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Adrenergic Drugs

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Author: [Khashayar Farzam](/content/point-of-care/17240#/ ""/index.html)Author: [Ariel Kidron](/content/point-of-care/17240#/ ""/index.html)Editor: [Anand D. Lakhkar](/content/point-of-care/17240#/ ""/index.html)Updated: 7/2/2023 12:07:24 AM

Indications

Adrenergic drugs are a broad class of medications that bind to adrenergic receptors throughout the body. These receptors include: alpha-1, alpha-2, beta-1, beta-2, beta-3. Adrenergic drugs will bind directly to one or more of these receptors to induce various physiologic effects. Some drugs indirectly act at these receptors to induce certain effects.

Adrenergic drugs must be classified based on the specific receptors they bind. Direct-acting drugs, which are the primary focus of this article, include vasopressors, bronchodilators, and other drugs. [[1]](/content/point-of-care/17240#ref_25849473 ""/index.html) Examples of indirect drugs are amphetamines and cocaine. [[2]](/content/point-of-care/17240#ref_21356420 ""/index.html)

The major effects of agonist binding depend on their adrenergic receptors. [[3]](/content/point-of-care/17240#ref_11454900 ""/index.html) [[4]](/content/point-of-care/17240#ref_23365239 ""/index.html) [[5]](/content/point-of-care/17240#ref_22759389 ""/index.html) The broad categories are:

  • Alpha-1 receptor: Smooth muscle contraction, mydriasis
  • Alpha-2 receptor: Mixed smooth muscle effects
  • Beta-1 receptor: Increased cardiac chronotropic and inotropic effects
  • Beta-2 receptor: Bronchodilation
  • Beta-3 receptor: Increased lipolysis

Examples of adrenergic drugs which selectively bind to alpha-1 receptors are phenylephrine and oxymetazoline. Selective alpha-2 receptor drugs include methyldopa and clonidine. The key beta-1 selective drug is dobutamine. Lastly, beta-2 selective drugs are bronchodilators, such as albuterol and salmeterol.

Adrenergic drugs can also be non-selective and bind to a combination of adrenergic receptors. Norepinephrine binds to the alpha-1, alpha-2, and beta-1 receptors. Dopamine binds to the alpha-1, alpha-2, beta-1 receptors, and also dopamine receptors. Epinephrine binds to all of the adrenergic receptors. These drugs bind to more adrenergic receptors when administered at higher doses, i.e., they can lose selectivity.

The following are key clinical indications of various adrenergic drugs:

Selective Drugs

Alpha-1 Receptor Agonists

  • Phenylephrine: FDA-approved as a decongestant and vasopressor. It has utility in cases of hypotension due to shock, such as septic shock. [[6]](/content/point-of-care/17240#ref_17264159 ""/index.html) Olson C. et al. reported on a patient who developed ischemic priapism from high doses of hydroxyzine hydrochloride (200 to 600 mg) for insomnia treatment. The patient received treatment with aspiration and 560 micrograms of intracavernosal phenylephrine, which led to detumescence. [[7]](/content/point-of-care/17240#ref_33836933 ""/index.html)
  • Oxymetazoline: FDA-approved as a decongestant and to treat rosacea. A patient with ptosis of the right eye caused by myasthenia gravis was treated with one eye drop of oxymetazoline (0.1%). [[8]](/content/point-of-care/17240#ref_34510144 ""/index.html) The ptosis was eliminated after 2 hours, and the effect lasted seven hours. This is a potential clinical use of oxymetazoline.

Alpha-2 Receptor Agonists

  • Methyldopa: FDA-approved for hypertension and gestational hypertension.
  • Clonidine: FDA-approved for treating hypertension and attention deficit hyperactivity disorder (ADHD). Non-FDA-approved indications include sleep disorders, post-traumatic stress disorder (PTSD), anxiety, restless leg syndrome, hot flashes associated with menopause, and other illnesses. [[9]](/content/point-of-care/17240#ref_24600280 ""/index.html)
  • Dexmedetomidine: This drug is indicated for sedation in the intensive care unit and does not cause respiratory depression. It causes an arousable state of sedation which is helpful during brain tumor surgery and implantation of deep brain stimulators because the patient is able to respond to neurological tests. [[10]](/content/point-of-care/17240#ref_34030806 ""/index.html)

Beta-1 Receptor Agonists

  • Dobutamine: Indicated for the treatment of cardiogenic shock and heart failure. [[11]](/content/point-of-care/17240#ref_29340539 ""/index.html) Patients in shock require hemodynamic support. Vasopressors (e.g., norepinephrine), inotropes (e.g., dobutamine), and IV fluid support are used for treatment. In most patients with shock (e.g., cardiogenic or septic), norepinephrine is commonly used to achieve appropriate arterial pressure. If the patient continues to have low tissue and organ perfusion, dobutamine can be added to increase cardiac output. [[12]](/content/point-of-care/17240#ref_32281470 ""/index.html)

Beta-2 Receptor Agonists

  • Bronchodilators: Indicated for treating obstructive lung disease, such as asthma. [[13]](/content/point-of-care/17240#ref_30261755 ""/index.html)

Beta-3 receptor Agonists

  • Mirabegron: This agent is indicated for treating overactive bladder, e.g., urinary incontinence and frequency. It is also indicated to treat pediatric (greater or equal to 3 years old) neurogenic detrusor overactivity. [[14]](/content/point-of-care/17240#ref_34056686 ""/index.html)

Non-Selective Drugs

  • Norepinephrine: Indicated for the treatment of shock and hypotension
  • Epinephrine (Adrenaline): Indicated for the treatment of cardiac arrest, anaphylaxis, and croup
  • Dopamine: Indicated for the treatment of hypotension, bradycardia, and cardiac arrest.
  • Isoprenaline: Indicated for treating bradycardia and heart block

Many of these medications, especially the non-selective ones, are used in critical care and emergency settings. They are referred to as vasopressors. Side effects depend on the specific agent. However, changes in heart rate and blood pressure are the most common side effects.

