32-Adrenergic receptor drug responsiveness

Class II antiarrhythmic drugs include beta (( -adrenergic blocking drugs, such as acebutolol (Sectral), esmolol (Brevibloc), and propranolol (Inderal). These drugp also decrease myocardial response to epinephrine and norepinephrine (adrenergic neurohormones) because of their ability to block stimulation of p receptors of the... 

Vasodilators. Hydralazine causes direct relaxation of arteriolar smooth muscle. An important consequence of this vasodilation, however, is reflex tachycardia (T CO). It may also cause sodium retention (T plasma volume). The resulting increase in CO tends to offset effects of the vasodilator. Therefore, these drugs are most effective when administered along with sympathetic agents such as P-adrenergic receptor antagonists, which prevent unwanted compensatory responses by the heart. 

The answer is c. (Hardman, pp 414-4163) Unwanted pharmacologic side effects produced by phenothiazine antipsychotic drugs (e.g., perphenazine) include Parkinson-like syndrome, akathisia, dystonias, galactorrhea, amenorrhea, and infertility. These side effects are due to the ability of these agents to block dopamine receptors. The phenothiazines also block muscarinic and a-adrenergic receptors, which are responsible for other effects. 

Some failures will be due to the presence of variants in drug handling. Patients who are rapid acetylators of isoniazid have a slower antituberculous response than slow acetylators (Evans and Clarke, 1961). Asthmatics who do not respond well to (32-agonist bronchodilators may have fewer functioning p2-adrenergic receptors (Drysdale et al., 2000). Variations in the synthesis or structure of the serotonin transporter protein, which is involved in selective reuptake of serotonin by presynaptic neurons, may explain why some patients with depressive disorders respond to selective serotonin reuptake inhibitors and others do not (Steimer et al., 2001). 

One of the few examples of decreased susceptibility among elderly is the effect of catecholamines on the heart. There is a down-regulation of beta-adrenergic receptors and a reduced response to beta-adrenergic stimulation (Turnheim 1998). This results in decreased effect of betablockers on heart rate and stroke volume. In the elderly betablockers may be less effective than other drugs against hypertension and they should not be considered appropriate for first-line therapy of uncomplicated hypertension in the elderly (Grossman and Messerli 2002). 

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