Dopamine vs Dobutamine

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Questions and Answers

Which receptor subtype has the highest affinity for dopamine at low doses, leading to vasodilation in renal and mesenteric vascular beds?

  • Beta 1
  • D1 (correct)
  • Alpha 1
  • Beta 2

A patient with cardiogenic shock requires a medication to increase cardiac output with minimal vascular effects. Which medication is most appropriate?

  • Dobutamine (correct)
  • Low-dose Dopamine
  • High-dose Dopamine
  • Xylometazoline

Which of the following effects is associated with stimulation of beta-2 adrenergic receptors?

  • Bronchodilation (correct)
  • Increased uterine contraction
  • Vasoconstriction
  • Decreased heart rate

Ritodrine is a selective beta-2 agonist used for tocolysis. By what route(s) can it be administered?

<p>Oral and injection (D)</p> Signup and view all the answers

A patient is experiencing premature labor. Which Beta-2 agonist could be administered as a tocolytic?

<p>Ritodrine (C)</p> Signup and view all the answers

What is a potential adverse effect associated with the use of selective Beta 2 agonists, particularly at high doses?

<p>Tachycardia and arrhythmias (A)</p> Signup and view all the answers

Mirabegron is a selective Beta 3 agonist used to treat overactive bladder. What is the mechanism of action?

<p>Relaxing the detrusor muscle of the urinary bladder. (C)</p> Signup and view all the answers

A patient using Xylometazoline nasal spray for an extended period reports increased nasal congestion when they stop using it. What is the likely cause?

<p>Rebound nasal congestion (C)</p> Signup and view all the answers

Why should caution be taken when using non-selective alpha agonists in hypertensive patients?

<p>They can increase blood pressure further (A)</p> Signup and view all the answers

Which of the following is a therapeutic use of phenylephrine?

<p>Treatment of nasal congestion (C)</p> Signup and view all the answers

A 68-year-old male with a history of hypertension is prescribed a nasal decongestant for a cold. Which of the following active ingredients in the decongestant should raise concern?

<p>Phenylephrine (A)</p> Signup and view all the answers

What is the primary mechanism of action of clonidine?

<p>Alpha 2 receptor agonist (C)</p> Signup and view all the answers

Tizanidine is a congener of clonidine, but it is primarily used as what?

<p>Skeletal muscle relaxant (A)</p> Signup and view all the answers

Which of the following statements best describes the difference between clonidine and tizanidine?

<p>Clonidine primarily affects central alpha-2 receptors to lower blood pressure, while tizanidine mainly affects spinal alpha-2 receptors to reduce muscle spasticity. (B)</p> Signup and view all the answers

Which short-acting selective Beta 2 agonist is administered by oral route?

<p>Ritodrine (A)</p> Signup and view all the answers

Which of the following adrenergic agonists is commonly present in nasal sprays to treat nasal congestion?

<p>Xylometazoline (C)</p> Signup and view all the answers

Which of the following is a use tizanidine?

<p>Skeletal muscle relaxant (D)</p> Signup and view all the answers

Which of the following a selective beta 2 agonists?

<p>Salbutamol (B)</p> Signup and view all the answers

A patient with a history of asthma is experiencing bronchospasm. Which of the following medications would be most appropriate to provide immediate relief?

<p>Salbutamol (B)</p> Signup and view all the answers

A patient on a Beta 2 agonist complains about experiencing hand tremors. What is the mechanism for this adverse effect?

<p>Facilitation of neuromuscular transmission (B)</p> Signup and view all the answers

A patient is experiencing orthostatic hypotension and requires a medication to increase blood pressure. Which of the following medications would be most appropriate?

<p>Phenylephrine (D)</p> Signup and view all the answers

A patient with an overactive bladder is prescribed Mirabegron. What is a possible side effect of this medication?

<p>Constipation (A)</p> Signup and view all the answers

A patient is prescribed clonidine for hypertension. What is the primary mechanism of action by which clonidine lowers blood pressure?

<p>Stimulating alpha 2 receptors in the brain. (C)</p> Signup and view all the answers

Which of the following medications is a synthetic catecholamine?

<p>Dobutamine (B)</p> Signup and view all the answers

Which medication causes the following: Stimulates D1 > β1 > α1 receptors?

<p>Dopamine (C)</p> Signup and view all the answers

Which of the following medications is used primarily as a tocolytic agent?

