Cap11 Adrenolitico

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Cap11 Adrenolitico SECCION II: CAPITULO 11 DROGAS SIMPATICOLITICAS O ADRENOLITICAS Malgor - Valsecia Como anteriormente se mencionara, el siste- Son un grupo de drogas que actúan en la ter- ma Simpático o Adrenérgico cumple num ero- minación adrenérgica, a nivel axoplasmático o sas e importantísimas funciones biológicas sobre receptores presinápticos alfa2, salvo indispensables para la modulación y regula- estos últimos agentes, los adrenolíticos presi- ción de organismos y sistemas que son vitales nápticos tienen ac tualmente un uso clínico para el mantenimiento de una vida normal. terapéutico limitado. CLASIFICACIÓN DE DROGAS SIMPATICO- Las drogas simpaticolíticas o adrenolíticas LÍTICAS son un grupo numeroso de fármacos que in- terfieren con las funciones del sistema simpá- I.SIMPATICOLITICOS PRESINAPTICOS. tico, las mismas actúan básicamente de dos maneras diferentes: a.Axoplasmáticos: I- Inhiben la liberación de las catecolaminas en *Reserpina (Serpasol) la terminación adrenérgica, actuando a nivel Deserpidina presináptico y Rescinamina Guanetidina (Ismelin) II- Bloquean los receptores adrenérgicos en Batanidina las células efectoras a nivel postsináptico. Debrisoquina (Declinax,Sintiapress) Bretilio Las primeras son drogas simpaticolíticas que IMAO:Pargilina (Eutonil;Tranilcipromina (Parna- inhiben la síntesis de catecolaminas. Interfie- te) ren con los proceso de depósito y liberación de las mismas. Algunas actúan a nivel central reduciendo la activi dad simpática cerebral. b.Agonistas alfa 2:(Adrenoliticas de accion Este grupo de fármacos son los llam ados central) Simpaticolíticos presinápticos. Los simpati- colíticos postsinápticos son los bloqueantes Clonidina (Catapresan) de los receptores alfa y beta adrenérgicos. *Alfa-metil-dopa (Aldomet) Guanabenz (Rexitene) Todos estos agentes adrenolíticos son drogas Guanfacina (Estulic,Hipertensal) de gran utilidad terapéutica, capaces de gene- rar una solución farmacológica a numerosos padecimientos clínicos, principalmente en el II.SIMPATICOLITICOS POSTSINAPTICOS área cardiovascular. a.BLOQUEADIRES ALFA 1 ADRENERGI- COS: I. FARMACOS SIMPATICOLITICOS PRESI- NAPTICOS. *Prazosin (Minipres) Trimazosin Terazosin 117 Doxazosin no para convertirlo en 5-hidroxitriptamina o serotonina, etc. b.BLOQUEADORES ALFA 2 ADRENERGI- COS La metildopa es una droga de un uso extensivo en terapéutica antihipertensiva, incorporada Yohimbina para tal fin en la década del 60. c.BLOQUEADORES ALFA TOTALES Mecanismo de acción: La alfa -metildopa, se (alfa 1 y alfa 2) distribuye am pliamente, sufre el proceso de racaptación neuronal y es biotransformada por Fentolamina (Regitina) la DOPA-decarboxilasa a alfa-metil-dopamina. Fenoxibenzamina Este precursor ingresa como si fuera dopami- Alcaloides dihidrogenados del na al gránulo adrenérgico y allí es transfor- Ergot,dihidroergotoxina (Hidergina) mado en alfa-metil-noradrenalina por la enzima dopamino-ß-hidroxilasa (DBH) La metilnora- drenalina liberada en el.proceso exocitósico es b.BLOQUEADORES BETA ADRENERGICOS un efectivo agonista de los receptores alfa2 presinápticos, que cuando se activan inducen Bloqueadores beta 1-2: un mecanismo de autorregulación negativo, inhibiendo la liberación de noradrenalina con el *Propanolol (Inderal) consiguiente efecto simpaticolítico. La metil- Timolol (Proflax) dopa actúa en el SNC a nivel del núcleo tracto Nadolol (Corgard) solitario y núcleo ambiguo, la respuesta sim- Pindolol (Visken) pática noradrenérgica refleja varios estímulos Sotalol (Betacardone) (barorreceptores por ejemplo), nace en dichos núcleos para alcanzar los centros de control Bloqueadores beta 1:(cardioselectivos) cardiovascular en el bulbo. La alfa-metilno- radrenalina, activando receptores alfa2, produ- *Atenolol (Prenormine) ce una inhibición simpática central y un efecto Metoprolol (Lopresor) antihipertensivo importante, entre otras accio- Acebutolol (Rodhiasectral) nes simpaticolíticas. Bloqueadores beta 2: Acciones farmacológicas: La metildopa re- duce la resistencia periférica y la presión arte- Butoxamine rial. No afecta significativamente la frecuencia Zinterol cardíaca, el volumen minuto y los reflejos va- somotores. Como interfiere con el funciona- Bloqueadores alfa y beta: miento del sistema simpático puede producir hipertensión ortostática. Labetalol (Labelol) La metildopa no afecta el flujo sanguíneo renal * AGENTES PROTOTIPOS. ni la filtración glomerular . Ocasiona sin em- bargo retención de Na+ e incrementa la prolac- tina plas mática. Este efecto ocurre porque la 1.Agonistas de los receptores alfa 2 presi- dopamina en el SNC produce una modulación nápti cos: o regulación inhibitoria de la secreción de pro- -Alfa-metil-dopa lactina. La metildopa origina por decarboxila- -Clonidina ción, la presencia de _-metildopamina