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Sympathetic Parasympathetic
MCMP 407
Ca 2+ Acetylcholinesterase
Na+
ACH
Action Potential
Nicotinic
Receptor
Na +
Ca 2+
Effector
Na+ Organ
NE
Action Potential
Adrenergic
Receptor
Postganglionic neuron
MCMP 407
Pharmacologic manipulation of the adrenergic system
Na+
Presynaptic neuron
Tyrosine
Na+
Dopamine
Tyrosine
Action Potential
H+ O
DA MA
NE NE
Ca2+
Uptake 1
(-) Na+, Cl-
NE
NE NE NE
Uptake 2
Effector organ
MCMP 407 HO CH2 CH NH2 TYROSINE
COOH
tyrosine hydroxylase
Synthesis of HO
dopamine -hydroxylase
HO
phenylethanolamine-
HO N-methyltransferase
HO CH CH2 NH EPINEPHRINE
OH CH3
MCMP 407
Metabolism of norepinephrine
OH OH
HO NH2 HO
Monoamine Oxidase (MAO) CHO
HO HO
Norepinephrine 3,4-Dihydroxyphenyl-
Aldehyde
glycolaldehyde
Reductase
OH
HO
CH2OH
OH OH
H3CO H3CO
CH2OH CO2H
1) Alcohol Dehydrogenase
HO 2) Aldehyde Dehydrogenase HO
3-Methoxy-4-hydroxy- 3-Methoxy-4-hydroxymandelic acid
phenylethylene glycol (Vanilylmandelic acid; VMA)
MCMP 407
Metabolism of norepinephrine
OH OH
1) MAO
HO NH2 HO
2) Aldehyde Dehydrogenase CO2H
HO HO
Norepinephrine 3,4-Dihydroxymandelic Acid
COMT COMT
OH OH
1) MAO
H3CO NH2 2) Aldehyde Dehydrogenase H3CO CO2H
HO HO
3-Methoxy-4-hydroxymandelic acid
Normetanephrine
(Vanilylmandelic acid; VMA)
MCMP 407
HO
HO
HO CH CH2 NH Epinephrine
(Adrenalin)
OH CH3
MCMP 407
Adrenergic Receptors
1 2
1A 1B 1D 2A 2B 2C 1 2 3
MCMP 407
Direct acting adrenergic receptor agonists:
1 receptors NH 3
Phospho -
lipase C
Phenylephrine (Neosynephrine)
Methoxamine (Vasoxyl)
Oxymetazoline (Visine)
(+)
Gq
PIP 2
HO
COOH IP 3 Diacylglycerol
CH CH2 NH CH3 2+
Increase Ca Activate Protein
Kinase C
OH
Phenylephrine
Response
MCMP 407
Direct acting adrenergic receptor agonists:
2 receptors
Clonidine (Catapres) NH3
Methyldopa (Aldomet)
Guanabenz (Wytensin)
Guanfacine (Tenex)
Tizanidine (Zanaflex)
Non-selective HO
Isoproterenol (Isuprel) CH3
HO CH CH2 NH CH
1-selective CH3
OH
Dobutamine (Dobutrex)
Dopamine (Intropin) Isoproterenol
2-selective
Terbutaline (Brethine, Bricanyl)
Metaproterenol (Metaprel, Alupent)
Albuterol (Proventil, Ventolin)
Salmeterol (Serevent)
Ritodrine (Yutopar)
MCMP 407
Direct acting adrenergic receptor agonists:
receptors
NH3
ATP cAMP
COOH
Increase cAMP-Dependent
Protein Kinase Activity
Response
MCMP 407
Molecular actions of norepinephrine
Phe 290 VI
VII
OH Ser 207
I HO
OH OH V
HO
Ser 204
II H3 N
CO2
receptor activation
1 Adrenergic
100 50
receptor activation
1 Adrenergic
50 0
-10 -8 -6 -4
Log [drug]
0 100
receptor activation
-10 -8 -6 -4
Log [drug] 2 Adrenergic
50
Phenylephrine
Epinephrine
Norepinephrine 0
Isoproterenol -10 -8 -6 -4
Log [drug]
MCMP 407
