{"id":7804,"date":"2013-03-06T22:05:32","date_gmt":"2013-03-07T03:05:32","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=7804"},"modified":"2013-03-09T10:40:01","modified_gmt":"2013-03-09T15:40:01","slug":"adrenergic-receptors","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2013\/03\/adrenergic-receptors\/","title":{"rendered":"Adrenergic Receptors"},"content":{"rendered":"

Adrenergic receptors are located throughout the body and are effected by numerous pharmacologic substances as summarized below:<\/p>\n

<\/p>\n\n\n\n\n\n\n\n\n\n
Drug<\/strong><\/td>\nalpha<\/strong><\/td>\nbeta-1<\/strong><\/td>\nbeta-2<\/strong><\/td>\nDA<\/strong><\/td>\neffects<\/strong><\/td>\n<\/tr>\n
epinephrine<\/td>\n+++<\/td>\n+++<\/td>\n++<\/td>\nnone<\/td>\n++CO, -SVR (low dose), +-SVR (high dose)<\/td>\n<\/tr>\n
norepinephrine<\/td>\n+++<\/td>\n+++<\/td>\nnone<\/td>\nnone<\/td>\n++SVR, +-CO<\/td>\n<\/tr>\n
Dopamine<\/p>\n

 <\/p>\n

Low dose<\/em><\/p>\n

Medium dose<\/em><\/p>\n

High dose<\/em><\/td>\n

 <\/p>\n

 <\/p>\n

0<\/p>\n

+<\/p>\n

++<\/td>\n

 <\/p>\n

 <\/p>\n

+<\/p>\n

++<\/p>\n

+++<\/td>\n

 <\/p>\n

 <\/p>\n

0<\/p>\n

0<\/p>\n

0<\/td>\n

 <\/p>\n

 <\/p>\n

++<\/p>\n

++<\/p>\n

++<\/td>\n

 <\/p>\n

 <\/p>\n

+CO, +SVR<\/p>\n

+ CO<\/p>\n

++SVR<\/td>\n<\/tr>\n

Dobutamine<\/td>\n0\/+<\/td>\n+++<\/td>\n++<\/td>\n0<\/td>\n+CO,-SVR<\/td>\n<\/tr>\n
Isoproterenol<\/td>\n0<\/td>\n+++<\/td>\n++<\/td>\n0<\/td>\n+CO,-SVR<\/td>\n<\/tr>\n
phenylephrine<\/td>\n+++<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n+\/-Co, ++SVR<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Location of adrenergic receptors<\/h4>\n

alpha – vascular walls and generally induce vasoconstriction
\nbeta- 1 – heart and act as inotropic and chronotropic agents
\nbeta -2 – blood vessels and induces vasodilation
\nDA receptors – coronary, mesenteric, renal, and cerebral vascular bed and cause vasodilation<\/p>\n

Common Clinical Use<\/h4>\n

Norepinephrine<\/strong> (Levophed) – popular with surgeon intensivists in septic shock. Generally should not be used when patient is hypovolemic and vigorous fluid resuscitation with isotonic or hypertonic saline should be initiated before use<\/p>\n

Epinephrine<\/strong> – second line agent after Levophed in septic shock. Used to rapidly interact with adrenergic receptors in codes and anaphylaxis.<\/p>\n

Vasopressin<\/strong> – second or third line agent in septic shock. Is generally not titrated. Hard on the kidneys and also with coronary and mesenteric ischemia, limb and skin ishcemia, and pulmonary effects.<\/p>\n

Dopamine<\/strong> – most common in cardiogenic shock. Can cause arrhythmias in sepsis<\/p>\n

Dobutamine<\/strong> – most common in cardiogenic shock and heart transplants<\/a>. Sometimes used by medical intensivists with Levophed in septic shock with depressed cardiac function<\/p>\n

Isoproterenol<\/strong> – rarely used outside of the cardiac ICU and most often for torsades and bradycardia causing hypotension<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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