Indirect-acting adrenergic drugs increase endogenous concentrations of norepinephrine and epinephrine through various mechanisms. Hence, their side effect profiles are similar to those seen with vasopressors. [[15]](/content/point-of-care/17240#ref_30725944 ""/index.html)

Mechanism of Action

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  • Anatomy and Physiology - Nursing Student
  • Anesthesiology - Adult Cardiac
  • Anesthesiology - Advanced
  • Anesthesiology - Basic
  • Anesthesiology - In-Training
  • Anesthesiology - Pediatric
  • Arizona State CME CE Requirements
  • Arkansas State CME CE Requirements
  • Audiology Praxis®
  • Australian Medical Council - IMG (AMC CAT MCQ)
  • Brain Injury Medicine (BIM®)
  • Calculations - Nursing Student
  • California State CME CE Requirements
  • Cardiac Surgery
  • Cardiology - Adult Congenital Heart Disease
  • Cardiology - Adult Echocardiography
  • Cardiology - Advanced Heart Failure and Transplant Cardiology
  • Cardiology - Cardiovascular Computed Tomography
  • Cardiology - Cardiovascular Disease
  • Cardiology - Cardiovascular Magnetic Resonance
  • Cardiology - Clinical Cardiac Electrophysiology
  • Cardiology - Interventional
  • Cardiology - Nuclear
  • Cardiothoracic - Congenital Surgery
  • Cardiothoracic Surgery
  • Caribbean Association of Medical Councils (CAMC)
  • Certified Anesthesiology Assistants (CAA®)
  • Certified Dental Assistant™ (CDA®)
  • Certified EKG Technician (CET)
  • Certified Healthcare Simulation Educator (CHSE®)
  • Certified Hyperbaric Technologist (CHT)
  • Certified Hypertension Clinician (CHC®)
  • Certified Hypertension Specialist (CHS®)
  • Certified in Healthcare Compliance (CHC®)
  • Certified Medical Assistant (AAMA® CMA®)
  • Certified Nursing Assistant (CNA®)
  • Certified Occupational Therapy Assistant® (COTA®)
  • Certified Registered Nurse Anesthetist (CRNA NCE® or SEE®)
  • Certified Surgical First Assistant™ (CSFA®)
  • Certified Surgical Technologist™ (CST®)
  • Child Health PN - Nursing Student
  • Child Health RN - Nursing Student
  • Clinical Informatics
  • Clinical Lipid Specialists (CLS®)
  • Clinical Nutritionist (CCN/CNS)
  • Clinical Tropical Medicine and Travelers' Health (CTropMed®)
  • CNS - Acute Care Clinical Nurse Specialist - Neonatal (ACCNS-N®)
  • CNS - Acute Care Clinical Nurse Specialist - Pediatric (ACCNS-P®)
  • CNS - Adult-Gerontology Clinical Nurse Specialist (ACCNS-AG® or AGCNS-BC™)
  • CNS - Advanced Diabetes Management (BC-ADM®)
  • Colon and Rectal Surgery / Colorectal
  • Colorado State CME CE Requirements
  • COMLEX-USA® Level 1
  • COMLEX-USA® Level 2
  • COMLEX-USA® Level 3
  • Community Health - Nursing Student
  • Complex General Surgical Oncology (CGSO®)
  • COMVEX®
  • Connecticut State CME CE Requirements
  • Correctional Medicine
  • Cosmetic Surgery (ABCS®)
  • Critical Care and Basic Rhythms - Nursing Student
  • Critical Care Medicine
  • Delaware State CME CE Requirements
  • Dental Licensure Objective Structured Clinical Examination (DLOSCE™)
  • Dermatology - Applied
  • Dermatology - Basic
  • Dermatology - Core
  • Dermatology - Micrographic Dermatologic Surgery (Mohs)
  • Dermatology - Pediatric
  • Dermatopathology
  • Disaster Medicine
  • District of Columbia CME CE Requirements
  • Egyptian Medical Licensing Exam (EMLE)
  • Elder Adult Care - Nursing Student
  • Emergency Medicine
  • Emergency Medicine - Emergency Medical Services (ABEM® EMS®)
  • Emergency Medicine - FRCEM SBA
  • Emergency Medicine - MRCEM Primary
  • Emergency Medicine - MRCEM SBA-FRCEM Intermediate
  • Emirates Medical Residency Entrance Examination (EMREE)
  • EMS - Advanced Emergency Medical Technician (NREMT® AEMT®)
  • EMS - Certified Flight Paramedic (IBSC FP-C®)
  • EMS - Community Paramedic (IBSC CP-C®)
  • EMS - Critical Care Paramedic (IBSC CCP-C®)
  • EMS - Emergency Medical Responder (NREMT® EMR®)
  • EMS - Emergency Medical Technician (NREMT® EMT®)
  • EMS - Paramedic (NREMT®)
  • EMS - Tactical Paramedic Certification (IBSC TP-C®)
  • EMS - Wilderness Paramedic (IBSC WP-C®)
  • ENARM Mexico
  • Endocrinology
  • Endovascular Medicine
  • Facial Cosmetic Surgery
  • Facial Plastic and Reconstructive Surgery
  • Family Medicine
  • Family Medicine - MRCGP-Applied Knowledge Test
  • Florida State CME CE Requirements
  • Fundamentals - Nursing Student
  • Gastroenterology
  • General Surgery
  • General Surgery - In-Training ABSITE®
  • General Surgery Review (All Subspecialties) - MRCS Part A
  • Genetics and Genomics - Clinical
  • Genetics and Genomics - General
  • Georgia State CME CE Requirements
  • Geriatrics
  • Guam State CME CE Requirements
  • Hand Surgery
  • Hawaii State CME CE Requirements
  • Health Assessment - Nursing Student
  • Healthcare Administration, Leadership, and Management (HALM®)
  • Healthcare Ethics Consultant Exam (HEC-C)
  • Hematology
  • Hospice And Palliative Medicine
  • Idaho State CME CE Requirements
