albuterol (Proventil, Ventolin)

Class, Drug Effect, Indications

Class: Bronchodilator

Drug Effect: Activates beta 2 receptors

Indications: Asthma, bronchodilation

epinephrine (Adrenalin)

Class, Drug Effect, Indications

Class: Adrenergic - Bronchodilator

Drug Effect: stimulates mixed alpha and beta receptors

Indications: acute asthma attacks, anaphylaxis

dobutamine (Dobutrex)

Class, Drug Effect, Indications

pseudoephedrine (Afrin)

Class, Drug Effect, Indications

Cause similar effects or mimic the effects of epinephrine, norepinephrine and dopamine

Stimulate alpha or beta receptors

Vasoconstriction

(by means of smooth muscle contraction)

Positive inotropic effects

(increase in force of contraction)

Positive chronotropic effects

(increase HR)

Positive dromotropic effects

(increase in conduction of cardiac electrical nerve impulses through the AV node)

Decreased insulin release (pancreas)

Muscle relaxation

(bronchi and uterus)

Increased glycogenolysis

(liver)

Increased renin secretion

(kidney)

Beta-1 receptors: cardiac stimulation

Beta-2 receptors: bronchodilation

phentolamine (Regitine)

Class, Drug Effect, Uses

Class: alpha-blocker

Drug Effect: Reduces peripheral vascular resistance

Uses: HTN,

Class: alpha-blocker

Drug Effect: Inhibits vasoconstriction

Uses: HTN, prostatic hyperplasia, PTSD symptoms

Class: Beta-1 blocker

Drug Effect: Reduces cardiac stimulation

Uses: HTN, early and late MI

Class: Beta-blocker

Drug Effect: Reduces cardiac stimulation and bronchodilation

Uses: Angina, HTN, dysrhythmias, post-MI, stenosis, tremor, migraine, pheochromocytoma, thyrotoxicosis

Drugs work by making more ACh available at the receptor sites

Don't bind directly to receptors

Drugs that bind directly to cholinergic receptors to activate them

Topical use only - increase GI motility and bladder relaxation

Generally, effects are opposite of adrenergic drugs

Stimulate PSNS - "rest and digest" system

Increase GI secretions and motility and urinary frequency

Increase salivation and sweating

CV - decreased HR and vasodilation

Lungs: bronchoconstriction

Brain: ACh needed to normal brain function

bethanechol (Urecholine)

Type of action, Drug effect, Uses

Type of action: direct-acting

Drug effects: stimulates cholinergic receptors on bladder smooth muscle (causes urination)

Uses: acute post-op and postpartum non-obstructive urinary retention, urinary retention associated with neurogenic atony of bladder

donepezil (Aricept)

Type of action, Drug effect, Uses

Type of action: Indirect-acting

Drug effect: Increases ACh by blocking its breakdown

Uses: Mild to moderate Alzheimer's disease (delays progression)

physostigmine (Antilirium)

Type of action, Drug effect, Uses

Type of action: Indirect-acting

Drug effect: Increases ACh by inhibiting enzyme that breaks it down

Uses: MG

neostigmine (Prostigmin)

Type and Effect 

Type: Anticholinesterase Agent (Cholinergic agent)

Effect: Increases ACh

Block the PSNS ("rest and digest"), allows SNS to dominate ("fight or flight")

Cholinergics have the same effects as adrenergics

Inhibit nerve transmission (ACh) at the muscarinic receptors of the PSNS

atropine (Atropine)

Drug Effect and Uses

Drug Effects: Cholinergic-blocking (anticholinergic) effects on the heart and smooth muscles of the bronchi and intestines (antimuscarinic)

Uses: symptomatic bradycardia, antidote for cholinergic crisis (SLUDGE crisis), anticholinesterase effect (insecticide poisoning)

dicyclomine (Bentyl)

Drug Effect and Uses

Drug Effect: Relax detrusor muscle, increase internal sphincter constriction

Uses: Irritable bowel syndrome (IBS)

tolterodine (Detrol)

Drug Effect and Uses

Drug Effect: muscarinic receptor blocker - relaxes detrusor muscle

Uses: overactive bladder (slows frequency of urge to pee)

scopolamine (Transderm-Scop Patch) 

Drug Effects and Uses 

(Patch placed behind ear)

Drug effects: dries pt out

Uses: post-op N/V

Influence the force or energy of muscular contraction/contractility, particularly those of the heart muscle

Positive: increase myocardial contractility

Negative: decrease myocardial contractility

Positive: increase HR

Negative: decrease HR

Positive: enhance the conduction of electrical impulses in the heart

Negative: diminish the conduction of electrical impulses in the heart

digoxin (Lanoxin)

Tropic effects and Uses

Positive inotropic (increased contractility)

Negative chronotropic (reduce HR)

Negative dromotropic (decrease electrical conduction)

Uses: systolic HF, SVTs

nitroglycerin (Nitrostat, Nitro-Bid)

Agent, Class and Mechanism of Action

Agent: Antianginal Agent

Class: Nitrates

Mechanism of Action: Dilate all blood vessels, especially venous vascular beds. 

