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General Information

• This document appears to be study notes on pharmacology, specifically focusing on drugs impacting the sympathetic nervous system.

Sympathomimetics (Mimicking the Sympathetic Nervous System)

• Classified into direct and indirect sympathomimetics.
• Direct sympathomimetics directly activate adrenergic receptors (alpha and beta).
  • Examples include adrenaline (epinephrine), Phenylephrine, Isoprenaline.
• Indirect sympathomimetics release norepinephrine from storage vesicles.
  • Examples include amphetamine.
• Mixed sympathomimetics both release norepinephrine and directly activate adrenergic receptors.
  • Examples include Ephedrine.
• Adrenaline (Epinephrine):
  • A catecholamine released by the adrenal medulla.
  • Directly activates α and β receptors.
  • Cardiac effects: increases heart contractility, rate, and AV nodal conduction. Increases cardiac output and O2 consumption.
  • Vascular effects: constricts blood vessels in skin, mucous membranes, and visceral tissues, dilates blood vessels in skeletal muscles.
  • Metabolic effects: raises blood sugar levels by stimulating glycogenolysis and lipolysis.
  • Uses: acute asthma, anaphylaxis, cardiac arrest, hemorrhage control, allergic rhinitis and conjunctivitis. Used for lowering blood sugar if needed.
• Phenylephrine: selective α1 receptor agonist; used as a vasoconstrictor and in nasal decongestants
• Isoprenaline : acts on both alpha and beta receptors non-selectively with significant beta effects; used to reverse bradycardia.
• Dopamine: found in sympathetic neurons and the adrenal medulla; is also in the central nervous system.
  • Use: For cardiac shock, as it's preferred to norepinephrine due to no reduced renal or visceral blood flow.
• Dobutamine: synthetic catecholamine, similar to dopamine effects on blood vessels; used in cardiac shock and acute heart failure; improves cardiac output.

Other Sympathomimetics

• Amphetamines: Indirect sympathomymetics, releasing catecholamines. Often used for ADHD in children, narcolepsy, and as appetite suppressants.
• Ephedrine: Mixed sympathomimetic that releases and directly activates α and β receptors. Used for acute asthma and respiratory distress. Removed from the market in some places due to side effects.
  • Metaraminol: Similar to norepinephrine, used in shock to raise blood pressure.

Sympatholytics (Blocking the Sympathetic Nervous System)

• Dividing into α-blockers and β-blockers.
• α-Blockers: Non-selective (block alpha1 and alpha2) and selective (mostly block alpha1).
  • Non-selective α-blockers : Phenoxybenzamine and Phentolamine - affect blood pressure. Used in hypertensive crises in pheochromocytoma patients and peripheral vascular insufficiency.
  • Selective α1 blocker: Prazosin, Terazosin, Tamsulosin-affect blood pressure, used in treating benign prostatic hyperplasia (BPH).
• β-Blockers: Non-selective (block beta1 and beta2) and selective (mainly block beta1). Propranolol: Non-selective β-blocker, used in hypertension, angina, arrhythmias, and anxiety disorders.

Other information

• The document discusses various other drugs for similar purposes.
• These drugs could have several side effects and contraindications, for which the notes should be consulted.