Epinephrine , also known as adrenaline or adrenaline , is a drug and hormone. As a medicine, it is used to treat a number of conditions, including anaphylaxis, heart attack, and superficial bleeding. Inhaled epinephrine can be used to correct the symptoms of croup. It can also be used for asthma when other treatments are ineffective. The drug is administered intravenously, by injection to the muscle, through inhalation, or by injection just under the skin.
Common side effects include frailty, anxiety, and sweating. Rapid heartbeat and high blood pressure can occur. Sometimes, it can produce abnormal heart rhythms. Although the safety of its use during pregnancy and breastfeeding is unclear, its benefits for mothers should be taken into account.
Epinephrine is usually produced by certain adrenal glands and neurons. It plays an important role in the fight-or-flight response by increasing blood flow to muscles, cardiac output, pupil dilatation, and blood sugar. Epinephrine does this by its effect on alpha and beta receptors. It is found in many animals and some cell organisms.
Jokichi Takamine first isolated epinephrine in 1901. It is on the World Health Organization's Essential Drug List, the most effective and safe medication needed in the health system. It is available as a generic drug. Wholesale costs in developing countries are between US $ 0.10 and US $ 0.95 a bottle. In the United States, the most frequently used autoinjector cost for anaphylaxis is about US $ 600 for two by 2016, while the generic version is around US $ 140 for two.
Video Epinephrine (medication)
Medical use
Epinephrine is used to treat a number of conditions including: cardiac arrest, anaphylaxis, and superficial bleeding. It has been used historically for bronchospasm and hypoglycemia, but newer treatments for this are selective for? 2 adrenoceptors, such as salbutamol are now preferred.
Cardiac arrest
While epinephrine is often used to treat cardiac arrest, it has not been shown to improve long-term survival or mental function after recovery. However, it improves the spontaneous circulation again.
Anaphylaxis
Epinephrine is the drug of choice for treating anaphylaxis. Different strengths, doses, and route of administration of epinephrine are used.
The commonly used epinephrine autoinjector provides 0.3 mg epinephrine injection (0.3 mL, 1: 1000) and is indicated in emergency treatment of allergic reactions including anaphylaxis against stings, contrast agents, drugs or people with a history of anaphylactic reactions to known triggers. One dose is recommended for people weighing 30 kg or more, repeated if necessary. Lower power products available for children.
Intramuscular injection can be complicated because subcutaneous fat depths vary and may cause subcutaneous injection, or may be injected intravenously in error, or incorrectly used strength. Intramuscular injection provides a faster and higher pharmacokinetic profile when compared with subcutaneous injection.
Asthma
Epinephrine is also used as a bronchodilator for asthma if specific? Agonis 2 is unavailable or ineffective.
When administered by a subcutaneous or intramuscular route to asthma, the exact dose is 0.3 to 0.5 mg.
Because of the high intrinsic properties (receptor binding ability) of epinephrine, high drug concentrations cause negative side effects when treating asthma. The value of using epinephrine nebulisation in acute asthma is unclear.
Croup
Racemic epinephrine has historically been used for croup treatment. However, regular epinephrine works well. Racemic adrenaline is a mixture of 1: 1 dextrorotatory ( D ) and levorotatory ( L ) adrenaline isomers. The L form is the active component. Racemic adrenaline works by stimulating alpha adrenergic receptors in the airways, with the resulting mucosal vasoconstriction and decreased subglottic edema, and by stimulation? adrenergic receptors, with relaxation resulting from bronchial smooth muscle.
Local anesthesia
Adrenaline is added to the injection form of a number of local anesthetics, such as bupivacaine and lidocaine, as a vasoconstrictor to slow up absorption and, therefore, extend the action of an anesthetic agent. Because of the ability of epinephrine vasoconstriction, the use of epinephrine in local anesthesia also helps reduce the total blood loss suffered by patients during minor surgical procedures. Some of the adverse effects of local anesthetic use, such as fear, tachycardia, and tremor, may be due to adrenaline. Epinephrine/adrenaline is often combined with dental and spinal anesthesia and can cause panic attacks in susceptible patients when they may not be able to move or speak due to twilight anesthesia. Currently the maximum recommended daily dose for people in dental settings requiring local anesthesia with peripheral vasoconstrictors is 10 Ã,Âμg/lb of total body weight.
Adrenaline is mixed with cocaine to form Moffett's solution, which is used in nasal surgery.
