Epinephrine

DEFINITION :
  • Epinephrine is a drug and more commonly known as adrenaline is a hormone secreted by the medullas of adrenaline gland.
  • Epinephrine is formed from Tyrosine
  • Metyrosine inhibits the rate limiting step in synthesis of epinephrine
MOA:
  • Epinephrine speeds the heart by accelerating the slow depolarization of SA nodal cells that takes place during diastole, i.e., during phase 4 of the action potential. 
  • Consequently, the transmembrane potential of the pacemaker cells rises more rapidly to the threshold level of action potential initiation. 
  • The amplitude the action potential and the maximal rate of depolarization (phase 0) also are increased.
USES:
  • As a drug Epinephrine is used chiefly as a
  1. Stimulant in Cardiac Arrest
  2. Vasoconstrictor In Anaphylactic shock(I.V)
  3. As a Bronchodilator
  4. Antispasmodic in Bronchial asthma
  5. Sympathomimietic causing increase in mean blood pressure, heart rate and cardiac output on intravenous infusion is Adrenaline
  6. Epinephrine Reduces aqueous production and increases outflow facility
  7. Uveitis glaucoma,Open angle glaucoma & Neovascular glaucoma
  8. Epinephrine action in liver is Glycogenoloysis
  9. Bupivacaine toxicity
  10. Gluconeogenesis by inhibiting insulin secretion
  11. Actively bleeding peptic ulcer can be managed endoscopically by injection therapy using epinephrine with concentration 1 in 10,000
  12. Epinephrine is found in a small amount in the body and is essential for maintaining cardiovascular homeostasis because of its ability to direct blood to tissue under stress.
  13. In Hepatomegaly & Hypoglycemia
  • Exception:A diagnosis of type I glycogen storage disease (Von Girke's disease) should be suspected whenever there is hepatomegaly with hypoglycemia that is unresponsive to glucagon or epinephrine
  • Epinephrine secreted by Pheochromocytoma to cause its clinical manifestations
STORAGE :
  • Adrenaline is Sensitive To Light
  • Do not store in cartons
  • Store Below 25 Degree
  • Do not refrigerate of freeze 
INDICATIONS:
  • Emergency treatment in anaphylaxis. Bronchospasm, Asthma,Caridac Failure.
  • Adult: 0.2–1mg (preferred) or IM (avoid buttocks) every 4 hrs as needed.
  • Children: 0.01mg/kg (max 0.5mg) every 4 hrs as needed.
  • In the beginning of resuscitation efforts, 0.5 mg of epinephrine is administered subcutaneously that acts via:
  1. Alpha-1 receptors in vascular smooth muscle, 
  2. beta-1 receptors in the heart, and 
  3. beta-2 receptors in bronchial smooth muscle
CONTRA-INDICATION:
  • People With High Blood Pressure
  • People With Diabetes
  • People With Hart Disease and Heart blood Slow problems
  • Children under 30 kg 
  • People with long term lung disease
  • People with mental health problem or with brain damage
SIDE EFFECTS:
  • Abnormal and decreased touch Sensation.
  • Arm, back or jaw pain.
  • Bleeding Discoloration of skin .
  • Fainting
  • Dizziness
  • Epinephrine causes hyperglycemia by increased glucagon & Decreased insulin secretion
  • Headache and Nervousness
  • Stress Syndrome:
  • In surgical stress Epinephrine is increased
Exam Question
  • In the beginning of resuscitation efforts, 0.5 mg of epinephrine is administered subcutaneously Alpha-1 receptors in vascular smooth muscle, beta-1 receptors in the heart, and beta-2 receptors in bronchial smooth muscle are responsible for the beneficial effect of epinephrine in this patient
  • Epinephrine secreted by Pheochromocytoma to cause its clinical manifestations
  • Epinephrine is formed from Tyrosine
  • Epinephrine stimulates gluconeogenesis 
  • Actively bleeding peptic ulcer can be managed endoscopically by injection therapy using epinephrine with concentration 1 in 10,000
  • Insulin secretion is inhibited by Epinephrine 
  • In surgical stress Epinephrine is increased
  • Stress-induced hyperglycemia is due to Epinephrine 
  • Epinephrine action in liver is Glycogenoloysis
  • Epinephrine causes hyperglycemia by increased glucagon & Decreased insulin secretion
  • Mechanism of action of epinephrine in cardiopulmonary resuscitation is Increase SA node activity
  • Drug of choice for anaphylactic shock is Adrenaline
  • In Anaphylactic shock epinephrine given by Intravenousroute 
  • A child presents with hepatomegaly and hypoglycemia. There is no improvement in blood sugar even after administration of epinephrine in Von girke's disease
  • Bupivacaine toxicity treated with Epinephrine
  • Epinephrine treats Uveitis glaucoma,Open angle glaucoma & Neovascular glaucoma
  • Epinephrine Reduces aqueous production and increases outflow facility
  • Sympathomimietic causing increase in mean blood pressure, heart rate and cardiac output on intravenous infusion is Adrenaline
  • IV dose of 1: 10000 concentration of epinephrine in pre term baby is 0.2 ml
  • Adrenaline is secreted by Adrenal medulla
  • Metyrosine inhibits the rate limiting step in synthesis of epinephrine
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