<p>Ritodrine (A)</p> Signup and view all the answers

What receptor selectivity is lost when Beta 2 agonists is administered in high doses?

<p>Selectivity on Beta 2 agonist (B)</p> Signup and view all the answers

Which of the following medications has a relatively minimal effect on blood pressure?

<p>Tizanidine (A)</p> Signup and view all the answers

A previously healthy 25-year-old female presents to urgent care with a chief complaint of nasal congestion for 1 week not resolving with saline nasal spray. She denies any allergies, fever, cough, or other symptoms. She asks if there is anything stronger she can use for her congestion. What would be your recommendation?

<p>Recommend topical oxymetazoline for 3 days (B)</p> Signup and view all the answers

A patient with a known history of stable heart failure taking appropriate medications presents to the Emergency Department with shortness of breath and is found to be hypotensive. The patient requires an agent to improve cardiac output and blood pressure. Which of the following medications would be most appropriate?

<p>Dobutamine (A)</p> Signup and view all the answers

A researcher is investigating the effects of adrenergic agonists on vascular smooth muscle. Which of the following receptors, when stimulated, would be most likely to cause vasoconstriction?

<p>Alpha-1 adrenergic receptors (C)</p> Signup and view all the answers

A pregnant woman in her third trimester is experiencing preterm labor. Her physician decides to administer a Beta-2 adrenergic agonist to help suppress uterine contractions. Which of the following is the most likely mechanism by which this class of drugs achieves uterine relaxation?

<p>Increased intracellular cAMP levels in uterine smooth muscle. (C)</p> Signup and view all the answers

An anesthesiologist is preparing to administer a medication to increase a patient's blood pressure during surgery. The patient has a known history of asthma, and the anesthesiologist wants to avoid any medication that could potentially trigger bronchoconstriction. Which of the following adrenergic agonists would be the MOST appropriate choice?

<p>Norepinephrine (C)</p> Signup and view all the answers

A patient is experiencing severe bradycardia and hypotension following a drug overdose. The medical team decides to administer an adrenergic agonist to increase heart rate and blood pressure. Which of the following medications, with its receptor selectivity, would be MOST effective in this scenario?

<p>Isoproterenol (non-selective β agonist) (D)</p> Signup and view all the answers

A 70-year-old man with a history of benign prostatic hyperplasia (BPH) is prescribed phenylephrine nasal drops for nasal congestion. Which of the following potential adverse effects should the patient be MOST cautious about due to his underlying BPH?

<p>Increased risk of urinary retention (D)</p> Signup and view all the answers

A researcher is studying the effects of various adrenergic agonists on uterine smooth muscle. Which of the following interventions would MOST likely promote uterine relaxation and be useful in the treatment of preterm labor?

<p>Administering a beta-2 adrenergic agonist. (D)</p> Signup and view all the answers

A patient with a known hypersensitivity to catecholamines requires vasopressor support during septic shock. The patient's physician decides to use a vasopressor with minimal interaction with adrenergic receptors. Which of the following agents is MOST appropriate?

<p>Vasopressin (D)</p> Signup and view all the answers

A researcher is investigating how different adrenergic agonists affect heart rate and blood pressure. They administer four different drugs (A, B, C, and D) to animal models and monitor the changes in heart rate (HR) and mean arterial pressure (MAP). The results are shown below:

Drug A: HR increased significantly, MAP remained relatively unchanged. Drug B: HR decreased significantly, MAP increased significantly. Drug C: HR increased moderately, MAP increased moderately. Drug D: HR decreased slightly, MAP remained relatively unchanged.

Based on these observations, which drug is MOST likely a selective α2-adrenergic agonist?

<p>Drug D (D)</p> Signup and view all the answers

A 30-year-old woman presents to her physician with complaints of frequent urination, urgency, and nocturia. After ruling out other potential causes, she is diagnosed with overactive bladder (OAB). The physician decides to prescribe mirabegron, a beta-3 adrenergic agonist. Which of the following mechanisms of action BEST describes how mirabegron helps to alleviate the symptoms of OAB?

<p>It relaxes the detrusor muscle, increasing bladder capacity. (B)</p> Signup and view all the answers

A researcher is investigating the effects of a novel adrenergic agonist on various tissues. The researcher observes that the drug causes significant bronchodilation but also increases heart rate and contractility. Upon further investigation, the researcher finds that the drug has high affinity for both β1 and β2 adrenergic receptors. Which of the following strategies would be MOST effective in reducing the cardiac side effects while maintaining the bronchodilatory effects?

