What are the key sympathomimetics (sympathetic nervous system stimulants), sympatholytics (sympathetic nervous system inhibitors), parasympathomimetics (parasympathetic nervous system stimulants), and parasympatholytics (parasympathetic nervous system inhibitors) and how can they be easily remembered?

From the Guidelines

The primary sympathomimetics include epinephrine (0.1-1.0 mg IV bolus), norepinephrine (0.01-1.0 mcg/kg/min IV infusion), and dopamine (1-20 mcg/kg/min IV infusion), which can be remembered using the mnemonic "END" (Epinephrine, Norepinephrine, Dopamine) 1. Key sympatholytics are propranolol (1-10 mg IV bolus) and phentolamine (1-5 mg IV bolus), recalled using "PP" (Propranolol, Phentolamine) 1. Parasympathomimetics include pilocarpine (5-10 mg oral) and bethanechol (10-50 mg oral), associated with "PB" (Pilocarpine, Bethanechol), while parasympatholytics are atropine (0.5-2.0 mg IV bolus) and glycopyrrolate (0.1-0.2 mg IV bolus), linked with "AG" (Atropine, Glycopyrrolate) 1.

Key Points

• Sympathomimetics: epinephrine, norepinephrine, dopamine
• Sympatholytics: propranolol, phentolamine
• Parasympathomimetics: pilocarpine, bethanechol
• Parasympatholytics: atropine, glycopyrrolate

Mnemonics

• END: Epinephrine, Norepinephrine, Dopamine (sympathomimetics)
• PP: Propranolol, Phentolamine (sympatholytics)
• PB: Pilocarpine, Bethanechol (parasympathomimetics)
• AG: Atropine, Glycopyrrolate (parasympatholytics)

Dosages

• Epinephrine: 0.1-1.0 mg IV bolus
• Norepinephrine: 0.01-1.0 mcg/kg/min IV infusion
• Dopamine: 1-20 mcg/kg/min IV infusion
• Propranolol: 1-10 mg IV bolus
• Phentolamine: 1-5 mg IV bolus
• Pilocarpine: 5-10 mg oral
• Bethanechol: 10-50 mg oral
• Atropine: 0.5-2.0 mg IV bolus
• Glycopyrrolate: 0.1-0.2 mg IV bolus

From the FDA Drug Label

Atropine is an antimuscarinic agent since it antagonizes the muscarine-like actions of acetylcholine and other choline esters. Bethanechol chloride acts principally by producing the effects of stimulation of the parasympathetic nervous system. Norepinephrine (sometimes referred to as l-arterenol/Levarterenol or l-norepinephrine) is a sympathomimetic amine

The key sympathomimetics (sympathetic nervous system stimulants) include:

• Norepinephrine 2 The key sympatholytics (sympathetic nervous system inhibitors) are not mentioned in the provided drug labels. The key parasympathomimetics (parasympathetic nervous system stimulants) include:
• Bethanechol chloride 3
• Acetylcholine 3 The key parasympatholytics (parasympathetic nervous system inhibitors) include:
• Atropine 4 These can be easily remembered by grouping them into:
• Sympathetic nervous system:
  • Stimulants: Norepinephrine
  • Inhibitors: Not mentioned
• Parasympathetic nervous system:
  • Stimulants: Bethanechol chloride, Acetylcholine
  • Inhibitors: Atropine