Adrenergic Drugs

Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Overview
Mimic the effects of SNS neurotransmitters

(catecholamines)

Norepinephrine (NE)
Epinephrine (EPI)
Dopamine

Adrenergic Receptors
Alpha 1 Receptors
All vascular smooth muscle,
GI & urinary sphincters
Dilator muscle of the iris
Arrector pili muscle of hair follicles
Alpha 2 Receptors:
Located on secretory terminals of
postsynaptic adrenergic neurons.

Adrenergic Receptors
Beta 1 Receptors
Cardiac pacemaker
Myocardium
Salivary gland ducts
Eccrine and apocrine sweat glands
Beta 2 Receptors:
gastrointestinal tract
urinary bladder
skeletal muscle arteries
bronchial tree
some coronary vessels
Beta 3 Receptors:
on the smooth muscle cells of the urinary bladder

Beta-Adrenergic Receptors

Dopaminergic Receptors
Stimulated by dopamine
Causes dilation of the following blood vessels,

resulting in increased blood flow

Renal
Mesenteric
Coronary
Cerebral

Dopaminergic Receptors
D1 Receptors:
Smooth muscles of pulmonary artery, kidney,
smooth muscles of various organs e.g sphincters of
stomach., proximal tubule of nephron, brain
D2 receptors:
Brain, Substantia nigra, neostraital pathway,
pulmonary artery, kidney
D3,D4,D5:
These are primarily present in brain. D4 receptors
are expressed in atrial wall. dopamine increases
myocardium contractility.

Adrenergic Receptors
Activation of alpha 1 and beta 1 receptors

cause stimulatory responses

Activation of alpha 2 , beta 2 & B3
receptors cause inhibitory responses

Responses to Stimulation

Mechanism by which stimulation of a nerve

fiber results in a physiologic response:

Catecholamines
Endogenous substances:
Epinephrine.
Norepinephrine.
Dopamine.
Exogenous substances:
Dobutamine.
Phenylephrine.

1- direct acting sympathomimetics.

2- indirect acting sympathomimetics.

Inhibit catecholamine breakdown

3- mixed acting sympathomimetics

Direct acting adrenergic agonists

Epinephrine. (alpha and beta)
Norepinephrine. (alpha and beta)
Dopamine. (alpha and beta)
Isoproterenol (on beta 1 and beta 2)
Dobutamine (beta 1 agonist).
Salbutamol (albuterol), terbutaline, salmetrol, and
formetrol (acting on beta 2 only).
Oxymetazoline(alpha1 and alpha2)
Phenylephrine (alpha 1)
Clonidine (alpha2)

Indications
Respiratory indications
Indications for topical nasal decongestants
Ophthalmic indications
Cardiovascular indications

Respiratory indications
1- as bronchodilators

Nasal congestion

Indications (contd)
Treatment of nasal congestion
Alpha1-adrenergic receptors
Examples: epinephrine, ephedrine, naphazoline,
oxymetazoline, phenylephrine, and tetrahydrozoline

Ophthalmic indications

Reduction of intraocular pressure and dilation of

pupils. (Phenylephrine )

Temporary relief of conjunctival congestion (eyes)

CVS indications
Support the cardiovascular system during cardiac

failure or shock.

Common vasoactive adrenergic drugs include

dobutamine, dopamine, ephedrine, epinephrine,

fenoldopam, midodrine, norepinephrine, and
phenylephrine.

Epinephrine/ adrenaline

Dopamine
Dopamine
At doses < 2 mcg/kg/min, stimulates
dopamine receptors, vasodilatation and
increase renal perfusion .
At doses between 5 and 10 mcg/kg/min,
stimulates beta-1 adrenergic receptors,
resulting in increased cardiac output.
At doses > 10 mcg/kg/min, dopamine
stimulates alpha-adrenergic receptors,
leading to vasoconstriction, which
increases the systemic vascular
resistance and increase BP

Dobutamine
Dobutamine
Primarily stimulates beta-1 receptors,
leading to increased inotropic and
chronotropic effects to al lesser extent
Dobutamine also stimulates beta-2
adrenergic receptors, leading to
vasodilatation.
This combination of effects contributes to
increased cardiac output with decreased
systemic vascular resistance.
Dobutamine is typically used for patients
with cardiogenic shock.

Nursing Implications (contd)

Overuse of topical nasal decongestants may cause

rebound nasal congestion or ulcerations

Administering two adrenergic drugs together

may precipitate severe cardiovascular effects

such as tachycardia or hypertension

Nursing Implications (contd)

Monitor for therapeutic effects (cardiovascular

uses)
Decreased edema
Increased urinary output
Return to normal vital signs
Improved skin color and temperature