Nursing Pharmacology:  Autonomic Pharmacology Adrenergic Drugs 

• Amphetamine

  • CNS stimulant (releasing biogenic nerve terminal amines):

    • Respiratory center

    • Mood elevation

    • Decreased perception of fatigue

  • Other effects: headache, palpitations, dysphoria

    • Appetite suppression

    • Weight loss due to decrease food intake

    • Psychological tolerance/dependence

  • Indirect acting sympathomimetic

  •  Toxicity:

    • CNS: restlessness, tremor, irritablity, insomnia, aggressiveness, anxiety, panic, suicidal ideation, etc.

    • Cardiovascular: arrhythmias, hypertension or hypotension, angina

    • GI: dry mouth, anorexia, vomiting, diarrhea, cramping

    • Treatment:

      • Urinary acidification by ammonium chloride

      • Hypertension: nitroprusside or α adrenergic receptor antagonist

      • CNS: sedative-hypnotic drugs

  • Therapeutic Use:

    • Narcolepsy

    • Obesity

    • Attention-deficit hyperactivity disorder

     

• Methylphenidate (Ritalin)

  • Mild CNS stimulant, chemically related to amphetamine

  • Effects more prevalent on mental than motor activities

  • General pharmacological profile similar to amphetamine

  • Major Therapeutic Use:

    • Narcolepsy

    • Attention-deficit hyperactivity disorder

• Ephedrine

  • α and ß adrenergic receptor agonist

  • Indirect sympathomimetic also, promoting norepinephrine release

  • Non-catechol structure, orally active

  • Pharmacological effects:

    • Increases heart rate, cardiac output

    • Usually increases blood pressure

    • May cause uriniary hesitancy due to stimulation of a smooth muscle receptors in bladder base.

    • Bronchodilation: ß adrenergic receptor response

  • Limited Clinical Use due to better pharmacological alternatives (asthma, heart block, CNS stimulation)

   

• Vasoconstrictors for Nasal Mucosal Membranes and for the Eye

  • Propylhexedrine

  • Naphazoline (Privine)

  • Retrahydrozoline (Visine)

  • Oxymetazoline (Afrin)

  • Phenylpropanolamine (Propagest)

  • Pseudoephedrine (Sudafed)

  • Ethylnorepinephrine (Brokephrine)

  • Xylometzoline (Otrivin)

Hoffman, B.B and Lefkowitz, R.J, Catecholamines, Sympathomimetic Drugs, and Adrenergic Receptor Antagonists, In, Goodman and Gillman's The Pharmacologial Basis of Therapeutics, (Hardman, J.G, Limbird, L.E, Molinoff, P.B., Ruddon, R.W, and Gilman, A.G.,eds) TheMcGraw-Hill Companies, Inc.,1996, pp.216-219

• Amphetamine and related drugs

  •  Use (very limited) as appetite suppressant with high abuse potential

  •  Fenfluramine: appetite suppressant; cardiotoxic (withdrawn from market)

  • Methylphenidate (Ritalin) similar but with fewer peripheral effects, useful in Attention Deficit Disorder.