Sympathomimetics

Question 1

Name a typical nonselective alpha agonist

Answer 1

Phenylephrine (flannel friends)

Alpha 1 receptors are widely expressed in vascular beds in the nasal mucosa
Nasal spray containing phenylephrine is used as a decongestant, because of local vasoconstriction it reduces edema of the nasal mucosa
Also causes mydriasis (pupillary dilator muscle)
Also increases MAP mean arterial pressure (increases sys and dias p)

Question 2

Norepinephrine has a higher affinity for
A. alpha
B. beta adrenergic receptor

Answer 2

A. alpha

Question 3

Name selective B1 agonists

Answer 3

DOPAMINE in medium dose (2.5-5 microgram/kg/min)

DOBUTAMINE
- causes less tachycardia compared with dopamine

Indications: cardiogenic shock, acute heart failure?
Adverse effects: tachycardia

Question 4

Name a nonselective Beta agonist

Answer 4

Isoproterenol

Question 5

Name a selective beta2 agonist

Answer 5

Terbutaline (do not disTURB) - prevents premature labor, relaxes the uterus

These agents are also useful in bronchodilation

1) for acute bronchospasm : Albuterol, Metaproterenol, Terbutaline
2) prophylaxis of asthma : Salmeterol, Formoterol, Indacaterol

Question 6

Name the slow onset, long acting B2 agonists used for prophylaxis of asthma or COPD

Answer 6

Salmeterol
Formoterol
Indacaterol
Olodaterol
Vilanterol

…are used in combination with corticosteroids or anti-muscarinic agents for prophylaxis in asthma or COPD

Question 7

What are the drugs of choice in the treatment of acute asthmatic broncho-constriction?

Answer 7

Short-acting beta2 selective agonists

Albuterol

Metaproterenol

Terbutaline

(Inhale via aerosol canister)

Question 8

What type of drug would be bad for someone with BPH (benign prostatic hyperplasia) ?

Answer 8

An alpha1 agonist!

Alpha 1 receptors are found in the prostatic urethra . They are Gq coupled so they lead to contraction -> urinalysis retention

Kaplan

Question 9

Identify the drug below, that can specifically inhibit sympathetic induced Renin release.

Answer 9

A beta1 blocker !!!!

for example: atenolol

Question 10

If you block beta2 receptors - what do you expect to happen to blood glucose levels?

Answer 10

Hypooooglycemia

Beta2 receptor activation on skeletal muscle and the liver leads to increased Glycogenolysis -> increased blood glucose levels

Question 11

Name an Alpha2 agonist and its effect/ use as a drug.

Answer 11

(This card would rather belong to sympathoplegic drugs…)

CLONIDINE

used to treat hypertension

Question 12

What is the drug of choice for the immediate treatment of anaphylactic shock (hypotension, bronchospasm, angioedema)

Answer 12

Epinephrine …because it is an effective physiologic antagonist of many of the mediators of anaphylaxis

Question 13

What drugs are used in attention deficit hyperkinetic disorder (ADHD)?

Answer 13

Methylphenidate (and other amphetamine analogues)

These drugs are abused or misused for the purpose of deferring sleep and for their mood-elevating, euphoria-producing action

Question 14

Why are alpha agonists often mixed with local anesthetics?

Answer 14

Alpha agonists, such as Epinephrine reduce the loss of anesthetic from the area of injection into circulation via vasoconstrictive properties

Question 15

Name of drug that an be used to treat orthostatic hypotension (e.g in autonomic failure, a neurodegenerative disorder)

Answer 15

Midodrine (an alpha 1 agonist)

Question 16

What are some possible side effects of Midrodrine (alpha 1 agonist)

Answer 16

Supine hypertension, piloerection (goose bumps), urinary retention

Question 17

Name a drug that could be used if pupillary dilation - but not cycloplegia- is desired.

Answer 17

Phenylephrine

An alpha1 agonist (sympathomimetic)

Question 18

You prescribe a highly selective beta2 agonist inhaler to be used when needed, to a patient with moderately severe asthma.

What is a possible side effect?

Answer 18

Skeletal muscle tremor
Tachycardia
Hyperglycemia
Hypokalemia

Question 19

Norepinephrine indications

Answer 19

Neurogenic shock (early phase)
Septic shock
Cardiogenic shock

Question 20

Name 3 indications for the use of Epinephrine

Answer 20

Anaphylactic shock (0.3-0.5 mg sc. or im.)
Emergency management of complete heart block and cardiac arrest (1mg iv.)
Inhaled epinephrine for treatment of croup (subglottic laryngitis)
Reduction of regional blood flow (in combination with local aneasthetics, or in facial nasopharyngeal and oral surgery)

Question 21

Peripheral Dopamine receptor agonists (D1)

Answer 21

Dopamine - in LOW dose !
…dilates mesenteric and renal blood vessels

Fenoldopam
…peripheral vasodilation in mesenteric vascular bed
(administered i.v for treatment of severe hypertension

Dopexamin
…D,beta2,(beta1) agonist , (reuptake inhibitor)

Question 22

Patients taking MAO-A inhibitors must avoid …?

Answer 22

Foods containing TYRAMINE ( cheese, wine, smoked fish)

If they don’t, tyramine reaches systemic circulation and increases the sympathetic tone by releasing norepinephrine-> hypertensive crisis !!

Question 23

A 25 year old woman at 32 weeks gestation begins taking a drug to delay the onset of preterm labor.
What type of drug could be used?

Answer 23

A beta2 agonist (i.e Terbutaline)

Question 24

CLONIDINE

Answer 24

Treats hypertension urgency
or ADHD or Tourette’s

CLONIDINE is a alpha2 agonist !!!
It’s a centrally acting sympatholytic
Decreases sympathetic tone