  • Illinois State CME CE Requirements
  • Indian PG Entrance (NEET-PG)
  • Indiana State CME CE Requirements
  • Infectious Disease
  • Integrated National Board Dental Examination (INBDE®)
  • Internal Medicine
  • Internal Medicine - Focused Practice In Hospital Medicine
  • Internal Medicine - MRCP UK and Ireland Part 1
  • Internal Medicine - MRCP UK and Ireland Part 2
  • International Trauma Life Support® (ITLS®)
  • Iowa State CME CE Requirements
  • Kansas State CME CE Requirements
  • Kentucky State CME CE Requirements
  • Lab - Medical Laboratory Scientist MLS(ASCP®)
  • Lab - Medical Laboratory Technician MLT(ASCP®)
  • Lab - Phlebotomy Technician PBT(ASCP®) or (NPS CPT®)
  • Lab - Technologist in Blood Banking BB(ASCP®)
  • Lab - Technologist in Chemistry C(ASCP®)
  • Lab - Technologist in Hematology H(ASCP®)
  • Lab - Technologist in Microbiology M(ASCP®)
  • Lab and Diagnostic Testing - Nursing Student
  • Lifestyle Medicine
  • Louisiana State CME CE Requirements
  • Maine State CME CE Requirements
  • Maryland State CME CE Requirements
  • Massachusetts State CME CE Requirements
  • Maternal Newborn PN - Nursing Student
  • Maternal Newborn RN - Nursing Student
  • MCCQE Part I (Medical Council of Canada Qualifying Examination)
  • Medical Council Nigeria (MDCN)
  • Medical Student Elective - Allergy
  • Medical Student Elective - Anesthesiology
  • Medical Student Elective - Biostatistics and Economics
  • Medical Student Elective - Cardiothoracic Surgery
  • Medical Student Elective - Cardiovascular Disease
  • Medical Student Elective - Critical Care
  • Medical Student Elective - Dermatology
  • Medical Student Elective - Diagnostic Radiology
  • Medical Student Elective - ECG and Rhythm Strip Review
  • Medical Student Elective - Endocrinology
  • Medical Student Elective - Gastroenterology
  • Medical Student Elective - Genetics
  • Medical Student Elective - Geriatrics
  • Medical Student Elective - Hand
  • Medical Student Elective - Hematology
  • Medical Student Elective - Infectious Disease
  • Medical Student Elective - Law, Medicine, and Ethics
  • Medical Student Elective - Neonatology
  • Medical Student Elective - Nephrology
  • Medical Student Elective - Neurosurgery
  • Medical Student Elective - Oncology
  • Medical Student Elective - Ophthalmology
  • Medical Student Elective - Orthopedic
  • Medical Student Elective - Otolaryngology
  • Medical Student Elective - Pathology, Clinical Laboratory
  • Medical Student Elective - Pediatric Cardiology
  • Medical Student Elective - Pediatric Critical Care
  • Medical Student Elective - Pediatric Endocrinology
  • Medical Student Elective - Pediatric Gastroenterology
  • Medical Student Elective - Pediatric Hematology & Oncology
  • Medical Student Elective - Pediatric Infectious Diseases
  • Medical Student Elective - Pediatric Nephrology
  • Medical Student Elective - Pediatric Neurology
  • Medical Student Elective - Pediatric Pulmonology
  • Medical Student Elective - Pediatric Surgery
  • Medical Student Elective - Physical Medicine and Rehabilitation
  • Medical Student Elective - Plastic Surgery
  • Medical Student Elective - Pulmonology
  • Medical Student Elective - Rheumatology
  • Medical Student Elective - Sports Medicine
  • Medical Student Elective - Urology
  • Medical Student Elective - Vascular Surgery
  • Mental Health PN - Nursing Student
  • Mental Health RN - Nursing Student
  • Metabolic and Bariatric Surgery (MBS FPD®)
  • Michigan State CME CE Requirements
  • Microbiology - Nursing Student
  • Minnesota State CME CE Requirements
  • Mississippi State CME CE Requirements
  • Missouri State CME CE Requirements
  • Montana State CME CE Requirements
  • Multistate Pharmacy Jurisprudence Examination® (MPJE®)
  • National Board Dental Hygienist Examination (NBDHE®)
  • NBME® Shelf - Ambulatory Care
  • NBME® Shelf - Anatomy
  • NBME® Shelf - Behavioral Science
  • NBME® Shelf - Biochemistry
  • NBME® Shelf - Clinical Neurology
  • NBME® Shelf - Comprehensive Basic Science (CBSE®)
  • NBME® Shelf - Comprehensive Clinical Science (CCC®)
  • NBME® Shelf - Embryology
  • NBME® Shelf - Emergency Medicine
  • NBME® Shelf - Family Medicine
  • NBME® Shelf - Health Systems Science
  • NBME® Shelf - Histology
  • NBME® Shelf - Internal Medicine (Advanced Clinical Exam)
  • NBME® Shelf - Introduction to Clinical Diagnosis
  • NBME® Shelf - Medicine
  • NBME® Shelf - Microbiology and Immunology
  • NBME® Shelf - Neuroscience
  • NBME® Shelf - Obstetrics and Gynecology
  • NBME® Shelf - Pathology
  • NBME® Shelf - Pediatrics
  • NBME® Shelf - Pharmacology
  • NBME® Shelf - Physiology
  • NBME® Shelf - Psychiatry
  • NBME® Shelf - Surgery
  • NBOME® Subject Exam / Shelf - Osteopathic Principles and Practice
  • NCLEX-PN® - Nursing Student
  • NCLEX-RN® - Nursing Student
  • Nebraska State CME CE Requirements
  • Nepal Medical Council Licensing Examination (NMCLE)
  • Nephrology
  • Neurology