Maps Epinephrine (medication)
Adverse effects
Side effects on adrenaline include palpitations, tachycardia, arrhythmias, anxiety, panic attacks, headaches, tremors, hypertension, and acute pulmonary edema. The use of epinephrine-based eye drops, commonly used to treat glaucoma, can also cause the buildup of adrenochrome pigment in the conjunctiva, iris, lens, and retina.
Usage is contraindicated in inactive people - -blockers, because severe hypertension and even cerebral hemorrhage may occur. While it is generally believed that adrenaline administration can lead to heart failure by constricting the coronary arteries, this is not the case. The coronary artery only has a receptor 2 , which causes vasodilation in the presence of adrenaline. However, high-dose adrenaline administration has not been definitively proven to improve survival or neurologic outcomes in adult heart attack survivors.
Action mechanism
As a hormone, epinephrine works in almost all body tissues. The action varies by tissue type and adrenergic receptor tissue expression. For example, high levels of epinephrine cause smooth muscle relaxation in the airways but cause smooth muscle contractions that line most of the arterioles.
Epinephrine acts by binding to various adrenergic receptors. Epinephrine is a non-selective agonist of all adrenergic receptors, including major subtypes? 1 ,? 2 ,? 1 ,? 2 , and? 3 . Epinephrine that binds these receptors triggers a number of metabolic changes. Binding? Adrenergic receptors inhibit insulin secretion by the pancreas, stimulate glycogenolysis in the liver and muscles, and stimulate glycolysis and inhibit glycogenesis of insulin-mediated glycogenesis in muscle. ? binding of adrenergic receptors triggers glucagon secretion in the pancreas, increases the secretion of adrenocorticotropic hormone (ACTH) by the pituitary gland, and increases in lipolysis by adipose tissue. Together, these effects lead to an increase in blood glucose and fatty acids, providing a substrate for energy production within cells throughout the body.
The action is to increase the peripheral resistance through substrate-dependent vasoconstriction <1> and to increase cardiac output by binding to receptor 1 . The goal of reducing peripheral circulation is to increase the pressure of coronary and cerebral perfusion and therefore increase the exchange of oxygen at the cellular level. While epinephrine increases aortic, cerebral, and carotid circulation pressures, it lowers carotid blood flow and end-tidal CO 2 or E T CO 2 levels. It seems that epinephrine can improve macroscopic circulation at the expense of capillary beds where actual perfusion occurs.
History
The adrenal gland extract was first obtained by the Polish physiologist Napoleon Cybulski in 1895. This extract, which he calls nadnerczyna, contains adrenaline and other catecholamines. American eye doctor William H. Bates discovers the use of adrenaline for eye surgery before April 20, 1896. Japanese chemist Jokichi Takamine and his assistant Keizo Uenaka independently discovered adrenaline in 1900. In 1901, Takamine succeeded in isolating and purifying hormones from the adrenal glands of sheep and ox. Adrenaline was first synthesized in the laboratory by Friedrich Stolz and Henry Drysdale Dakin, independently, in 1904.
Society and culture
Cost
The cost of wholesale epinephrine in developing countries is between US $ 0.10 and US $ 0.95 a bottle.
Brand name
Common brand names include:
- Asthmanefrin
- Micronefrin
- Nefron
- VapoNefrin
Delivery form
Epinephrine is available in autoinjector delivery systems.
There are inhaler doses of inhaled epinephrine that are sold freely in the United States to remove bronchial asthma. Introduced in 1963 by Armstrong Pharmaceuticals. In 2008, the Food and Drug Administration (FDA) announced that the inhaler, containing chlorofluorocarbons (CFC), failed to comply with the Montreal Protocol environmental regulations and therefore could not be produced or sold after December 31, 2011. In April 2013, after completing several year trial, Armstrong Pharmaceuticals submitted a New Drug Application to the FDA for the hydrofluoroalkane (HFA) version.
The general concentration for epinephrine is a 2.25% epinephrine solution, which contains 2.25 g/100 mL or 2.25 mg/mL. While a 1% solution is usually used for aerosolization.
- Adult: 0.5-0.75 ml of 2.25% solution in 2.0 ml of normal saline.
- Pediatric: 0.25-0.75 ml of 2.25% solution in 2.0 ml normal saline.
References
External links
- US. National Drug Library: Drug Information Portal - Epinephrine
Source of the article : Wikipedia
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