en las -Guanfacina neuronas dopaminérgicas, que se libera como -Guanabenz un falso neurotransmisor y no desarrolla dicha acción inhibitoria. ALFA-METIL-DOPA: es un agonista análogo de la DOPA (dihidroxifenilalanina), inhibidor de Farmacocinética: Se absorbe principalmente la dopa-decarboxilasa o decarboxilasa de ami- por vía oral (50% de la dosis aproximadamen- noácidos aromáticos. Esta enzima decarboxila te). El efec to hipotensor máximo se desarrolla la DOPA para convertirla en dopamina. Ta m- luego de 4-6 horas. Se liga escasamente a bién decarboxila otra aminas como el triptofa- proteínas plasmáticas y atraviesa la barrera hematoencefálica. La metildopa pasa a través 118 de la placenta y se excreta en la leche mater- Estas reacciones son irreversibles si el trata- na. La metildopa se metaboliza formando con- miento se suspende rápidamente. jugados (metildopa- mono-O-sulfato) en el hígado e intestino, que parecen ser activos. Se eliminan por filtración glomerular en forma inal- Otros efectos adversos: náuseas, vómitos y terada o por sus conjugados. Su vida media sequedad de boca, urticaria, eczema, hiper- plasmática es de 2 horas. queratosis, congestión nasal, pueden ocurrir con el uso crónico de metildopa. También Usos terapéuticos: La metildopa se usa para ginecomastia, galactorrea e hiperprolactine- el tratamiento de la hipertensión arterial mode- mia. Ocasionalmente puede observarse tam- rada o grave. Actualmente los inhibidores bién impotencia, signos de parkinsonismo y adrenérgicos de este tipo se utilizan en la 2ª depresión psíquica. etapa del tratamiento para pacientes que no responden a terapia con monodrogas. Es más Los pacientes que se encuentran con trata- efectiva generalmente, si se la administra con- miento crónico de metildopa deben controlarse juntamente con diuréticos tiazídicos. Puede la función hepática y las transaminasas cada usarse también la combinación con otras dro- 2-3 meses. gas. La metildopa es probablemente una de las drogas de mayor uso como anti - hipertensivo. Esta droga también es útil en el CLONIDINA, GUANABENZ, GUANFACINA. manejo de la hipertensión de la embarazada. Clonidina es un derivado imidazólico. Guanfa- cina y guanabenz son drogas químicamente Efectos adversos: relacionadas derivadas de la feni- lacetilguanidina. El agente de mayor uso es la SNC: el efecto adverso más común es la se- clonidina. Son drogas liposolubles que atra- dación, aunque con el uso prolongado tiende a viesan fácilmente la barrera hematoenc efálica. desaparecer por tolerancia. También se obser- vó disminución de la memoria y dificultad para concentrarse, astenia, cefalea, vértigo y debili- Mecanismos de acción: Al igual que la me- dad. tildopa estos agentes son agonistas a adre- nérgicos, que actúan a nivel central desenca- Aparato cardiovascular: La hipotensión or- denando un efecto simpaticolítico sobre los tostática aparece con frecuencia, acompañada centros vasomotores, hipotensión arterial y de bradicardia, si no se adminis tra junto con bradicardia. Con dosis altas o cuando se ad- un diurético puede observarse retención de ministran por vía i.v. pueden activar también Na+ y agua y edemas. Este efecto puede los receptores alfa2 postsinápticos del múscu- agravar una insuficiencia cardíaca. lo liso vascular, ocasionando vas oconstric ción y efecto hipertensivo, solo inicial, que poste- Efectos hematológicos: Luego de 6-12 me- riormente es seguido por el efecto hipotensor ses de tratamiento puede aparecer un test de más prolongado. Coombs positivo, que no indica necesidad imprescindible de suspender el tratamiento. Acciones farmacológicas: Son similares a la Raramente puede aparecer anemia hemolítica, alfa-metildopa: descenso de la presión sistóli- debiendo suspenderse la metildopa en este ca y diastólica, disminución del volumen minu- caso. También leucopenia (granulocitopenia) to y bradicardia. Este efecto también puede reversible. La anemia hemolítica puede apare- ser originado en un es tímulo parasimpático cer con más frecuencia en pacientes con defi- central. La clonidina puede desarrollar hipoten- ciencia genética de glucosa-6-fosfato deshi - sión ortostática por disminución del retorno drogenasa. venoso. El flujo sanguíneo renal y la filtración glomerular no se altera con estos agentes y Reacciones de hipersensibilidad y hepato- puede ocurrir retención de agua y sodio, por lo toxicidad: El tratamiento prolongado con me- que también en este caso es conveniente el tildopa puede producir fiebre y eosinofilia por uso conjunto de un diurético tiazídico. Los hipersensibilidad. Esta reacción puede acom- efectos antihipertensivos de los diuréticos pañarse con alteración de la función hepática, tiazídicos y los agonistas alfa2, son aditivos. incremento de fosfatasa alcalina y más rara- Lo mismo ocurre con la mayoría
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