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Sympathetic Nervous System/ Adrenergic System

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Sympathetic Nervous System/ Adrenergic System

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Neurotransmitters: - Acetylcholine (ACH)
- Norepinephrine (NE)
- Epinephrine (EPI)
- Dopamine (DA)
- ACH is released in the ganglion
-Dopamine is the precursor to Norepinephrine
-NE is released in the postganglionic nerve ending
-Epinephrine is released by the adrenal medulla

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1) alpha-1: Locations: gland, smooth muscle, eyes, most arteries, and veins
Actions: -smooth muscles of blood vessel contract & vasoconstrict. This results in increased blood pressure.
- pupils will dilate

2) alpha-2: Locations: smooth muscle of blood vessels, brain, prejunctional membrane in nerve endings
Actions: - Contraction of smooth muscles in blood vessels decrease, which result in decreased blood pressure
- Decrease release of NE at the postganglionic nerve endings.

3)beta-1: Location: Heart
Actions: increases force of contraction, heart rate, and conduction of the heart.

4) beta-2 : Location: smooth muscle, lungs, uterus, skeletal muscle arteries, coronary arteries
Actions: - smooth muscle relaxation
- Bronchodilation (lungs+ bronchi)
- uterine relaxation
- relaxation of cornonary arteries + skeletal muscle arteries, resulting in vasodilation.

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Drug Classification of Sympathetic / Adrenergic System

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Drug Classification of Sympathetic / Adrenergic System

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- Alpha-1 Adrenergic Agonists
- Adrenergic Agonists
- Alpha-1 Adrenergic Blocking Drugs
-Beta-Adrenergic Drugs
-Beta-Adrenergic Blocking Drugs

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- Stimulates Alpha-1 receptor

- Actions: - contraction of smooth muscle + blood vessel constrict resulting in increased blood pressure.
- vasoconstriction of nasal passages resulting in decongestant effect.

Drugs: 1. ephedrine (increases BP)
2. phenylephrine (Neo-Synephrine®)

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- Stimulates all alpha and beta receptors

-Actions: - vasopressor-vasoconstriction (increases BP)
- Bronchodilator
- cardiac stimulator

Drugs: 1. epinephrine (Adrenalin®)

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- stimulates alpha-1 receptors

Actions: - binds to alpha-1 receptor and blocks it
- causes relaxation of smooth muscle
- vasodilates blood vessel (decrease BP)
- relaxes uterine smooth muscles ( increase urination)

Drugs: 1. prazosin (Minipress®) (for hypertension)
2. terazosin (Hytrin®) - (for hypertension, Benign Prostatic Hyperplasia)
3. doxazosin (Cardura®)-  (for hypertension, Benign Prostatic Hyperplasia)

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Two subcategories: Beta-1 Adrenergic Agonists + Beta-3 Adrenergic Agonists

Beta-1 Adrenergic Agonists:
Stimulates either d-1, beta-1, or alpha-1 depending on level of dose

Low Dose: - stimulates d-1 receptor in kidneys
- vasodilation
- increased renal blood flow
Moderate Dose: - stimulates beta-1 receptors in heart
- increase force of contraction and CO.
High Dose: - stimulates alpha-1 receptors
- vasoconstriction ( Increases BP)

Drugs: 1. dobutamine (Dobutrex®)

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Generic name: dobutamine [ doe-BUE-ta-meen ]
Brand name: Dobutrex
Dosage form: intravenous solution (1 mg/mL-D5%; 12.5 mg/mL; 2 mg/mL-D5%; 4 mg/mL-D5%)
Drug classes: Cardiac stressing agents, Catecholamines, Inotropic agents, Vasopressors

Medically reviewed by Drugs.com on Mar 18, 2022. Written by Cerner Multum.

What is dobutamine?

Dobutamine stimulates heart muscle and improves blood flow by helping the heart pump better.

Dobutamine is used short-term to treat cardiac decompensation due to weakened heart muscle.

Dobutamine is usually given after other heart medicines have been tried without success.

Dobutamine may also be used for purposes not listed in this medication guide.

Warnings

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving dobutamine.

Before taking this medicine

You should not use dobutamine if you are allergic to it.

To make sure dobutamine is safe for you, tell your doctor if you have:

FDA pregnancy category B. Dobutamine is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether dobutamine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How is dobutamine given?

