Beta-2 Adrenergic Agonists

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Beta-2 Adrenergic Agonists

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Abstract

The beta-2 adrenergic agonists are a large group of drugs that mimic the actions of naturally occurring catecholamines such as norepinephrine, epinephrine and dopamine. Direct agonists directly interact with the adrenergic receptors, whereas indirect agonists typically stimulate the release of endogenous catecholamines. The beta-2 adrenergic agonists act mainly on the smooth muscle of the vasculature, bronchial tree, intestines and uterus. These agents also act on the liver stimulating glycogenolysis and release of glucose from the liver and muscle (particularly if used in high doses). The beta-2 adrenergic agonists are used largely as bronchodilators in the management of asthma, both in control of acute symptomatic attacks as well as chronic, long term prevention and management. These agents are some of the most commonly prescribed drugs for asthma and are widely used and proven to be well tolerated and safe. The use of beta adrenergic agonists in asthma has not been associated with elevations in serum aminotransferase or alkaline phosphatase levels or in causing clinically apparent liver disease. When given in large doses or after intentional overdose, beta adrenergic agonists can cause liver injury. Most case reports of liver damage from these agents have been associated with their use in control of premature labor (for their effects on relaxation of uterine smooth muscle). The liver injury typically arises within a few days of starting high dose intravenous beta adrenergic agonists, is usually asymptomatic, not associated with jaundice, and rapidly reversed once the medication is stopped. Commonly used beta adrenergic drugs include albuterol, bitolterol, metaproterenol, pirbuterol, salmeterol and terbutaline. These agents share structural similarity and are discussed together.

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Drugs: Isoprenaline