  • -alpha 1 agonist
  • -give early in the day to avoid nocturnal hypertension
27
Q

Sympathomimetics as cardiac stimulants

  • when?
  • which?
A

Use in AV block to prevent loss of consciousness

  • -“Stokes Adams” syndrome
  • -some pts alternate b/t 2nd and 3rd degree block
  • -definitive tx is pacements

Use after bypass surgery

IV epinephrine, isoproterenol, dobutamine, dopamine

28
Q

Indirect-acting sympathomimetics

A
  • -Tyramine in some cheese, sausage
  • -Dopamine
  • -Pseudoephedrine, ephedrine

Use NE uptake system, get into nerve end and cause some NE release

Pharmacology (45 decks)

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