  • Neurology - Behavioral Neurology and Neuropsychiatry
  • Neurology - Clinical Neurophysiology
  • Neurology - Epilepsy Medicine
  • Neurology - Headache
  • Neurology - Neurocritical Care
  • Neurology - Neurodevelopmental Disabilities
  • Neurology - Neuromuscular Medicine
  • Neurology - Vascular Neurology
  • Neurosurgery
  • Nevada State CME CE Requirements
  • New Hampshire State CME CE Requirements
  • New Jersey State CME CE Requirements
  • New Mexico State CME CE Requirements
  • New York State CME CE Requirements
  • North Carolina State CME CE Requirements
  • North Dakota State CME CE Requirements
  • NP - Adult-Gerontology Acute Care Nurse Practitioner (AGACNP® or ACNPC-AG®)
  • NP - Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP® or AGNP®)
  • NP - Advanced Certified Hospice and Palliative Nurse (ACHPN®)
  • NP - Advanced Health Assessment and Diagnostic Reasoning Nurse Practitioner
  • NP - Advanced Neurovascular Practitioner Certification (ANVP-BC®)
  • NP - Advanced Oncology Certified Nurse Practitioner (AOCNP®)
  • NP - Advanced Pathophysiology Nurse Practitioner
  • NP - Advanced Pharmacology Nurse Practitioner
  • NP - Advanced Physiology Nurse Practitioner
  • NP - Biostatistics and Epidemiology Nurse Practitioner
  • NP - Board Certified Advanced Diabetes Management (BC-ADM®)
  • NP - Cardiovascular Nurse Practitioner (CVNP-BC®)
  • NP - Certified Addictions Registered Nurse - Advanced Practice (CARN-AP®)
  • NP - Certified Continence Care Nurse - Advanced Practice (CCCN-AP®)
  • NP - Certified Midwife (CNM®/CM®)
  • NP - Certified Nephrology Nurse - Nurse Practitioner™ (CNN-NP™)
  • NP - Certified Ostomy Care Nurse - Advanced Practice (COCN-AP®)
  • NP - Certified Pediatric Nurse Practitioner - Acute Care (CPNP-AC®)
  • NP - Certified Pediatric Nurse Practitioner – Primary Care (CPNP-PC®)
  • NP - Certified Urologic Nurse Practitioner (CUNP®)
  • NP - Certified Wound Care Nurse - Advanced Practice (CWCN-AP® / AWCC™)
  • NP - Certified Wound Ostomy Continence Nurse - Adv. Practice (CWOCN-AP®)
  • NP - Dermatology Certified Nurse Practitioner (DCNP®)
  • NP - Emergency Nurse Practitioner (ENP®)
  • NP - Ethics & Legal Issues Nurse Practitioner
  • NP - Family Nurse Practitioner (ANCC/FNP-BC™ or AANP/FNP-C®)
  • NP - Health Promotion and Disease Prevention Nurse Practitioner
  • NP - Neonatal Nurse Practitioner (NNP-BC®)
  • NP - Nurse Executive Advanced Certification (NEA-BC®)
  • NP - Orthopedic Nurse Practitioner (ONP-C®)
  • NP - Pediatric Primary Care Mental Health Specialist (PMHS®)
  • NP - Psychiatric-Mental Health Nurse Practitioner Certification (PMHNP-BC™)
  • NP - Theory and Evidence-Based Practice Nurse Practitioner
  • NP - Women's Health Nurse Practitioner (WHNP®)
  • Nuclear Medicine
  • Nurse - Ambulatory Care Nursing Certification (AMB-BC™)
  • Nurse - Assisted Living Nursing Certification (C-AL®)
  • Nurse - Bariatric (CBN®)
  • Nurse - Cardiac Medicine Certification (CMC®) Adult
  • Nurse - Cardiac-Vascular Nursing Certification (CV-BC™)
  • Nurse - Cardiovascular Nursing (CVN®)
  • Nurse - Case Management Certification (CMGT-BC™)
  • Nurse - Certified Addictions Registered Nurse (CARN®)
  • Nurse - Certified Anticoagulation Care Provider (CACP®)
  • Nurse - Certified Breast Care Nurse (CBCN®)
  • Nurse - Certified Clinical Transplant Nurse (CCTN®)
  • Nurse - Certified Continence Care Nurse (CCCN®)
  • Nurse - Certified Diabetes Care and Education Specialist® (CDCES®)
  • Nurse - Certified Emergency Nurse® (CEN®)
  • Nurse - Certified Flight Registered Nurse (CFRN®)
  • Nurse - Certified Foot Care Nurse (CFCN®)
  • Nurse - Certified Gastroenterology Registered Nurse (CGRN®)
  • Nurse - Certified Hemodialysis Nurse (CHN®)
  • Nurse - Certified Hospice and Palliative Nurse (CHPN®)
  • Nurse - Certified Hyperbaric Registered Nurse® (CHRN®)
  • Nurse - Certified Infection Control (CIC®)
  • Nurse - Certified Managed Care Nurse (CMCN®)
  • Nurse - Certified Nephrology Nurse (CNN®)
  • Nurse - Certified Neuroscience Registered Nurse (CNRN®)
  • Nurse - Certified Nurse Educator (CNE®)
  • Nurse - Certified Nurse Manager and Leader (CNML®)
  • Nurse - Certified Occupational Health Nurse (COHN® and COHN-S®)
  • Nurse - Certified Ostomy Care (COCN®) / Ostomy Management Specialist (OMS®)
  • Nurse - Certified Otorhinolaryngology Nurse (CORLN®)
  • Nurse - Certified Pediatric Emergency Nurse (CPEN®)
  • Nurse - Certified Pediatric Hematology Oncology Nurse (CPHON®)
  • Nurse - Certified Pediatric Nurse (CPN®)
  • Nurse - Certified Perioperative Nurse (CNOR®)
  • Nurse - Certified Peritoneal Dialysis Nurse (CPDN®)
  • Nurse - Certified Plastic Surgery Nurse (CPSN®)
  • Nurse - Certified Post and Ambulatory Perianesthesia Nurse (CPAN® / CAPA®)
  • Nurse - Certified Professional in Health Care Risk Management (CPHRM®)
  • Nurse - Certified Professional in Healthcare Quality (CPHQ®)
  • Nurse - Certified Radiology Nurse (CRN©)
  • Nurse - Certified Registered Nurse in Ophthalmology (CRNO®)