Dobutamine is injected into a vein through a catheter. A healthcare provider will give you this injection.

You will receive dobutamine in a hospital or clinic setting to quickly treat any serious side effects that occur.

While using dobutamine, you may need frequent medical tests. Your heart function may need to be checked using an electrocardiograph or ECG (sometimes called an EKG).

What happens if I miss a dose?

If you are using the medicine at home, call your doctor for instructions if you miss a dose of dobutamine.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using dobutamine?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Dobutamine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregiver right away if you have:

shortness of breath (even with mild exertion), swelling, rapid weight gain;

chest pain, fast or pounding heartbeats;

a light-headed feeling, like you might pass out;

wheezing, chest tightness;

dangerously high blood pressure-severe headache, blurred vision, buzzing in your ears, anxiety, confusion, uneven heartbeats, seizure; or

signs of infection in your catheter--pain, swelling, warmth, redness, oozing, or skin changes where the medicine is injected.

Common side effects of dobutamine may include:
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Dobutamine dosing information
Usual Adult Dose for Congestive Heart Failure:
Initial dose: 0.5 to 1 mcg/kg/min IV infusion
Maintenance dose: 2 to 20 mcg/kg/min IV infusion
Maximum dose: 40 mcg/kg/min IV infusion

Comments:
-Rate of administration and duration of therapy should be based on blood pressure, heart rate, frequency of ectopic activity, and urine flow; cardiac output, central venous pressure, and pulmonary capillary wedge pressure should also be considered whenever possible.
-Concentrations up to 5000 mcg/mL have been administered to humans. Determine final volume based on fluid requirements of the patient.
-No controlled-trial experience exists beyond 48 hours of repeated boluses and/or continuous infusions.

Use: Inotropic support when parenteral therapy is needed in the short-term treatment of patients with cardiac decompensation due to depressed contractility resulting from organic heart disease or cardiac surgical procedures.
Usual Pediatric Dose for Congestive Heart Failure:
Initial dose: 0.5 to 1 mcg/kg/min IV infusion
Maintenance dose: 2 to 20 mcg/kg/min IV infusion
Maximum dose: 40 mcg/kg/min IV infusion

Comments:
-Certain container systems of this drug may be inappropriate for the dosage requirements of pediatric patients less than 30 kg.
-Rate of administration and duration of therapy should be based on systemic blood pressure, heart rate, frequency of ectopic activity urine flow; cardiac output, central venous pressure, and pulmonary capillary wedge pressure should also be considered whenever possible.
-Concentrations up to 5000 mcg/mL have been administered to humans. Determine final volume based on fluid requirements of the patient.
-No controlled-trial experience exists beyond 48 hours of repeated boluses and/or continuous infusions.

Use: Inotropic support when parenteral therapy is needed in the short-term treatment of patients with cardiac decompensation due to depressed contractility resulting from organic heart disease or cardiac surgical procedures.

What other drugs will affect dobutamine?

Other drugs may interact with dobutamine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medical Disclaimer

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Dobutamine Uses, Side Effects & Warnings - Drugs.com

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Generic name: dobutamine [ doe-BUE-ta-meen ] Brand name: Dobutrex Dosage form: intravenous solution (1 mg/mL-D5%; 12.5 mg/mL; 2 mg/mL-D5%; 4 mg/mL-D5%) Drug classes: Cardiac stressing agents, Catecholamines, Inotropic agents, Vasopressors Medically reviewed by Drugs.com on Mar 18, 2022. Written by Cerner Multum. Dobutamine stimulates heart muscle and improves blood flow by helping the heart pump better.

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Beta-2 Adrenergic Agonists:

Stimulates beta-2 receptors

Actions: - uterine relaxation
- bronchodilation

Drugs: 1. albuterol (Proventil®, Ventolin®) (bronchodilator)
2. terbutaline (Brethine®) (bronchodilator, uterine relaxant)
3. formoterol (Foradil®) (bronchodilator)
4. salmeterol (Serevent®) ( bronchodilator)

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2 subcategories: selective beta-1 blockers +non-selective beta blockers

Selective beta-1 blockers:
- Stimulates beta-1 receptors and blocks it
- decreases force of contraction
- decreases HR, conduction, CO, BP

Drugs: 1. atenolol (Tenormin®)

2. metoprolol (Lopressor®)

Non-selective beta blockers:
- Stimulates and blocks beta-1 and beta-2 receptors
- decreases force of contraction
-decreases HR, conduction, CO, BP
- can cause bronchoconstriction

Drugs:    1. nadolol (Corgard®)
2. propanolol (Inderal®)
3. timolol (Blocadren®)

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Neurotransmitters: Acetylcholine (ACH)
ACH is released at the ganglia as well as the postganglionic nerve ending.