<p>Developing a more selective β2-adrenergic agonist (B)</p> Signup and view all the answers

Flashcards

Dopamine

A natural catecholamine given intravenously with a very short duration of action.

Dopamine (low doses)

Dopamine at low doses stimulates D1 receptors in renal and mesenteric vascular beds, leading to vasodilation and increased renal/hepatic blood flow.

Dopamine (intermediate doses)

Dopamine at intermediate doses stimulates beta-1 receptors, which increases contractility and Cardiac Output.

Dopamine (large doses)

Dopamine at large doses stimulates alpha-1 receptors, leading to vasoconstriction and increased blood pressure.

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Dobutamine

A synthetic catecholamine given intravenously with a very short duration of action.

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Dobutamine's primary effect

Dobutamine primarily stimulates cardiac beta-1 receptors, increasing cardiac output with little to no vascular effects.

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Dobutamine uses

Dobutamine is used for cardiogenic shock and acute ventricular failure

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Selective Beta-2 Agonists

Synthetic non-catecholamines that cause relaxation of smooth muscles.

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Bronchial Beta-2 Agonist Effect

Beta-2 agonists cause relaxation of bronchial smooth muscle, leading to bronchodilation.

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Vascular Beta-2 Agonist Effect

Activation of Beta-2 receptors on vascular smooth muscle leads to vasodilation.

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Uterine Beta-2 Agonist Effect

β2 agonists cause relaxation of uterine smooth muscle, resulting in tocolysis (inhibition of uterine contractions).

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Short-Acting Beta-2 Agonists (SABA)

Work quickly to provide relief from acute bronchospasm.

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Long-Acting Beta-2 Agonists (LABA)

Provide longer-lasting bronchodilation and are used for maintenance therapy.

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Beta-2 Agonists Therapeutic Use

Treatment of bronchial asthma

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Tocolytic use of Beta-2 Agonists

Beta-2 agonists can be used as a tocolytic because they relax the uterus.

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Adverse effects of Beta-2 Agonists

May cause tachycardia, arrhythmias, reflex hypotension, tremors, tolerance, and hypokalemia.

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Mirabegron

A Beta-3 agonist that relaxes the detrusor smooth muscle of the bladder.

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Mirabegron use

Mirabegron is used to treat overactive bladder

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Side effects of Mirabegron

Constipation, increased blood pressure, common cold symptoms, bladder infection, and increased heart rate.

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Non-Selective Alpha Agonists

Xylometazoline and Oxymetazoline stimulate alpha-1 and alpha-2 receptors, causing vasoconstriction.

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Xylometazoline & Oxymetazoline Use

Decongestants and locally for eye redness.

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Side effects of Non-Selective Alpha Agonists

Irritation, sneezing, rebound nasal congestion, nervousness, headaches, increased blood pressure.

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Alpha-1 Agonists Effects

Cause vasoconstriction, increasing both systolic and diastolic pressures, which can lead to reflex bradycardia.

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Alpha-1 Selective Agonists Uses

Vasopressor to treat orthostatic hypotension and decongestants

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Clonidine Mechanism

Centrally-acting alpha-2 agonist.

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Tizanidine Mechanism

Centrally-acting alpha-2 agonist that reduces muscle spasms through greater effect in the spinal cord.

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Clonidine Effects

Decreases central sympathetic outflow and lowers blood pressure.

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Tizanidine Effects

Inhibits neurotransmitter release and reduces muscle spasm with minimal effect on blood pressure.

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Clonidine Uses

Antihypertensive drug to lower blood pressure.

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Tizanidine Uses

Skeletal muscle relaxant, treats muscle spasticity caused by multiple sclerosis, stroke, or spinal cord injury.

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Clonidine Side Effect

Clonidine can cause a dry mouth, which is a common side effect.

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Tizanidine Side Effects

Tizanidine has minimal side effects compared to other muscle relaxants.