  • Nurse - Certified Registered Nurse Infusion (CRNI®)
  • Nurse - Certified Rehabilitation Registered Nurse (CRRN®)
  • Nurse - Certified Transport Registered Nurse (CTRN®)
  • Nurse - Certified Urologic Registered Nurse (CURN®)
  • Nurse - Certified Wound Care Nurse (CWCN® / WCC®)
  • Nurse - Critical Care Registered Nurse - Adult (CCRN®)
  • Nurse - Critical Care Registered Nurse - Neonatal (CCRN®)
  • Nurse - Critical Care Registered Nurse - Pediatric (CCRN®)
  • Nurse - Dermatology Nurse Certified (DNC®)
  • Nurse - Emergency Nurse Pediatric Certification© (ENPC®)
  • Nurse - Gerontology Nursing Certification (GERO-BC™)
  • Nurse - Informatics Nursing Certification (NI-BC™)
  • Nurse - Inpatient Obstetric Nursing (RNC-OB®)
  • Nurse - International Board Certified Lactation Consultant® (IBCLC®)
  • Nurse - Low Risk Neonatal Intensive Care Nursing (RNC-LRN®)
  • Nurse - Maternal Newborn Nursing (MNN®)
  • Nurse - Medical-Surgical Nursing Certification (MEDSURG-BC™)
  • Nurse - Nationally Certified School Nurse (NCSN®)
  • Nurse - Neonatal Pediatric Transport (C-NPT®)
  • Nurse - Nurse Executive Certification (NE-BC®)
  • Nurse - Nursing Professional Development Certification (NPD-BC™)
  • Nurse - Oncology Certified Nurse (OCN®)
  • Nurse - Orthopedic Nurse Certification (ONC®)
  • Nurse - Pain Management Nursing Certification (PMGT-BC™)
  • Nurse - Progressive Care Certified Nurse (PCCN®) - Adult
  • Nurse - Psychiatric-Mental Health Nursing Certification (PMH-BC™)
  • Nurse - Registered Nurse First Assistant (RNFA©)
  • Nurse - Sexual Assault Nurse Examiner (SANE®)
  • Nurse - Stroke Certified Registered Nurse (SC-RN®)
  • Nurse - Trauma Certified Registered Nurse (TCRN®)
  • Nurse - Vascular Access Board Certified Nursing (VA-BC®)
  • Nutrition - Nursing Student
  • Nutrition Medicine
  • Obesity Medicine
  • Ob-Gyn - CREOG® In-Service
  • Ob-Gyn - Gynecologic Oncology
  • Ob-Gyn - Maternal-Fetal Medicine
  • Ob-Gyn - MRCOG UK and Ireland Part 1
  • Ob-Gyn - MRCOG UK and Ireland Part 2 and Part 3
  • Ob-Gyn - Obstetrics and Gynecology
  • Ob-Gyn - Reproductive Endocrinology and Infertility
  • Ob-Gyn - Urogynecology and Reconstructive Pelvic Surgery
  • Occupational Medicine
  • Occupational Therapist Registered (NBCOT® OTR®)
  • Ohio State CME CE Requirements
  • Oklahoma State CME CE Requirements
  • Oncology
  • Ophthalmology
  • Ophthalmology - Cataract
  • Ophthalmology - Cornea and External Eye Disease
  • Ophthalmology - Glaucoma
  • Ophthalmology - Medical and Surgical Retina
  • Ophthalmology - Neuro-Ophthalmology
  • Ophthalmology - Oculoplastic Surgery
  • Ophthalmology - Optics
  • Ophthalmology - Pediatric and Strabismus
  • Ophthalmology - Uveitis
  • Ophthamology - Trauma
  • Optometry - Advanced Medical Care
  • Optometry - Applied Basic Science (ABS®)
  • Optometry - Patient Assessment and Management (PAM®)
  • Oral And Maxillofacial Surgery
  • Oregon State CME CE Requirements
  • Orthopedic Surgery
  • Osteopathic Neuromusculoskeletal Medicine (OMT/NMM®/OMM®)
  • Otolaryngology - Head and Neck Surgery
  • PA - Cardiovascular and Thoracic Surgery (CAQ-CVTS®)
  • PA - Cardiovascular Physician Assistant/Associate (CVPA-BC®)
  • PA - Clinical Knowledge Rating and Assessment
  • PA - Dermatology (CAQ-Derm® or NBDPA™)
  • PA - Emergency Medicine (CAQ-EM®)
  • PA - Emergency Medicine End of Rotation
  • PA - End of Curriculum
  • PA - Family Medicine End of Rotation
  • PA - Hospital Medicine (CAQ-HM®)
  • PA - Internal Medicine End of Rotation
  • PA - Nephrology (CAQ-Neph®)
  • PA - Obstetrics and Gynecology (CAQ-OBGYN®)
  • PA - Occupational Medicine (CAQ-OM®)
  • PA - Orthopedic (CAQ-OS®)
  • PA - Palliative Medicine and Hospice Care (CAQ-PMHC®)
  • PA - PANCE®
  • PA - PANRE®
  • PA - Pediatric (CAQ-Peds®)
  • PA - Pediatric End of Rotation
  • PA - Psychiatric and Behavioral Health End of Rotation
  • PA - Psychiatry (CAQ-Psy®)
  • PA - Surgery End of Rotation
  • PA - Womens Health End of Rotation (Gyn, Sexual, & Reproductive Health)
  • Pain Medicine
  • Pakistan - 1st Professional MBBS
  • Pakistan - 2nd Professional MBBS
  • Pakistan - 3rd Professional MBBS
  • Pakistan - 4th Professional MBBS
  • Pakistan - Final Professional MBBS
  • Pakistan FCPS Part I (Basic Science)
  • Pathology - Anatomic
  • Pathology - Blood Banking Transfusion Medicine
  • Pathology - Chemical
  • Pathology - Clinical
  • Pathology - Cytopathology
  • Pathology - Forensics
  • Pathology - Hematopathology
  • Pathology - Microbiology
  • Pathology - Molecular Genetic
  • Pathology - Neuropathology
  • Pathology - Pediatric
  • Pathophysiology - Nursing Student
  • Pediatric
  • Pediatric - Cardiology
  • Pediatric - Child Abuse
  • Pediatric - Critical Care
  • Pediatric - Developmental Behavioral
  • Pediatric - Emergency Medicine
  • Pediatric - Endocrinology
  • Pediatric - Gastroenterology
  • Pediatric - Hematology-Oncology
  • Pediatric - Hospital Medicine
