Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics- Ph d Mahatma Gandhi Medical college and research institute, puducherry, India
WHAT IS THIS ?? Two transmitters Adrenaline Acetyl choline Its noradrenaline
α α 1 α 2 β β1 β2 β3
Dopamine DA 1 DA 2
Vasoconstriction Metabolism Conscious status Nociception
α 1 Smooth vessels of blood vessels Vasoconstriction Liver – glycogenolysis Intestine – contraction
mydriasis (pupillary dilation due to contraction of the radial eye muscles), broncho constriction, uterine contracture, contraction of sphincters in the gastrointestinal and genitourinary tracts. α 1 -Stimulation also inhibits insulin secretion and lipolysis. α 1 -receptors that have slightly positive inotropic and negative chronotropic effects
Platelet aggregation Sympathetic nerve endings Decrease norad release Pancreatic beta cell Decrease insulin release
Heart – force, rate, excitability increased Renal JG apparatus - ↑ rennin release
Smooth muscle of bronchi, blood vessel, uterus bladder- vasodilation and relaxation Heart – force, rate increased Skeletal muscle – hypokalemia Beta cell pancreas- ↑ insulin
Fat – thermogenesis Subcutaneous tissue Lipolysis
Dopamine-1: vascular smooth muscle (renal, mesentery, coronary causing vasodilation),renal tubules (natriuresis, diuresis), juxtaglomerular cells (increased renin release). Dopamine-2: postganglionic sympathetic nerves (inhibits NE release), smooth muscle (renal, mesenteric causing possible constriction).
Noradrenaline > adrenaline > > isoprenaline beta receptors Isoprenaline > adrenaline > noradrenaline
After stoppage of beta blockers, there is sudden increase of beta receptors
AlphaBeta Alpha 1Alpha 2Beta 1Beta 2Beta 3 Adrenaline Noradrenaline PhenylephClonidineDobutamine Terbutalin Isoprenaline norad Oxymetazoline Dopamine Ephedrine
Adrenaline, noradrenaline and dopamine – Natural catecholamines Direct acting and indirect acting
Alpha 1 Alpha 2 Beta 1 Beta 2
alpha-adrenergic receptors, _____lessens the vasodilation and increased vascular permeability. action on beta- receptors, ________causes bronchial smooth muscle relaxation that helps alleviate bronchospasm, wheezing, and dyspnoea Adrenaline
Additives CPR
Direct B1 and B 2 and indirect alpha 1 May cause tachycardia and hypertension Ideal for spinal epidural hypotension especially in pregnant patients- should not cross placenta
Dobutamine Acts on b1 and b2, with minimal action on a1 receptors. It increases cardiac output and reduces afterload (b2effects on skeletal muscle).
Vasodilation is predominant pathology Inotrope with minimal beta 2 action Use noradrenaline Sys, dias, MAP increase without CO increase No chronotropic effects
Complete heart block, overdose of beta blocker or severe bradycardia unresponsive to atropine Acts on b1 and b2 receptors Isoprenaline
Beta 1, alpha 1 and DA 1 and DA 2 Dopamine 2 µg / kg 5 µg / kg 10 µg / kg
Alpha and beta Inotropy with minimal vasodilation at low doses But alpha vasoconstriction predominates in higher doses Increases myocardial oxygen consumption – stress testing Use in patients where myocardial O2 consumption ??
Sudden hypotension and aortic stenosis obstructive hypertrophic cardiomyopathy, Phenylephrine Nitrates and viagra induced BP fall
Dopamine and dobutamine individual or combination Vasopressin RV infarct – IV fluids and dobutamine
Correction of the cause with dobutamine Adrenaline Isoprenaline where we need the highest kick and not bother about tachycardia
We want only beta 2 agonists Terbutaline and others
Adrenergic receptor agonist But hypotension Analgesia Sedation Alpha 2 agonist
Preterm labour Beta 2 agonist Not much tachycardia not much hypotension
AlphaBeta Alpha 1Alpha 2Beta 1Beta 2Beta 3 Adrenaline Noradrenaline PhenylephClonidineDobutamine Terbutalin Isoprenaline norad Oxymetazoline Dopamine Ephedrine
Alpha Beta Alpha 1Alpha 2Beta 1Beta 2Beta 3 labetolol Phent, phenoxy propranolol PrazosinYohimbine Aten Butoxami Tamsulo sin