Sympathomimetic medications

Phenelzine and tranylcypromine are both effective in the treatment of social phobia. Many practitioners continue to be hesitant to use this class of medications, given the dietary restrictions required of patients and the potential risk of hypertensive crises when combined with dietary tyramine and sympathomimetic medications. However, the proven effectiveness of this class makes it an important option in the treatment of social phobia. 

If type A inhibitors eventually prove to be as efficacious as other MAOIs and non-MAOIs, there is no doubt that some clinicians will prescribe them with increasing frequency. In addition, if there is minimal risk of adverse interactions with tyramine and other substances (e.g., sympathomimetics), medical and legal concerns about their use will be appreciably reduced. 

Sympathomimetic medications that stimulate adrenergic receptors are organized into three categories. These are ... 

Infection, acute coronary syndrome, cerebrovascular accidents, trauma, noncompliance with insulin pharmacotherapy, new-onset diabetes mellitus, and medications (e.g., corticosteroids and sympathomimetics)... 

Isolated seizures that are not epilepsy can be caused by stroke, central nervous system trauma, central nervous system infections, metabolic disturbances (e.g., hyponatremia and hypoglycemia), and hypoxia. If these underlying causes of seizures are not corrected, they may lead to the development of recurrent seizures I or epilepsy. Medications can also cause seizures. Some drugs that are commonly associated with seizures include tramadol, bupropion, theophylline, some antidepressants, some antipsy-chotics, amphetamines, cocaine, imipenem, lithium, excessive doses of penicillins or cephalosporins, and sympathomimetics or stimulants. 

Hoffman, B.B., Adrenoceptor-activating and other sympathomimetic drugs, in Basic and Clinical Pharmacology, 8th ed., Katzung, B.G., Ed., Lange Medical Books/McGraw-Hill, New York, 2001, chap. 9. 

Avoid cough, cold, or allergy medications containing sympathomimetics... 

The most common reason for the underutilization of MAOIs is the potential for serious consequences of MAOI drug-food and drug-drug interactions. Combined MAOI treatment with (1) foods or medications involved in monoamine synthesis (2) monoamines themselves or (3) other sympathomimetics routinely found in over-the-counter medications can result in hy-peradrenergic crises or serotonin toxicity (Blackwell, 1991). 

Medications with serotonergic activity may also have other monaminergic or sympathomimetic activity. Combining MAOIs with these medications may result in a complex side effect profile. For example, combining meperidine or dextromethorphan with MAOIs may result in respiratory depression, in addition to symptoms of serotonin excess. Furthermore, interactions between MAOIs and tricyclic antidepressants (TCAs) more commonly result in potentiating shared adverse events such as othostatic hypotension, as opposed to hyperadrenergic crises or the serotonin syndrome. 

Despite impressions to the contrary, MAOIs are generally well tolerated if patients observe the restricted diet and avoid medications that contain sympathomimetic amines. Adverse effects are rarely a treatment-limiting problem with the exception of hypotension. MAOIs also fall between TCAs and SSRIs in terms of overdose risk. Major toxic reactions to MAOIs are uncommon but require immediate discontinuation and symptomatic treatment. 

Ephedrine occurs in various plants and has been used in China for over 2000 years it was introduced into Western medicine in 1924 as the first orally active sympathomimetic drug. It is found in ma huang, a popular herbal medication (see Chapter 64). Ma huang contains multiple ephedrine-like alkaloids in addition to ephedrine. Because ephedrine is a noncatechol phenylisopropylamine (Figure 9-... 

The diagnosis of GHB withdrawal may be difficult because it is similar to sedative or alcohol withdrawal syndromes, as well as to withdrawal from sympathomimetic agents such as cocaine, methamphetamine, and ecstasy. GHB withdrawal may also be confused with serotonin syndrome (a reaction caused by a combination of drugs, one of which increases serotonin levels in the body, such as Prozac) and neuroleptic malignant syndrome (a rare reaction to an antiseizure medication). 

Sympathomimetic A medication similar to amphetamine, but is less powerful and has less potential for addiction than amphetamine. 

Approximately 25% of all patients with hypertrophic cardiomyopathy (HCM) have latent left ventricular outflow obstruction with an intraventricular gradient (I). Pathophysiologic features are asymmetric hypertrophy of the septum and a systolic anterior movement of the anterior leaflet. Medical treatment includes betablockers, and calcium antagonists of the verapamil type. Approximately 5— 10% of the patients with outflow obstruction are refractory to such negative inotropic therapy (2). Positive inotropic drugs such as digitalis or sympathomimetics are strictly contraindicated. In the presence of atrial fibrillation, anticoagulation therapy should be started. Since endocarditis is more common in patients with HCM because of turbulence in the left ventricle, prophylactic antibiotics should be administered for periods of potential bacteraemia. 

As an example I cite our early searches on the chemical structure properties indole and ethyiamine and the medical use properties sympathomimetic and parasympathomimetic 8). These searches revealed two sets ot intersecting hyperspace axes. One ot these intersections contains compounds with ethyiamine structures (Property A in Table IV) which have the medical use property sympathomimetic the other cluster indicates organic ammonium ions... 

Step 1. Medications of first choice for the acute attack are short-acting, aerosolized fS2-sympathomimetics, e.g., salbutamol or feno-terol. Their action occurs within minutes after inhalation and lasts for 4-6 hours. 

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