MOA - activation of pre-synaptic alpha-2 receptors in the locus coeruleus and rostroventral lateral medusa inducing a negative feedback on norepinephrine release, Main Uses - Sedation, muscle relaxation, analgesia/visceral analgesia, sparing effects of general anesthesia, Cardiovascular effects - reduced HR and BP by binding to receptors, useful for treatment of hypotension and heart failure, hemodynamic biphasic effect , Respiratory effects  - decreased RR, blood gases are maintained, pale blue/grayish mucous membranes (peripheral vasoconstriction), Muscle relaxation - ataxia, recumbency, reduce lower esophageal sphincter pressure - risk of gastroesophageal reflux and regurgitation  , Hormonal effects - diuresis - decreased ADH and renin secretion, decreased insulin secretion, decreased ACTH leading to decrease in cortisol, Contraindications - anticholinergics during second phase of hemodynamic biphasic effect, Small ruminants causes bronchoconstriction and pulmonary edema, Brachycephalic dogs causes laryngeal paralysis, Diabetic animals, Blocked cat, pediatric patients, cardiovascular unstable patients  , GI effects - emesis, reduced gut motility, increased transit time, reduced GI secretions, reduced gut blood flow , Xylazine  - used in small/large animals, short DOA. Small animals: emetic, neuroleptanalgesia, chemical restrain used with ketamine. Horse: premedication, used in TIVA. Bovine: very sensitive, certain breeds are more sensitive.  , Detomidine - Primarily used in horse. More potent than xylazine. Less stimulation of uterus contractions compared to xylazine (cattle), sublingual gel form available, excellent GI analgesia. , Romifidine - License for horses only, longest DOA - 2 hours, less ataxia than detomidine and xylazine. , Dexmedetomidine - Primarily used in small animals and wild/exotics, off label used in horse, less emetic than xylazine, great reduction on general anesthetics, use half the dose of medetomidine. , Antipamizole - Selective alpha 2 antagonist, specific antagonism of medetomidine and dexmedetomidine, IM administration is only recommendation, reversal of sedative and analgesia effects. reversal of cardiovascular depression , Yohimbine  - Used to antagonize xylazine, many side effects, use mainly in humans., Tolazoline - Mixed alpha 1/2 antagonists, use to antagonize xylazine in horses, may cause hypotension and sweating.  , MK-467 (Vatinoxan) - Peripheral alpha 2 antagonist, does not cross BBB, co-administered with (dex)medetomidine, hastens IM absorption of the alpha agonist , MK-e67 - prevents - (dex)medetomidine-mediated vasoconstriction and reduction in heart rate and cardia output without compromising sedation nor analgesia., Alpha 2 Agonist - Strong sedative, good analgesia, muscle relaxant. use only in cardiovascular stable animals, avoid in peds, aggressive animals, dysphoric animals, reversible. ,

Alpha 2 agonists

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