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The 3  Parasympathetic/Cholinergic Receptors

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The 3  Parasympathetic/Cholinergic Receptors

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1) muscarinic: Locations: cardiac, smooth muscle, and glands, parasympathetic postganglionic nerve endings

Actions: -decrease HR,
-bronchoconstriction
- increases digestion, GI secretions,                    urination
- constricts pupils

2) nicotinic 1(Nn): Locations: ganglia of parasympathetic nerves and sympathetic nerves
Actions: conduct impulses across the autonomic ganglia to the postganglionic fibers of both autonomic divisions

3) nicotinic 2 (Nm): Locations: cell membranes of skeletal muscles
Actions: contracts skeletal muscles

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- Direct –Acting Cholinergic Agonists
- Indirect-acting drugs
- Anti-Cholinergics

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- stimulates + binds to  muscarinic receptors

Actions: - mimics ACH (creating a longer duration of action)
-pupil constriction
-increases urination
-increases GI secretions

Drugs: 1. acetylcholine (Miochol-E®)
2. pilocarpine (Pilocar®)
3. bethanechol (Urecholine®)

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Generic name: Acetylcholine [ a-se-teel-KOE-leen ]
Brand name: Miochol-E
Drug class: Ophthalmic glaucoma agents

Medically reviewed by Drugs.com. Last updated on Jun 3, 2022.

Uses of Acetylcholine:

It is used during eye surgery.

What do I need to tell my doctor BEFORE I take Acetylcholine?

If you have an allergy to acetylcholine or any other part of acetylcholine.

If you are allergic to acetylcholine; any part of acetylcholine; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.

This medicine may interact with other drugs or health problems.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take acetylcholine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take Acetylcholine?

Tell all of your health care providers that you take acetylcholine. This includes your doctors, nurses, pharmacists, and dentists.

Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using acetylcholine while you are pregnant.

Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

How is this medicine (Acetylcholine) best taken?

Use acetylcholine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

It is given as a shot into the eye.
What do I do if I miss a dose?

Call your doctor to find out what to do.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Change in eyesight, eye pain, or very bad eye irritation.

What are some other side effects of Acetylcholine?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child's doctor or get medical help if your child has any side effects that bother your child or do not go away.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch.

If OVERDOSE is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out Acetylcholine?

If you need to store acetylcholine at home, talk with your doctor, nurse, or pharmacist about how to store it.

Consumer Information Use and Disclaimer

If your symptoms or health problems do not get better or if they become worse, call your doctor.

Do not share your drugs with others and do not take anyone else's drugs.

Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.

Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about acetylcholine, please talk with your doctor, nurse, pharmacist, or other health care provider.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medical Disclaimer

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Acetylcholine: Indications, Side Effects, Warnings - Drugs.com

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Generic name: Acetylcholine [ a-se-teel-KOE-leen ] Brand name: Miochol-E Drug class: Ophthalmic glaucoma agents Medically reviewed by Drugs.com. Last updated on Jun 3, 2022. It is used during eye surgery. If you have an allergy to acetylcholine or any other part of acetylcholine.

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-stimulates all cholinergic receptors by inhibiting the enzyme acetylcholinesterase, resulting in increase of ACH.

Drugs: 1. neostigmine (Prostigmin®)

* Used as a treatment for Myasthenia gravis.

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stimulates and binds to cholinergic receptors

Actions: -act as a blocking drugs
- Increases HR
-Decrease digestion + urination + GI secretion
- decreases vagus nerve activity
- bronchodilation

Drugs: 1)atropine (increase HR, decrease unrination+digestion, vagus nerve activity)
2) dicyclomine (Bentyl®) (decreases GI secretion)
3) ipratropium bromide (Atrovent®) )bronchodilation