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By: Melissa R. Pleva, PharmD, BCPS, BCNSP Clinical Pharmacist Specialist, Department of Pharmacy Services, University of Michigan Hospitals and Health Centers; Adjunct Clinical Assistant Professor, University of Michigan College of Pharmacy, Ann Arbor, Michigan
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It dilates the pupil (mydriasis) by con- traction of the radial muscle of the eye (a-receptor activation) cheap 200mg doxycycline free shipping virus titer. Dopamine activates peripheral b1-adrenoceptors to increase heart rate and contractility purchase cheapest doxycycline and doxycycline antibiotic resistance powerpoint. Dopamine activates prejunctional and postjunctional dopamine D1-receptors in the renal discount doxycycline master card bacteria 0157, coronary cheap extra super viagra online, and splanchnic vessels to reduce arterial resistance and increase blood flow order generic aurogra on line. At low doses cialis professional 40mg with visa, dopamine has a positive inotropic effect and increases systolic pressure, with little effect on diastolic pressure or mean blood pressure. At higher doses, dopamine activates a-receptors and causes vasoconstriction, with a reflex decrease in heart rate. Dobutamine (1) Dobutamine is a synthetic catecholamine that is related to dopamine. Terbutaline (Brethine, Bricanyl), albuterol (Proventil, Ventolin), metaproterenol (Alupent), pirbuterol (Maxair), levalbuterol (Xopenex), bitolterol (Tornalate), salmeterol (Serevent), and formoterol (Foradil) (1) These drugs are more selective b2-receptor agonists that relax bronchial smooth mus- cle with fewer cardiac effects and longer duration of action than epinephrine. Isoproterenol (Isuprel) (1) Isoproterenol activates b-receptors with little activity on a-receptors. Phenylephrine, methoxamine (Vasoxyl), and metaraminol (Aramine) (1) These drugs produce effects primarily by direct a1-receptor stimulation that results in va- soconstriction, increased total peripheral resistance, and increased systolic and diastolic pressure. Metaraminol also has indirect activity; it is taken up and released at sympathetic nerve endings, where it acts as a false neurotransmitter. Xylometazoline (Otrivin) and oxymetazoline (Afrin) (1) These drugs have selective action at a-receptors. Clonidine (Catapres), methyldopa (Aldomet), guanabenz (Wytensin), and guanfacine (Tenex) (1) These antihypertensive agents directly or indirectly activate prejunctional and, prob- ably, postjunctional a2-receptors in the vasomotor center of the medulla to reduce sym- pathetic tone. At higher, nontherapeutic doses, it activates peripheral a-receptors to cause vasoconstriction. Ephedrine and mephenteramine (1) These drugs act indirectly to release norepinephrine from nerve terminals and have some direct action on adrenoceptors. Amphetamine, dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), phendime- trazine (Preludin), modafinil (Provigil), methylphenidate (Ritalin), and hydroxyamphet- amine (Paredrine) (see Chapter 5) (1) These drugs produce effects similar to those of ephedrine, with indirect and some direct activity. Phenylephrine, methoxamine, norepinephrine, and other direct-acting a-receptor sympa- thomimetic drugs are used for short-term hypotensive emergencies when there is inad- equate perfusion of the heart and brain such as during severe hemorrhage. Ephedrine and midodrine (Pro-Amatine), prodrug that are hydrolyzed to the a1-adrenoceptor agonist desglymidodrine, to treat chronic orthostatic hypotension. The use of sympathomimetic agents in most forms of shock is controversial and should be avoided. Fenoldopam (Corlopam) is a selective dopamine D1-receptor agonist used to treat severe hypertension.

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