Cardiovascular effects of sympathomimetics
PERIPHERAL
RESISTANCE
0 15 0 15 0 15
TIME
(min)
MCMP 407
Direct acting adrenergic receptor agonists:
Norepinephrine and Epinephrine
l-Norepinephrine (Levophed)
MCMP 407
Direct acting adrenergic receptor agonists:
Norepinephrine and Epinephrine
H OH
H3CO NH2 Potent 1 receptor agonist
H Potent vasoconstrictor
H 3C
Parenteral administration
OCH3
Use: Pressor agent
Methoxamine (Vasoxyl)
MCMP 407
Direct acting adrenergic receptor agonists:
1 receptor agonists: 2-aralkylimidazolines
H+
H H
N N N
R X R X R X
N N N
H H H
H3 C OH
Oxymetazoline (Afrin, Visine)
MCMP 407
Direct acting adrenergic receptor agonists:
2 receptor agonists
(Phenylimino)imidazolidine
Selective 2 receptor agonist
The basicity of the guanidine
Cl
group (pKa = 13.6) is decreased
N (to pKa = 8.0) because of the
H
N attachment to the dichlorophenyl
N ring
H Clinical effect linked to activation
Cl
of 2 receptors in the nucleus of
Clonidine (Catapres)
the solitary tract (cardiovascular
center)
Administration: Oral, parenteral,
transdermal
Uses: Hypertension, opiate
withdrawal
MCMP 407
2-Adrenergic Agonists Reduce Blood Pressure by
Reducing Sympathetic Output from the Brain
Brain
1 Receptors
Y
Heart Y
1 Receptors
Kidney
1 Receptors
Y
MCMP 407
2-Adrenergic Agonists Reduce Blood Pressure by
Reducing Sympathetic Output from the Brain
Brain
1 Receptors
Decreased sympathetic tone
Y
Decr. HR Heart Y
Decr. Contractility 1 Receptors
Decr. Renin release
Kidney
Decr. Vasoconstriction
1 Receptors
Y
MCMP 407
Direct acting adrenergic receptor agonists:
2 receptor agonists
Cl NH2
NH Open-ring imidazolidines
CH N Two atom bridge to the guanidine
NH
group decreases the pKa so that
the drug is mostly non-ionized at
Cl
Guanabenz (Wytensin) physiological pH
Guanabenz has the shortest t-1/2
at ~ 6 hours. Half-life of clonidine
Cl NH2 and guanfacine is 12-16 hours
NH Administration: oral
CH2 C NH Uses: Hypertension
O
Cl
Guanfacine (Tenex)
MCMP 407 HO NH3
Cl
Direct acting adrenergic H3 C
CO2Et
receptor agonists: HO
Methyldopate
2 receptor agonists Esterases
Other Uses:
Apraclonidine (Iopidine): Glaucoma
Tizanidine (Zanaflex): Muscle spasticity
H OH H
Meta hydroxymethyl derivatives
N Selective receptor agonists
R Bronchodilation
Cardiac effects observed only at
HO
high doses
CH2OH Not metabolized by MAO or COMT
Longer duration of action than
Albuterol (Ventolin, Proventil) isoproterenol
R= C(CH3)3
Administration: Oral, local
(inhaled); Salmeterol only inhaled
Salmeterol (Serevent)
Uses: Asthma, COPD
R= CH2(CH3)5O(CH2)4Ph
MCMP 407
Direct acting adrenergic receptor agonists:
Long acting receptor agonists
OH
H Selective receptor
N
agonists