  • Pediatric - Infectious Diseases
  • Pediatric - MRCPCH UK
  • Pediatric - Neonatal Perinatal
  • Pediatric - Nephrology
  • Pediatric - Neurology
  • Pediatric - Pulmonology
  • Pediatric - Rehabilitation Medicine
  • Pediatric - Rheumatology
  • Pediatric Advanced Life Support® (PALS®)
  • Pediatric Surgery
  • Pennsylvania State CME CE Requirements
  • Pharmacology PN - Nursing Student
  • Pharmacology RN - Nursing Student
  • Pharmacy - Ambulatory Care (BCACP®)
  • Pharmacy - Applied Toxicology (ABAT®)
  • Pharmacy - Cardiology (BCCP®)
  • Pharmacy - Certified Pharmacy Technician (PTCB® CPhT®)
  • Pharmacy - Critical Care (BCCCP®)
  • Pharmacy - Emergency Medicine (BCEMP®)
  • Pharmacy - Geriatric (BCGP®)
  • Pharmacy - Infectious Disease (BCIDP®)
  • Pharmacy - NAPLEX®
  • Pharmacy - Nutrition Support (BCNSP®)
  • Pharmacy - Oncology (BCOP®)
  • Pharmacy - Pediatric (BCPPS®)
  • Pharmacy - Pharmacotherapy (BCPS®)
  • Pharmacy - Psychiatric (BCPP®)
  • Physical Medicine and Rehabilitation
  • Physical Therapy - Geriatric Clinical Specialist (ABPTS® APTA® GCS)
  • Physical Therapy - Neurology Clinical Specialist (ABPTS® APTA® NCS)
  • Physical Therapy - Orthopedic Clinical Specialist (ABPTS® APTA® OCS)
  • Physical Therapy - Pediatric Clinical Specialist (ABPTS® APTA® PCS)
  • Physical Therapy - Physical Therapist (NPTE-PT)®
  • Physical Therapy - Physical Therapist Assistant (NPTE-PTA)®
  • Physical Therapy - Sports Clinical Specialist (ABPTS® APTA® SCS)
  • Plastic Surgery
  • Podiatry - APMLE® Part 1
  • Podiatry - APMLE® Part 2
  • Podiatry - APMLE® Part 3
  • Podiatry Foot and Ankle Surgery
  • Podiatry Medicine
  • Professional Ethics, Leadership, and Management - Nursing Student
  • Psychiatry
  • Psychiatry - Addiction
  • Psychiatry - Child and Adolescent
  • Psychiatry - Consultation-Liaison
  • Psychiatry - Forensic
  • Psychiatry - Geriatric
  • Psychology - Examination for Professional Practice In Psychology (EPPP®)
  • Psychology - Neuropsychology
  • Psychology - Psychopharmacology Examination (PEP®)
  • Public Health and
General Preventive Medicine
  • Puerto Rico State CME CE Requirements
  • Pulmonary
  • Quality Board
  • Radiation Oncology
  • Radiologic Technologist - Magnetic Resonance Imaging (ARRT-MRI®)
  • Radiologic Technologist - Radiography (ARRT-R®)
  • Radiology - Breast
  • Radiology - Cardiac
  • Radiology - Diagnostic Radiology Qualifying (Core)
  • Radiology - Gastrointestinal
  • Radiology - Genitourinary
  • Radiology - Musculoskeletal
  • Radiology - Neuroradiology
  • Radiology - Pediatric
  • Radiology - Physics and Safety
  • Radiology - Thoracic
  • Radiology - Ultrasound
  • Radiology - Vascular and Interventional
  • Radiology Technology - Computed Tomography (ARRT-CT® or NMTCB-CT®)
  • Radiology Technology - Nuclear Medicine (ARRT® or NMTCB-CNMT®)
  • Radiology Technology - Vascular Interventional Radiography
  • Registered Cardiovascular Invasive Specialist (RCIS)®
  • Registered Dietitian (RD®) / Registered Dietitian Nutritionist (RDN®)
  • Respiratory Therapist - Certified or Registered (CRT® or RRT®)
  • Respiratory Therapy - Adult Critical Care Specialist (RRT-ACCS®)
  • Respiratory Therapy - Neonatal and Pediatric (RRT-NPS®)
  • Respiratory Therapy - Pulmonary Function Technologist (CPFT® or RPFT®)
  • Rheumatology
  • Rhode Island State CME CE Requirements
  • Sleep
  • Social Work - ASWB® Advanced Generalist
  • Social Work - ASWB® Bachelors and Associate
  • Social Work - ASWB® Clinical
  • Social Work - ASWB® Masters
  • Sonography - Cardiac Sonographer
  • Sonography - Registered Diagnostic Medical Sonographer® (RDMS-Ob/Gyn®)
  • Sonography - Registered Diagnostic Medical Sonographer®-Abdomen (RDMS-AB®)
  • Sonography - Vascular (ADRMS® RVT®, ARRT® VS®, CCI® RVS®)
  • South Carolina State CME CE Requirements
  • South Dakota State CME CE Requirements
  • Speech-Language Pathology Praxis® (SLP®)
  • SPEX®
  • Spinal Cord Injury Medicine
  • Spine Surgery
  • Sports Medicine
  • Surgical Critical Care
  • Tennessee State CME CE Requirements
  • Texas State CME CE Requirements
  • Thoracic Surgery
  • Toxicology
  • Transesophageal Echocardiography
  • Transplant Hepatology
  • UK - Medical Licensing Assessment (UKMLA/MLA)
  • UK - Multi-Specialty Recruitment Assessment (MSRA - CPS)
  • UK - Prescribing Safety Assessment (PSA)
  • UK Overseas Registration (ORE)
  • UK PLAB 1
  • Undersea and Hyperbaric
  • Urology
  • Urology - Pediatric
  • USMLE® Step 1
  • USMLE® Step 2
  • USMLE® Step 3
  • Utah State CME CE Requirements
  • Vascular Medicine (ABVMVascular Medicine (ABVM®)
  • Vascular Surgery
  • Venous, Lymphatic, and Phlebology Medicine
  • Vermont State CME CE Requirements
  • Virgin Islands State CME CE Requirements
  • Virginia State CME CE Requirements
  • Washington State CME CE Requirements
  • West Virginia State CME CE Requirements
  • Wisconsin State CME CE Requirements
  • Wound
  • Wyoming State CME CE Requirements