***Potent dilating effect on coronary arteries.

atenolol (Tenormin)

Agent, Class, Mechanism of Action

Agent: Antianginal Agent

Class: Beta1-blocker

Mechanism of Action: Block the beta receptors of the heart to slow the HR (slows firing of SA node, slow conduction to AV node and reduce myocardial contractility)

diltiazem (Cardizem)

Agent, Class, Mechanism of Action

Agent: Antianginal Agent

Class: Calcium channel blocker

Mechanism of Action: Blocks Ca++ in the excitation-contraction process of heart and vascular muscle cells >>> promotes contraction of heart and vessels (vasodilation).  Also decreases automaticity of and conduction thru SA and AV node >>> decreases/slows heart rate. 

clonidine (Catapres)

Classification and Mechanism of Action

Classification: Alpha-2 adrenergic receptor stimulator (agonist)

Mechanism of Action: Works by stimulating the alpha-2 adrenergic receptors in the brain which reduce sympathetic outflow from the CNS which reduces BP  

captopril (Capoten)

Classification and Mechanism of Action

losartan (Cozaar)

Classification and Mechanism of Action

hydralazine HCl (Apresoline)

Classification and Mechanism of Action

Negative inotropic (decreased contractility)

Negative chronotropic (decreased HR)

Negative dromotropic (decreased conduction)

furosemide (Lasix) 

Mechanism of Action and Uses

AKA - Loop diuretic

Mechanism of Action: block chloride absorption, blocks sodium - water follows sodium and excreted

(unfortunately, K+ is also excreted)

Uses: rapid diuresis

minoxidil (Rogaine) 

Classification and Uses

Classification: vasodilator

Uses: in topical form, used to restore hair growth

mannitol (Osmitrol)

Type, Mechanism of Action and Uses

Type: osmotic diuretic

Mechanism of Action: Produces osmotic pressure in the GF >>> pulls fluid into tubules >>> diuresis

Uses: promotes diuresis without significant electrolyte effects, early oliguric phase of acute renal failure, increased intracranial pressure and cerebral edema

spironolactone (Aldactone)

Type, Mechanism of Action and Uses

Type: Diuretic Agent

Mechanism of Action: Binds to aldosterone receptors (blocks aldosterone) >>> blocks resorption of Na+ and water, spare potassium

Uses: hyperaldosteronism, HTN, reverse K+ loss caused by K+ wasting (loop, thiazide) diuretics

hydrochlorothiazide (HydroDIURAL)

Type, Mechanism of Action, Uses

Type: Diuretic Agent

Mechanism of Action: Inhibit resorption of Na+, K+, Cl^- >>> osmotic water loss. 

Direct relaxation of arterioles >>> reduces afterload. 

Works best with adequate creatinine clearance (> 50 mL/min).

Uses: HTN, edematous states, idiopathic hypercalciuria, diabetes insipidus

lidocaine (Xylocaine)

Type, Mechanism of Action, Uses

Type: antidysrhythmic

Mechanism of Action: Class Ib - block sodium channels, delay repolarization and increase action potential duration

Uses: used to treat PVCs (more than 6 at a time) and V-tach

amiodarone (Cordarone)

Type, Mechanism of Action, Uses

Type: antidysrhythmic

Mechanism of Action: Class III - principal effect on myocardial tissue is to increase action potential duration

Uses: Treatment of V-tach, V-fib, V flutter and A fib

Treats only ventricular dysrhythmias

*Proarhythmic properties

adenosine (Adenocard)

Type, Mechanism of Action, Uses

Type: antidysrhythmic

Mechanism of Action: causes transient asystolic pause

Uses: converts SVTs to normal sinus rhythm

Treats both atrial and ventricular dysrhythmias

Adrenergic drugs mimic the effects of the SNS

Produce a "fight or flight" response

Produce their effects by binding with one or both types of receptors: alpha and beta

Think: brain is getting the body ready for action

Adrenaline released for fight/flight

Increased BP

Glycogenolysis (liver)

Slowed or ceased digestion

Sphincters close, then relax

Cortisol is released (responsible for helping the body deal with stress - depresses the immune system)

Pupils dilate

Mucous membrane dry out

Muscles tense for action

Increased HR (chest pains, palpitations)

Sweating

Resp: fast and shallow (hyperventilation - increased oxygen need for muscle action)

post-synaptic effector cells that control the structure (organ, tissue or muscle) stimulated.

dilation or relaxation frequently result with activation of these receptors

pre-synaptic nerve cells that regulate neurotransmitter (epinephrine, norepinephrine and dopamine) release

constriction or contraction frequently result when these receptors are activated

Beta-1 receptors

Location and association

located primarily on the surface of the heart

associated with post-synaptic effector cells or target organs

think - beta-1: you have one heart

Beta-2 receptors

Location and Association

located primarily in the lungs, uterine smooth muscle and intestinal lining

think - Beta-2: you have two lungs

heart: + inotropic, chronotropic and dromotropic effects

pancreas: decreased insulin release (increased blood sugar)

Blood vessels (esp of the muscles) - dilation

Liver - glycogenolysis

Kidney - increased renin secretion (increase BP)

Smooth muscle - relaxation (slowed peristalsis)

Uterus - relaxation (suppress labor)

Bronchial Smooth Muscle - relaxation (dilation of airways - increased oxygen consumption)

Stimulates dilation of arteries supplying kidneys, mesentery, coronary vasculature, cerebrum

Increases bloodflow to these areas

low dose - renal dosing

mid-range dose - cardiac dosing

high dose - hypotension dosing