1. 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

4.  WHAT IS THIS ??  Two transmitters  Adrenaline  Acetyl choline  Its noradrenaline

5.  α  α 1  α 2  β  β1  β2  β3

6.  Dopamine  DA 1  DA 2

8.  Vasoconstriction  Metabolism  Conscious status  Nociception

9.  α 1  Smooth vessels of blood vessels  Vasoconstriction  Liver – glycogenolysis  Intestine – contraction

10.  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

11.  Platelet aggregation  Sympathetic nerve endings  Decrease norad release  Pancreatic beta cell  Decrease insulin release

13.  Heart – force, rate, excitability increased  Renal JG apparatus - ↑ rennin release

14.  Smooth muscle of bronchi, blood vessel, uterus bladder-  vasodilation and relaxation  Heart – force, rate increased  Skeletal muscle – hypokalemia  Beta cell pancreas- ↑ insulin

15.  Fat – thermogenesis  Subcutaneous tissue  Lipolysis

16.  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).

17.  Noradrenaline > adrenaline > > isoprenaline  beta receptors  Isoprenaline > adrenaline > noradrenaline

18.  After stoppage of beta blockers, there is sudden increase of beta receptors

19. AlphaBeta Alpha 1Alpha 2Beta 1Beta 2Beta 3 Adrenaline Noradrenaline PhenylephClonidineDobutamine Terbutalin Isoprenaline norad Oxymetazoline Dopamine Ephedrine

20.  Adrenaline, noradrenaline and dopamine –  Natural catecholamines  Direct acting and indirect acting

21.  Alpha 1  Alpha 2  Beta 1  Beta 2

22.  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

23.  Additives  CPR

24.  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

25.  Dobutamine  Acts on b1 and b2, with minimal action on a1 receptors.  It increases cardiac output and reduces afterload (b2effects on skeletal muscle).

26.  Vasodilation is predominant pathology  Inotrope with minimal beta 2 action  Use noradrenaline  Sys, dias, MAP increase without CO increase No chronotropic effects

27.  Complete heart block, overdose of beta blocker or severe bradycardia unresponsive to atropine  Acts on b1 and b2 receptors  Isoprenaline

28.  Beta 1, alpha 1 and DA 1 and DA 2  Dopamine  2 µg / kg  5 µg / kg  10 µg / kg

29.  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 ??

30.  Sudden hypotension and aortic stenosis  obstructive hypertrophic cardiomyopathy,  Phenylephrine  Nitrates and viagra induced BP fall

31.  Dopamine and dobutamine individual or combination  Vasopressin  RV infarct – IV fluids and dobutamine

32.  Correction of the cause with dobutamine  Adrenaline  Isoprenaline where we need the highest kick and not bother about tachycardia

33.  We want only beta 2 agonists  Terbutaline and others

34.  Adrenergic receptor agonist  But hypotension  Analgesia  Sedation  Alpha 2 agonist

35.  Preterm labour  Beta 2 agonist  Not much tachycardia  not much hypotension

36. AlphaBeta Alpha 1Alpha 2Beta 1Beta 2Beta 3 Adrenaline Noradrenaline PhenylephClonidineDobutamine Terbutalin Isoprenaline norad Oxymetazoline Dopamine Ephedrine

37. Alpha Beta Alpha 1Alpha 2Beta 1Beta 2Beta 3 labetolol Phent, phenoxy propranolol PrazosinYohimbine Aten Butoxami Tamsulo sin