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Mechanism of Action

Adrenergic receptors, otherwise known as adreno-receptors, are classified as either alpha or beta receptors. Those two classes are further subdivided into alpha-1, alpha-2, beta-1, beta-2, and beta-3. Alpha-1 and alpha-2 receptors both have three subtypes. These receptors are all G-protein-coupled receptors.

Alpha-1 receptors are Gq-coupled receptors, whereas alpha-2 receptors are Gi-coupled receptors. Beta-2 and beta-3 are also Gi-coupled receptors. All beta receptors are also Gs-coupled receptors.

Agonist binding to the adrenergic receptors induces the following cellular mechanisms:

Alpha-1 Receptor

Phospholipase C is activated, which leads to the formation of inositol triphosphate (IP3) and diacylglycerol (DAG). As a result, intracellular calcium rises.

Alpha-2 Receptor

Adenylate cyclase is inactivated, which leads to a decrease in intracellular cyclic adenosine monophosphate (cAMP).

Beta-1 Receptor

Adenylate cyclase is activated, and intracellular cAMP increases.

Beta-2 Receptor

The adenylate cycle becomes activated through the Gs-protein-coupled receptors, and there is an increase in intracellular cAMP. Gi protein-coupled receptors are also activated, and this will decrease intracellular cAMP. [[16]](/content/point-of-care/17240#ref_15694819 ""/index.html) [[17]](/content/point-of-care/17240#ref_30120106 ""/index.html)

Investigators screened several cardiovascular drugs (e.g., methyldopa, amiodarone, doxazosin) and found that these affected in vitro Schistosoma mansoni viability. [[18]](/content/point-of-care/17240#ref_34358112 ""/index.html) This suggests that methyldopa might have antiparasitic properties.

Administration

Given adrenergic drugs are a broad class of medications, they are collectively available in almost every drug dosage form. Common methods of administration are oral, intravenous, intranasal, and topical. Dosages for beta-1 agonists such as dobutamine can begin with 0.5 to 1 mcg/kg/min and go up to 40 mcg/kg/min on the maximum end. The doses at the lower end can also be prescribed at 2.5 mcg/kg/min to 5 mcg/kg/min. While doses at the higher end can be prescribed at 5 mcg/kg/min to 20 mcg/kg/min. [[19]](/content/point-of-care/17240#ref_29262042 ""/index.html)

While other medications such as clonidine (alpha-2 agonists) may be prescribed as transdermal patches with dosages of 0.1 mg/day to 0.3 mg/day while changing the patch every week. Clonidine can also be prescribed via an immediate-release tablet at 0.1 mg/day to 0.3 mg/day and an extended-release tablet with a dosage of 0.1 mg/day. Caution should be used when prescribing the medication to patients with renal failure as and it is recommended to begin with a low dose and increase as needed. [[20]](/content/point-of-care/17240#ref_29083638 ""/index.html)

Adverse Effects

The adverse effects seen with adrenergic drugs are broad. The most common side effects are changes in heart rate and blood pressure.

