Adrenergic Drugs Sympathomimetic drugs Based on chemical structure and action According to Chemical Structure 1.

Catecholamine natural / synthetic Life saving drugs 2. Non-catecholamine According to Action 1. Direct acting directly affects the organ 2. Indirect triggers release of neurotransmitters 3. Dual both effects Therapeutic Use: Depend on what receptor they stimulate and intensity Adrenergic: Alpha, Beta, Dopamine receptor CATECHOLAMINE Stimulate CNS Constrict peripheral blood vessels Inc. heart rate Dilate bronchi Can be manufactured in the body Ex synthetic: isoproterenol Common Catecholamine: Dobutamine, EpinephrineBitartrate, Na citrate, Epi. HCl Dopamine, Isoproterenol HCl, Isoproterenol sulfate Salts like HCl are added to drugs to make it more absorbable

Positive chonotropic; inc. cardiac output / heart rate; heart beats faster Can cause to purkinje fibers; carry electrical impulses into the ventricles to function fact to pump Spontaneous firing producing abnormal heart rhythm. Pharmacotherapeutics: Depend on the receptor linked: Beta/ alpha receptor almost exclusively Isoproterenol & Dopamine - beta receptor Dopamine dopaminergic receptor Alphareceptor drugs, treat hypotension caused by the relaxation of blood vessels, blood loss (hemorrhage) Beta receptor; treat brachycardia , low cardiac output & heart clock (respond to electric impulses) Ventricular fibrillation Cardiac arrest Beta 2 Drugs Acute / chronic asthma Emphysema Bronchitis Allergic reaction to drug Dopamine Stimulate Used in low doses to improve blood flow in the kidneys by dilating renal blood vessels Natural VS. Synthetic short duration of manufactured action Drug interaction hypothermia, hypotension, seizure, High Blood glucose level (diabetic), Arrhythmias Alpha blocker ex. Phentolamine > hypotension Beta blocker ex. Propanolol > bronchial constriction Epinephrine Hypoglycemic in diabetic patient < increase dose of insulin (antidiabetic) Other adrenergic drugs + additive (double hypo / Hyperthermia arrhythmia) w/ tricyclic antidepressants: lead to hypertension ADR

Catecholamines Destroyed by digestive enzymes Sublingually can be rapidly absorbed in the mucus membrane and are metabolized by the salivary enzymes (amylase / pepsin) SubQ > slow, can cause blood vessel constriction in the injection site IM more rapid absorption with less constriction in the local blood vessel (deltoid) mostly IV Distribution and Metabolism Widely distributed in the body Metabolized in the GI tract, Kidney, Liver, Lungs, Plasma & other Excretion Urine mostly Epinephrine same in breastmilk Isoproterenol feces Pharmacodynamics Direct Acting o When combined with alpha and beta receptors: Excitatory (alpha) except for intestinal relaxation Inhibitory effects (beta) except for heart cells (norepinephrine); excitatory effect on heart cells Clinical Effects Catecholamines Depend on dosage and route Potent inotropic (inc. myocardial contractility) Allow the heart to contract forcefully the ventricles in the heart Rapidly increase heart work and inc. in oxygen demand

restlessness anxiety dizziness headache palpitate hypotension cardiac arrhythmia stroke angina inc. blood glucose tissue necrosis hypertension

NON-CATECHOLAMINE Local/ Systemic constriction of blood vessels Used in nasal & eye decongestion & dilation of bronchioles Used for smooth muscle relaxation Absorption Depend on the route

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Inhaled absorbed from the bronchi with lower drug level in the body (Albuterol) Oral absorbed well from GI tract & distributed in the body Ephedrine can pass blood, brain barrier & can be found in the cerebro-spinal fluid & brain

Metabolism Liver/ lungs, GI tract, other tissues Excretion Urine Inhaled, albuterol w/in 24 hours through the lungs Oral Albuterl w/in 3 days Acidic urine in excretion Pharmacodynamics Direct- stimulate alpha receptor: Phenylephrine Beta 2: Albuterol, metaproterenol, terbutaline, Isotharine; Dual: ephedrine, mephentermine PH Therepeutic Stimulate sympathetic NS o Mephentermine vasoconstriction; treat hypotension in cases of severe shock o Terbutaline (Bricanyl) stop premature labor (preterm labor) Drug interaction: Anesthetics: cause arrhythmias interact w/ MAOinhibitors, sever hypertension, even death Oxytoxic drugs (stimulate labor contraction) Tricyclic antidepressant: hypertemia/ arrhythmia Urine alkanizer (acetazolamide N4HCO3) ADR Headache Restlessness Anxiety Irritability Trembling Drowsiness Light headache Seizures Hyper/ hypotension Palpitation Brady/ tachycardia Cardiac arrest Cerebral hemorrhage Coldness in arms Flushing Angina