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Vasoconstrictors
Chemical Structure
Classification of Adrenergic Drugs
Classification by chemical structure is related to the
presence or absence of a catechol nucleus
Catechol is orthodihydroxybenezene
Sympathomimetic drugs that have a hydroxy (OH-)
substitution in the 3rd and 4th positions of the aromatic ring
are termed catechols
Catecholamines
If the 3rd and 4th positions contain an amine group (NH2) attached to
the aliphatic side chain, they are then called catecholamines
Epinephrine
Norepinephrine
Dopamine
Isoproterenol
and
Levonordefrin
synthetic catecholamine
Chemical Structure
Catecholamines
*Epinephrine
*Norepinephrine
*Levonordefrin
Isoproterenol
Dopamine
Noncatecholamines
Amphetamine
Methamphetamine
Ephedrine
Mephentermine
Hydroxyamphetamine
Metaraminol
Methoxamine
Phenylephrine
Modes of Action
3 Classes of Sympathomimetic Amines:
1)*Direct Acting directly on adrenergic receptors
2) Indirect Acting use norepinephrine release
3) Mixed Acting both direct and indirect actions
.036 mg epinephrine
.018 mg epinephrine
.009 mg epinephrine
Norepinephrine
NOREPINEPHRINE
Norepinephrine lacks Beta 2 actions (bronchodilation and
vasodilation) and produces intense peripheral vasoconstriction
with possible dramatic elevations in blood pressure
Norepinephrines side effect ratio is 9 times higher than
epinephrine
Norepinephrines use in dentistry is not recommended and its
use is diminishing around the world
Epinephrine remains the vasopressor of choice in dentistry
*Norepinephrine is not used because of its many side effects
Epinephrine
Epinephrine
8.3 cartridges
.04 mg
Two cartridges of 1:100,000 epinephrine
Levonordefrin
References
Malamed, Stanley: Handbook of Local Anesthesia. 5 th Edition. Mosby. 2004