Selective agonist binding to the alpha-1 receptor can lead to hypertension. Certain drugs that bind to the alpha-1 receptor, such as phenylephrine, may cause reflex bradycardia. [[21]](/content/point-of-care/17240#ref_26022219 ""/index.html)

Drugs that selectively bind to alpha-2 receptors may cause hypotension, dry mouth, and sedation. At higher doses, respiratory depression and somnolence may occur. These effects are most pronounced with clonidine and similarly acting drugs. [[20]](/content/point-of-care/17240#ref_29083638 ""/index.html)

Selective binding to beta-1 receptors commonly causes tachycardia, palpitations, and hypertension. Tachyarrhythmias and anxiety can also be common. High doses may induce dangerous arrhythmias. An example of a selective beta-1 receptor agonist is dobutamine.

Beta-2 receptor agonists can cause tremors, tachycardia, palpitations, and anxiety. Common examples are the various bronchodilator drugs such as albuterol and salmeterol. [[22]](/content/point-of-care/17240#ref_30085570 ""/index.html) Pediatric status asthmaticus is treated with continuous albuterol, which can cause hypokalemia. [[23]](/content/point-of-care/17240#ref_35018439 ""/index.html)

Non-selective binding to the adrenergic receptors can cause different side effects that vary based on the specific agent as well as the dosage. The common non-selective agonists are norepinephrine, epinephrine, and isoproterenol (isoprenaline). Common side effects are tachycardia, hypertension, arrhythmias, palpitations, and anxiety. Norepinephrine is less likely to cause arrhythmias than some of the other pressor medications, probably because it is more alpha-1 receptor-selective as compared with the beta-1 receptor. [[15]](/content/point-of-care/17240#ref_30725944 ""/index.html)

Contraindications

Alpha-1 receptor agonists are relatively contraindicated in those with the following medical conditions: hypertension, bradycardia, prostatic hyperplasia, and anyone using medications that may also increase blood pressure.

Alpha-2 receptor agonists should be used cautiously in anyone who has low blood pressure. Geriatric patients may be at increased risk of falls due to the sedating and hypotensive effects.

Beta-1 receptor agonists require caution in patients who have arrhythmias.

Beta-2 receptor agonists are relatively contraindicated in patients who have hypokalemia.

Norepinephrine is relatively contraindicated when using certain anesthetics. When dosing halothane or cyclopropane, there is an increased risk of dangerous arrhythmias.

Epinephrine is contraindicated in patients who have angle-closure glaucoma. [[22]](/content/point-of-care/17240#ref_30085570 ""/index.html) [[24]](/content/point-of-care/17240#ref_14767264 ""/index.html)

Monitoring

There is a broad variation in the therapeutic index of adrenergic drugs given a large number of medications. When prescribing beta-1 agonists, care should be taken to monitor hypertension as well as potential arrhythmias. [[19]](/content/point-of-care/17240#ref_29262042 ""/index.html)

While prescribing alpha-2 agonists, patients should be monitored for bradycardia, hypotension, and potential substance abuse. [[20]](/content/point-of-care/17240#ref_29083638 ""/index.html)

Recent research has also counseled caution when administering beta-2 agonists as patients should be monitored for paradoxical bronchospasm, blood pressure, heart rate, and central nervous system effects. [[25]](/content/point-of-care/17240#ref_29489143 ""/index.html)

There are case reports of patients abusing clonidine alone or with benzodiazepines and opioid analgesics. Clonidine may extend the opioid-induced euphoria and decrease the opioid dose needed for euphoria. [[26]](/content/point-of-care/17240#ref_33814003 ""/index.html)

Toxicity

Adrenergic receptors all have drug antagonists. Alpha-blockers are not generally indicated for the treatment of alpha-agonist overdoses. Beta-blockers may be used to treat adverse effects arising from adrenergic receptor agonists acutely. Beta-blockers can treat tachycardia and hypertension that may occur from vasopressors. Toxicity should be monitored in the pediatric population when using beta-2 agonists as they can increase liver aminotransferase concentrations. [[25]](/content/point-of-care/17240#ref_29489143 ""/index.html)

In addition, when prescribing alpha-2 agonists, there are instances where angioedema, atrioventricular (AV) block, and hypersensitivity may occur. Potential toxicities of beta-1 agonists may include tremors, headaches, and vomiting. [[19]](/content/point-of-care/17240#ref_29262042 ""/index.html) [[20]](/content/point-of-care/17240#ref_29083638 ""/index.html)

Enhancing Healthcare Team Outcomes

There are many types of adrenergic agents, and clinicians, including physicians, nurse practitioners, and physician assistants who prescribe these agents, should be aware of their side effects and contraindications. Management requires an interprofessional team approach to drug therapy with these drugs since they cover such a broad spectrum of indications and effects, both therapeutic and adverse. It is essential to consult with a pharmacist if there is any question about the use of an adrenergic agent; this can include drug-drug interactions, appropriate dosing based on the condition treated, and adverse event profile. Nurses can also access this resource as they will often administer the drugs inpatient and will need to know what signs to watch for in the event of an adverse reaction of any sort.

All interprofessional team embers must document any changes in patient status in the patient's medical record and communicate their findings to other team members so therapeutic adjustments can be made. An interprofessional team approach is vital to coordinate the care of patients taking these medications safely and effectively. [Level 5]

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