Direct acting Sympathomimetics:

Mixed or Nonselective Agonists

(4)

1. Epinephrine (E)-on all receptors
2. Norepinephrine (NE)-on all but B2 
3. Isoproterenol-on B1 and B2
4. Dopamine (DA)- on D, and B1, then A1

Direct Acting Sympathomimetic Agents:

Selective Beta-1 agonists

Direct Acting Sympathomimetic Agents:

Selective Beta-2 Agonists

1. Albuterol (proventil)
2. Metaproterenol
3. Pirbuterol (Maxair)
4. Salmeterol (serevent)
5. Terbutaline

Direct Acting Sympathomimetic Agents:

Selective Alpha-1 Agonists

1. Phenylephrine
2. Midodrine

Indirect Acting Sympathomimetic Agents:

Cocaine

Pseudoephedrine and Ephedrine

Amphetamine and Methamphetamine

Methylphenidate

Direct acting Sympathomimetic (mixed or non selective)

1. Stimulates all alpha and beta receptors (1 and 2)
2. Low IV rates- hit the extra synaptic receptors (a2 and b2).  decreae diastolic and barely increase systolic and mean arterial pressure. HIGH IV Rates- Increases pulse pressure further, increase Diastolic, little effect on mean arterial pressure
3. High dose to treat bronchospasm (from circulatory shock) and Circulatory Collapse (from anaphylactic shock)
4. Stimulates B2 for bronchostimulation (asthma)
5. At high dose, Treats Bradycardia due to AV block
6. mixed with local anasthetics to prolong their effects (local vasoconstriction keeps the drug there)

Direct Acting Sympathomimetic (Non selective)

Acts on Beta 1 and 2

1. decrease diastolic and mean pressures, increase pulse pressur and heart rate
2. NO LONGER a bronchodialator
3. bradyarrhythmias
4. assists in tilt table tests to diagnose synchopies.

direct acting Sympathomimetic

(non-selective)

Acts on Alpha-1 and 2, and Beta-1

1. Increase all pressure measures at any IV infusion rate (Higher degree of increase at higher increase of dose)
2. used to treat shock (Cardiogenic and neurogenic, early phase Septic shock)
3. Supports BP during Spinal Anesthesia
4. Can be used to keep local injection sites with a lasting effect, like Epinephrine, but DISCONTINUED.

direct acting Sympathomimetic

(non-selective)

Acts on D receptors, then B1, then A1

1.  (Low dose) stimulates D receptors on GI tract and Renal--> (intermediate Dose) stimulates the B1 receptors --> (High Dose) stimulates A1 receptors  
2. At low dose-increase the blood flow to those areas. At intermediate dose-stimulate cardiac contractility and rate.  At high doses-raise arterial BP and increase the total peripheral vascular resistance.
3. Cardiogenic and neruogenic shock. early septic shock.
4. Used in patients with congestive Heart Failure
5. Treat Bradychardia (use Intermediate does to only act on B1 and D receptors, NOT A1)

Direct acting Sympathomimetics

(Beta 2>1 selective)

1. Bronchodilator (rescue inhaler for asthma and COPD)
2. Terbutaline used to manage premature labor (B2 stimulated uterine relaxation)

Direct acting Sympathomimetics

(Selective Alpha-1 Agonists)

1. IV to treat Supraventricular tachycardia
2. Mydriatic Agent
3. treat hemorrhoids and nasal congestion
4. Phenylephrine via IV used to maintain diastolic and mean BP during neurogenic shock.  raises diastolic and mean BP
5. Midodrine used to treat orthostatic hypotension symptoms (ORALLY) and urinary incontinence.

Indirect acting Sympathomimetic agent

1. inhibits reuptake of NE sympathetic nerve terminals-leaves more NE available to receptors
2. a good local anasthetic agent (local vasoconstriction)

Indirect acting Sympathomimetic

1. stimulate release of NE from sympathetic nerve endings (independent of nerve action potentials)
2. Mainly used to treat nasal snd bronchial congestions. (Promotes drainage)

Sinoatrial Node

Atrioventricular Node

Ventricles

Vessels (mainly sympathetic)

Thermoreceptors

attempt to shift blood one way or another to regulate body temperature

1. when faced with cold environment, brain tells Adrenomedulla to put out more______ in order to_______
2. What is Raynaud's Disease?

1. Epinephrine, to increase glucose output from hepatic cells, and increase free fatty acid output, from fat cells--> For Thermogenesis
2. abnormally excessive sympathetic NE response to cold stress.  May cut off circulation to fingers etc.

Sympathomimetic B1 selective

• Actually a combo of 2 (A1 agonist)+(B1 Agonist and A1 Antagonist) net effect=B1 agonist
• Increases Cardiac contractility-->increases Cardiac Output and Pulse Pressure
• treats Shock: cardiogenic and late phase septic
• stimulate heart in emergence of surgery