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Study Notes

  • Adrenergic drugs work on the autonomic nervous system

Dopamine vs Dobutamine

  • Dopamine is a natural catecholamine, while dobutamine is synthetic
  • Both have a very short duration of action and are administered via intravenous infusion
  • Dopamine stimulates D1, beta-1, and alpha-1 receptors
  • Low doses of dopamine stimulate D1 receptors in renal and mesenteric vascular beds, leading to vasodilation and increased renal/hepatic blood flow
  • Intermediate doses of dopamine stimulate beta-1 receptors, increasing contractility and cardiac output
  • Large doses of dopamine stimulate alpha-1 receptors, causing vasoconstriction and increased blood pressure
  • Dopamine's therapeutic uses include the treatment of shock states, increasing cardiac output, renal blood flow, and blood pressure
  • Dobutamine primarily stimulates cardiac beta-1 receptors, increasing cardiac output with little or no vascular effects
  • Dobutamine is used therapeutically for cardiogenic shock or acute ventricular failure

Selective Beta-2 Agonists

  • Selective beta-2 agonists cause relaxation of smooth muscles
  • Beta-2 agonists cause bronchodilation in bronchial smooth muscles
  • Beta-2 agonists cause vasodilation in vascular smooth muscles
  • Beta-2 agonists cause tocolysis (inhibition of uterine contractions) in uterine smooth muscles
  • Short-acting beta-2 agonists (SABA) include salbutamol and terbutaline
  • Long-acting beta-2 agonists (LABA) include salmeterol and formeterol
  • Beta-2 agonists can be administered by inhalation, orally, or by injection
  • Ritodrine is a short-acting selective beta-2 agonist available in oral and injectable forms
  • At high doses, beta-2 agonists lose their selectivity and may act on beta-1 receptors

Beta-2 Agonists: Therapeutic Uses and Adverse Effects

  • Beta-2 agonists treat bronchial asthma
  • Beta-2 agonists can be used as tocolytics to delay premature labor; ritodrine and terbutaline are examples
  • Adverse effects of beta-2 agonists include tachycardia and arrhythmias (at high doses), due to loss of selectivity and reflex hypotension
  • Other adverse effects include tremors (due to facilitation of neuromuscular transmission), tolerance, and hypokalemia

Selective Beta-3 Agonist: Mirabegron

  • Mirabegron relaxes the detrusor smooth muscle of the urinary bladder by activating beta-3 receptors, thus improving the filling capacity of the bladder
  • Mirabegron can be used alone or with a muscarinic antagonist to treat overactive bladder
  • An overactive bladder presents as frequent and urgent urination, and an inability to control urination
  • Mirabegron’s side effects include constipation, increased blood pressure and heart rate, common cold symptoms, and bladder infection

Non-Selective Alpha Agonists

  • Non-selective alpha agonists include xylometazoline and oxymetazoline, which stimulate alpha-1 and alpha-2 receptors, leading to vasoconstriction
  • They are used locally as eye or nose drops for decongestion
  • Adverse effects when used locally include irritation, sneezing, and rebound nasal congestion with long-term use
  • Rebound nasal congestion can counteracted by using the minimal dose over the shortest duration
  • If absorbed systemically, adverse effects include nervousness, headaches, trouble sleeping, and increased blood pressure (caution in patients who are hypertensive)

Selective Alpha-1 Agonists

  • Selective alpha-1 agonists, which are non-catecholamines include phenylephrine and midodrine
  • Alpha-1 agonists lead to vasoconstriction, increasing both systolic and diastolic pressures, which results in reflex bradycardia
  • They are used as vasopressors to correct chronic hypotension, including orthostatic hypotension
  • Alpha-1 agonists can locally produce vasoconstriction to relieve congestion, as in eye or nose drops that are decongestants

Selective Alpha-2 Agonists

  • Clonidine and tizanidine are selective alpha-2 agonists
  • Clonidine is a centrally-acting alpha-2 agonist and is used as an antihypertensive drug, which can cause dry mouth
  • Tizanidine works as a centrally-acting alpha-2 agonist but with greater effect presynaptically in the spinal cord
  • Tizanidine inhibits neurotransmitter release and reduces muscle spasm, with a minimal effect on blood pressure and causes slight side effects
  • Tizanidine is used as a skeletal muscle relaxant to minimize spasticity caused by multiple sclerosis, stroke, and spinal cord injury
  • Clonidine will be discussed in more detail in the next lecture

Review Question 1

  • Which of the following adrenergic agonists is commonly present in nasal sprays to treat nasal congestion?
  • The correct answer is B. Xylometazoline

Review Question 2

  • Which of the following is a use for tizanidine?
  • The correct answer is B. Skeletal muscle relaxant

Review Question 3

  • Which of the following is a selective beta 2 agonists?
  • The correct answer is D. Salbutamol

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