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Sympathetic (Adrenergic Agonist (Direct Acting (NE (strong a, weak B)…

- - - - action: release of stored NE
      - adverse effect: precipitation cause vasopressor episodes (low BP)
    - - action: increase non-vesicular release of NT, increase BP significantly (a1 & B1 effect)
      - marked central stimulatory action (decrease brain activity)
    - - action: block reuptake of NE, enhance sympathetic activity of EPI & NE, increase BP by a1 & B1 action
  - - - therapeutic use: treat hypotension, asthma, improve athletic performance
      - adverse effect: treat asthma but also increase BP
      - action: raise SBP & DBP, bronchodilation, mild CNS stimulant
    - - therapeutic use: used orally to treat nasal & sinus congestion
      - adverse effect: illegally used to produce methampetamine
  - - - nasal spray decongestants, by producing vasoconstriction
      - long term use: rebound congestion & dependence
    - - action: increase SBP & DBP
      - therapeutic use: hypotension, mydriatic agent, nasal decongestant (topically or orally)
      - adverse effect: hypertensive headache & cardiac irregularities
    - - action: lower dose, activate B1. higher dose, activate a1. can activate D1 at renal vascular beds, increase renal blood flow
      - therapeutic use: cardiogenic (more useful than NE) & septic shock, hypotension & severe congestion HF
    - - action: decrease DBP with moderate increase SBP, potent bronchodilator
      - adverse effect: similar to EPI
    - - action: inhibit sympathetic vasomotor, decrease sympathetic outflow to periphery
      - therapeutic use: hypertension
    - - action: increase SBP & DBP with reflex bradycardia
      - therapeutic use: cardiogenic shock (SBP<90 mmHg for >30 mins)
      - adverse effects: similar to EPI
      - reverse NE with a-receptor antagonist (phentolamine)
    - - action: bronchodilation. albuterol (short-acting), salmaterol (long-acting, B2 selective)
    - - therapeutic use: bronchospasm, anaphylactic shock, cardiac arrest, anesthetic adjunct
      - adverse effects: pulmonary edema, trigger cardiac arrythmias for patients with digoxin, enhance CV actions in patients with hyperthyroidism
      - action: increase SBP with slight decrease DBP, bronchodilation, hyperglycemia
    - - therapeutic action: overactive bladder
      - adverse effect: may increase BP, not used in patient with uncontrolled HPT
- - - - Acebutolol, Atenolol, Bisoprolol, Metoprolol &Nebivolol
        
        preferentially block B1, minimize unwanted bronchoconstriction, most pronounced at low doses
        
        therapeutic use: angina (increase exercise tolerant) & HPT (lower BP)
    - - Acebutolol & Pindolol
        
        have intrinsic sympathomimetics activity (ISA)
        
        action: inhibit stimulation by EPI & NE, minimized disturbances of lipid & carbohydrate metabolism
        
        therapeutic use: HPT with moderate bradycardia
        
        NOT USED FOR ANGINA & ARRYTHMIAS (due to partial agonist effect)
    - - Propanolol
        
        therapeutic use: hypertension, angina pectoris, myocardial infarction, migraine. hyperthyroidism (protect against cardiac arrythmias)
        
        adverse effect: bronchoconstriction, arrythmias (if stopped abruptly), metabolic disturbances, CNS effects (depression,dizziness, lethargy, fatigue) - replace with atenolol (do not cross BBB readily-more hydrophilic)
        
        action: -ve inotrope & chronotrope, decrease CO & O2 consumption, decrease glycogenolysis (pronounced hypoglycemia may occur after insulin injection)
        
        blocks B1 & B2 with equal affinity, can penetrate CNS
      - Timolol
        
        more potent that propanolol
        
        therapeutic use: chronic glaucoma (apply topically) & HPT
    - - Labetalol & Carvedilol
        
        useful in treating HPT with undesirable increase in PVR, common for usage in pregnancy women
        
        adverse effect: orthostatic hypotension & dizziness (associated with a1 blockade)
  - - - Tamsulosin
        
        action: decrease PVR, lower BP (more selective for a1A receptor in prostate & bladder- improves urine flow)
        
        therapeutic use: treat benign prostatic hyperplasia
        
        adverse effect: similar with prazosin
      - Prazosin
        
        adverse effect: dizziness, lack energy, nasal congestion, headache, drowsiness, orthostatic hypotension, inhibit ejaculation
        
        therapeutic use: treatment of HPT (first dose may cause orthostatic hypotensive response-syncope), minimized dose by 1/3 or 1/4
        
        action: decrease PVR, lower BP
    - - Yohimbine
        
        usage: sexual stimulant (viagra), CNS & cardiac stimulant
        
        action: increase sympathetic outflow to periphery
    - - Phentolamine
        
        competitive, action lasts 4 hrs
        
        action: reflex cardiac stimulation & tachycardia
        
        therapeutic use: short-term management of pheochromocytoma, prevent dermal necrosis, treat hypertensive crisis (due to abrupt withdrawal of clonidine)
      - Phenoxybenzamine
        
        therapeutic use: pheochromocytoma (used prior to surgery to prevent hypertensive)
        
        action: a1--> decrease PVR with reflex tachycardia, a2--> stimulate B2, increase CO, reverse EPI actions (decrease BP)
        
        irreversible block, non-competitive, action lasts 24 hrs
        
        adverse effect: postural hypotension, nasal stuffiness, inhibit ejaculation, induce reflex tachycardia
- - - - eg: heart
      - increase cardiac contractility, renin release, lipolysis
    - - vasodilation, decrease TPR, increase glucose
      - eg: skeletal muscle
  - - - inhibit NE, ACh, insulin release
    - - eg: skin & abdominal viscera
      - vasoconstriction, increase TPR, increase BP, mydriasis