CH3
Administration: Oral,
HO OH parenteral
Ritodrine (Yutopar) Uses: Tocolytic
MCMP 407
Direct acting adrenergic receptor agonists:
receptor agonists OH
H
HO N
CH3
HO
Dobutamine (Dobutrex)
Dopamine derivative Metabolized by COMT and
Available as a racemic mixture conjugation, not sensitive to
(+)-enantiomer: potent 1 MAO
receptor agonist Short half-life (~2 min)
(-)-enantiomer: potent 1 Administered: Parenteral
receptor agonist, potency for Use: Acute heart failure,
receptors reduced 10X shock
Net effect is positive inotropic
effect on heart with little
chronotropic effect
MCMP 407
Indirect-acting sympathomimetics
Na+
Presynaptic neuron
Tyrosine
Na+
Dopamine
Tyrosine
Action Potential
H+
DA 3 MA
O
NE NE
Ca2+
Uptake 1
1 Na+, Cl-
NE
NE NE
2
NE
Effector organ
MCMP 407
Indirect-acting sympathomimetics:
Amphetamine, pseudoephedrine, ephedrine, phenylpropanolamine,
tyramine
Promote release of NE via
Extracellular
reverse action of plasma
membrane transporter
Clinical uses: AMPH
Amphetamines: ADHD,
narcolepsy, anorexiant
Others: Nasal decongestants
NET
CH2 CH NH2
CH3 NE
Amphetamine
Intracellular
MCMP 407
Indirect-acting sympathomimetics:
D-(-)-Ephedrine vs. L-(+)-Pseudoephedrine
CH3 CH3
H NHCH3 H NHCH3
H OH HO H
D-(-)-Ephedrine L-(+)-Pseudoephedrine
erythro threo
MCMP 407
Indirect-acting sympathomimetics: Transporter blockers
Cocaine
Antidepressants
Desipramine
Na+
Venlafaxine
Action Potential
H+
NE
NE
NE NE
Ca2+
Uptake 1
Na+, Cl-
NE
NE NE
2
NE
Effector organ
MCMP 407
Indirect-acting sympathomimetics:
Cocaine
Antidepressants
Desipramine Na+
Venlafaxine
Action Potential
H+
NE
NE
NE
Ca2+
Cocaine
NE
NE
NE NE NE
2
NE NE NE
NE
Effector organ
MCMP 407
Metabolism of norepinephrine
OH OH
HO NH2 HO
Monoamine Oxidase (MAO) CHO
HO HO
Norepinephrine 3,4-Dihydroxyphenyl-
Aldehyde
glycolaldehyde
Reductase
OH
HO
CH2OH
OH OH
H3CO H3CO
CH2OH CO2H
1) Alcohol Dehydrogenase
HO 2) Aldehyde Dehydrogenase HO
3-Methoxy-4-hydroxy- 3-Methoxy-4-hydroxymandelic acid
phenylethylene glycol (Vanilylmandelic acid; VMA)
MCMP 407
Indirect-acting sympathomimetics: MAO Inhibitors
Phenelzine
Selegiline
Na+
Action Potential
H+ 3 MA
O
NE NE
Ca2+
Na+, Cl-
NE
NE NE
2
NE
Effector organ
MCMP 407
Indirect-acting sympathomimetics: MAO Inhibitors
Phenelzine
Na +
Selegiline
NE
NE
Action Potential NE
H +
3 MA
O
NE NE
NE
NE NE
NE NE
Ca2+
NE
Na+, Cl-
NE
NE NE NE
NE
NE
2
NE
Effector organ
MCMP 407
Indirect-acting sympathomimetics: MAO Inhibitors
Co-admininstration with other
indirect-acting drugs can lead Phenelzine
to hypertensive crisis
Selegiline
NE
NE
NE
H +
3 MA
O
NE NE
NE
NE NE
NE NE
NE
NE
NE NE Amphetamine,
NE NE NE NE NE
NE NE NE NE Tyramine
NE
NE
Effector organ