Adrenergic Agonists

Adrenergic agonists

affect receptors stimulated by Epi/NE

sympathomimetic or sympatholytic

Alpha-1

Vasoconstriction

increased BP/TPR

mydriasis

Alpha-2

inhibits norepi release

inhibits ACh release

inhibits insulin release

Beta-1 “one heart”

increase HR

increase BP

increase renin release

increase contractility

Beta-2 “two lungs’

vasodilation

bronchodilation

decrease TPR

relaxes uterine muscle

Norepinephrine

direct acting

alpha effects

vasoconstriction=increase BP/TPR

TU: shock

AE: skin slough at site

Epinephrine

direct acting

low dose= beta effects

high dose = alpha effects

TU: anaphylaxis, asthma, cardiac arrest

Isoproterenol

direct acting

beta effects

synthetic drug

intense cardiac stimulation

bronchodilator

Clonidine

direct acting

alpha-2

inhibits SNS

TU: HTN, withdrawal, ADHD

AE: fatigue, constipation, xerostomia

hard stop, rebound HTN

Dobutamine

direct acting

beta-1 mainly

increase HR

increase CO

Cl: Afib

TU: heart failure, post cardiac surgery

Dopamine

direct acting

high dose =alpha-1

low dose=beta-1

TU: cardiogenic/septic shock, hypotension

Fenoldopam

direct acting

D1 dopaminergic

AE: HA, N/V, increase HR

TU: rapid vasodilation in HTN emergencies

Midodrine

direct acting

alpha-1

TU: orthostatic hypotension

avoid w/in 4 hours bed:supine HTN

Mirabegron

direct acting

beta-3

relaxes bladder

AE: increase BP

TU: overactive bladder

Oxymetazoline

direct acting

alpha effects

vasoconstriction=increase BP/TPR

TU: nasal spray, eye drops

rebound congestion>3 days

Phenylephrine

direct acting

alpha-1

vasoconstriction (increase BP)

AE: HTN HA

TU: IV for hypotension, decongestant, mydriasis

SABA

DOA: <3hr

TU: asthma rescue therapy

“Al is short”

albuterol

terbutaline (off label uterine relaxant

direct acting (inhaled)

beta-2

LABA

DOA: >12hr

TU: asthma, COPD

always with corticosteroids

“Sal is long”

formoterol

salmeterol

indacaterol

direct acting (inhaled)

beta-2

Amphetamine

indirect acting

alpha-1, beta-1

increase catecholamine release

TU: ADHD/ADD (adderall)

Cocaine

indirect acting

prevents NE reuptake

enhanced SNS effects

increase BP

Tyramine

indirect acting

found in fermented foods

bad if on MAO inhibitor drug

Ephedrine

mixed acting

alpha and beta

long DOA

TU: HTN, fatigue, increase athletic performance

Pseudoephedrine

mixed acting

alpha and beta

long DOA (make meth)

TU: nasal/sinus congestion

Adrenergic agonist general effects

“FIGHT F”

Fast HR

Increase BP

Gluconeogenesis

Hot (sweaty palms)

Tremors

Fight or flight (SNS)