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Class Notes

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1. Alpha-1 Adrenergic Blocking Drugs:
a. prazosin (Minipress®) - HTN
b. terazosin (Hytrin®) - HTN, BPH
c. doxazosin (Cardura®) - HTN, BPH
2. Selective Beta-1 Adrenergic Blocking Drugs: used for HTN, angina, arrhythmias, tachycardia, migraines, glaucoma (lowers IOP), Heart failure (decreases sympathetic activity)
a. atenolol (Tenormin®)
b. metoprolol (Lopressor®)
3. Non-Selective Beta Adrenergic Blocking Drugs: used for arrhythmias, angina, tachycardia, migraines, glaucoma (lowers IOP), heart failure (decreases sympathetic activity)
a. nadolol (Corgard®)
b. propanolol (Inderal®)
c. Timolol (Blocadren®)

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1. Alpha-1 Adrenergic Agonists:
a. ephedrine - increases BP
b. phenylephrine (Neo-Synephrine®) - increases BP, nasal decongestion
2. Adrenergic Agonists:
a. epinephrine (Adrenalin®) - stimulates all alpha and beta receptors, vasopressor-vasoconstriction, increases BP, cardiac stimulant, bronchodilator
3. Beta-1 Adrenergic Agonists:
a. dobutamine (Dobutamine®) - for treatment of shock, increases blood pressure, and increases heart function
4. Beta-2 Adrenergic Agonists:
a. albuterol (Proventil®, Ventolin®)- bronchodilator
b. terbutaline (Brethine®) - bronchodilator, uterine relaxant
c. formoterol (Foradil®) - bronchodilator
d. salmeterol (Serevent®) - bronchodilator

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1. Parasympatholytics/Anticholinergics:
a. atropine - antidote for cholinergic poisoning, increase HR, decrease vagus nerve activity (parasympathetic), pre-op med, slows digestion and urination, mydriasis.
b. dicyclomine (Bentyl ®) - used for GI disorders (ulcers, colitis, IBS), decrease GI secretions and motility.
c. ipratropium bromide (Atrovent®) - bronchodilation.

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1. Direct-Acting Cholinergic Agonists:
a. acetylcholine - used for miosis, cataract and other eye surgeries MOA: pupil constriction
b. pilocarpine (Pilocar ®) - used for glaucoma. MOA: pupil constriction, decreases amount of fluid in eye, decreases intraocular pressure.
c. bethanechol (Urecholine ®) - used for urinary retention and ileum/intestinal stasis. MOA: stimulates muscarinic receptors of bladder and GI tract to prevent constipation and urinary retention post-op and in the elderly.
2. Indirect- Acting Cholinergic Agonists:
a. neostigmine (Prostigmin ®) - Used for urinary retention and intestinal stasis/ileus, reversal of anticholinergicrocuronium bromide (Zemuron ®) with respiratory paralysis from anesthesia by increasing ACH at the nicotinic 2 (Nm) receptors on skeletal muscle, treatment for myasthenia gravis.

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1. Parasympatholytics/Anticholinergics: Bind to cholinergic receptor; Acts as a blocking drug or as a competitive antagonism. Actions: increase HR, decreases vagus nerve activity, decreases GI secretions and motility, and bronchodilation.

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1. Direct-Acting Cholinergic Agonists: directly stimulate/bind to the muscarinic receptors in the parasympathetic division. Mimics ACH .
2. Indirect-Acting Cholinergic Agonists: Inhibit acetylcholinesterase, the enzyme that destroys ACH in the synapse thereby increasing ACH at the Nm receptors on skeletal mm.

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- Parasympathomimetics: drugs that mimic parasympathetic system (agonists, cholinergic)
- Parasympatholytics: drugs that work against parasympathetic system (antagonists, anticholingerics)

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1. Alpha-1 Adrenergic Blocking Drugs: Binds and blocks alpha-1 receptors. Action: vasodilation of blood vessels, decreases BP, relaxes smooth muscle of ureters, and increases urine flow.
2. Beta-adrenergic blocking drugs: Selective Beta-1 receptors are blocked (antagonizes beta-1 effects of NE & EPI). Action: decreases force of contraction (negative inotropic), decreases cardiac output, decreases HR (negative chronotropic), decreases conduction (negative dromotropic) and decreases BP.
3. Beta-Adrenergic Blocking Drugs: Non-selective Beta blockers: Block beta-1 and beta-2 receptors. Action: decreases force of contraction (negative inotropic), decreases cardiac output, decreases HR (negative chronotropic), decreases conduction (negative dromotropic) and decreases BP, and can cause bronchoconstriction.

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1. Alpha-1 Adrenergic Agonists: Alpha-1 receptor is stimulated. Action: contraction of smooth muscle, blood vessels constrict, increase BP, vasoconstriction of nasal passages.
2. Adrenergic Agonists: Stimulates all alpha and beta receptors. Action: vasopressor-vasoconstriction, increases BP, cardiac stimulant, and bronchodilator (beta-2).
2. Beta-1 Adrenergic Agonists:
- Low dose: stimulates dopaminergic (d-1) receptors in kidneys causing vasodilation and increased renal blood flow
- Moderate dose: stimulates beta-1 receptors on heart causing increased force of contraction and cardiac output.
- High dose: stimulates alpha-1 receptors causing vasoconstriction which increases BP.
3. Beta-2 Adrenergic Agonists: stimulates beta-2 receptors. Action: relaxation of smooth muscle on lungs (bronchodilator), relaxation of smooth muscle of the uterus.

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- Sympathomimetics: drugs that mimic the sympathetic system (adrenergic, agonists)
- Sympatholytics: drugs that work against the sympathetic system (adrenergic blocking, blockers, inhibitors, antagonists)

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1. Muscarinic: located on cardiac, smooth muscle and glands.
2. Nicotinic-1 (Nn): at ganglia of parasympathetic nerves and sympathetic nerves (synapse area)
3. *Nicotinic-2 (Nm): somatic, neuromuscular junction of skeletal muscle. If stimulated muscle contracts.

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1. Alpha 1: found on glands, smooth muscle, eyes, most arteries and veins. Stimulated by NE & EPI
2. *Alpha-2: relaxation/inhibition; PARASYMPATHETIC RESPONSE
3. Beta 1: located on heart. Stimulated by NE & EPI.
4. Beta 2: located on smooth muscle, lungs, uterus, skeletal muscle arteries, & coronary arteries. Stimulated by EPI ONLY.

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- At ganglia: Nicotinic 1 or Nn
- At Target cell: Cholinergic (muscarinic ) receptors

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- At Ganglia: Nicotinic 1 or Nn
- At Target cell: Adrenergic receptors

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2. Parasympathetic Nervous System (Cholinergic System: Rest and Digest)

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2. Parasympathetic Nervous System (Cholinergic System: Rest and Digest)

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- acetylcholine is the neurotransmitter at the ganglia presynaptic and postganglionic nerve endings.

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1. SYMPATHETIC NERVOUS SYSTEM (Adrenergic System: Fight, Fright, Flight)

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1. SYMPATHETIC NERVOUS SYSTEM (Adrenergic System: Fight, Fright, Flight)

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- acetylcholine is the neurotransmitter at the ganglia presynaptic, and norepinephrine is the neurotransmitter at the postganglionic nerve endings.