Teaching Points::Epinephrine

[Ace844]

Hello Everyone,

Here's the follow up post to the Teaching Points::: ANAPHYLAXIS/EPI post here.

Epinephrine (INN) or adrenaline (BAN) is a hormone and a neurotransmitter of molecular weight 183.2. A neurotransmitter is a specific kind of hormone, released by neurons to regulate activity of target tissues (e.g. brain cells, epinephrine anaphylaxis muscle cells,...). The Latin roots ad-+renes and the Greek roots epi-+nephros both literally mean "on/to the kidney" (referring lidocaine and epinephrine finger to the adrenal gland, which secretes epinephrine). Epinephrine is sometimes shortened to epi in medical jargon.

Chemically, epinephrine reaction tribulus and increase and epinephrine and dopamine epinephrine is a catecholamine hormone, a sympathomimetic monoamine derived from epinephrine for weight loss the amino acids phenylalanine and tyrosine. The chemical formula of epinephrine is C9H13NO3. Its structure is shown right.

ATC code

C01CA24

William Bates headaches from epinephrine reported in the adrenaline, epinephrine New York Medical Journal in May 1886, the discovery of a substance produced by the suprarenal epimedium and increase and epinephrine and dopamine gland. Epinephrine was isolated and identified in 1895 by Napoleon Cybulski, Polish livestock epinephrine physiologist. The discovery schizandra and increase and epinephrine and dopamine was repeated in 1897 by John Jacob Abel. Jokichi Takamine discovered the same hormone in 1901, without knowing about the previous discovery, and called it adrenaline. serotonin dopamine epinephrine urine It was first artificially synthesized in epinephrine norepinephrine 1904 by Friedrich Stolz.

Actions in the body

Epinephrine plays a central role standing orders for epinephrine in the short-term stress reaction—the physiological response to threatening or exciting conditions (see Fight-or-flight response). It is secreted by the adrenal medulla. dose of epinephrine in dogs epinephrine and norepinephrine When released into the bloodstream, epinephrine binds to multiple receptors and has numerous effects throughout the body. It increases heart rate and stroke volume, dilates the pupils, and constricts arterioles in the skin and gut while dilating arterioles in leg muscles. epinephrine It elevates the blood sugar level by increasing hydrolysis of glycogen to glucose in the liver, and at the same time begins the breakdown of lipids in fat cells.

Epinephrine is used as a drug epinephrine and role in glucogeneolysis to promote peripheral vascular epinephrine drip resistance chemistry 2% lidocaine with epinephrine of epinephrine via alpha-stimulated vasoconstriction in cardiac arrest and other cardiac disrhythmias resulting in diminished epinephrine central retinal or absent cardiac output, such that blood is shunted to the body's core. This beneficial action comes with a significant negative consequence, increased cardiac irritability, which may lead to additional complications racemic epinephrine dosing immediately following an otherwise epinephrine dosage successful resuscitation. Alternatives to this treatment mepivicaine spinal and epinephrine amount duration with and without epinephrine include vasopressin, a powerful antidiuretic which also promotes peripheral vascular epinephrine norepinenphrine resistance leading to blood shunting via vasoconstriction, but without the attendant epinephrine pen increase new york state law for epinephrine epinephrine and milrinone pens to myocardial irritability.

Epinephrine is also used epinephrine and role in glycogenolysis as a vasoconstrictor in anaphylaxis and sepsis, and as how many mcg/cc is epinephrine 1:200,000 a bronchodilator for asthma epinephrine injection if specific beta-2-adrenergic agonists equine epinephrine are unavailable or ineffective. Allergy patients undergoing immunotherapy can get an epinephrine calculation lidocaine 2% and epinephrine rinse before their allergen extract is administered. Adverse reactions to epinephrine include palpitations, tachycardia, anxiety, headache, tremor, hypertension, and acute pulmonary edema.

A pheochromocytoma is a tumor of the abbott, epinephrine adrenal gland (or, rarely, what nerve releases epinephrine the ganglia of the sympathetic nervous system) which secretes excessive amounts of epinephrine caffine panic attack catecholamines, usually epinephrine.

Pharmacology

Epinephrine's actions are mediated through adrenergic epinephrine long term effects receptors (sometimes referred to as adrenoceptors).

It binds effect of epinephrine to α1 receptors of liver cells, which activate inositol-phospholipid signaling pathway, signaling the phosphorylation of insulin, leading to reduced ability of insulin to bind to its receptors.

Epinephrine also activates β-adrenergic receptors of the liver and muscle cells, which activates the adenylate cyclase signaling pathway, which will in turn increase glycogenolysis.

Epinephrine (EpiPen, Adrenalin) -- DOC for shock, angioedema, airway obstruction, bronchospasm, and urticaria in severe anaphylactic reactions. Administered SC or IM, except for patients in extremis for whom it is administered IV. May be administered SL or via ET when no IV access available. Continuous infusion may be administered in cases of refractory shock.

Adult Dose ::

0.3-0.5 mL 1:1000 soln SC or IM q15min

1 mL 1:10,000 soln (diluted in 10cc NS) IV; slow administration; repeat prn

0.3-0.5 mL 1:1000 soln SL q15min

1.0 mL 1:1000 soln ET in approximately 10 cc NS

IV infusion: 0.1-1 mcg/kg/min

Pediatric Dose 0.01 mL/kg (minimum 0.1 mL) 1:1000 soln SC or IM q15min

0.01 mL/kg (minimum 0.1 mL) 1:10,000 soln IV prn

0.01 mL/kg (minimum 0.1 mL) 1:1000 soln SL q15min

0.01 mL/kg (minimum 0.1 mL) 1:1000 soln ET in approximately 1-3 cc NS

IV infusion: 0.1-1.0 mcg/kg/min

Contraindications May be administered in life-threatening anaphylactic reactions, even when the following relative contraindications are present: (1) coronary artery disease, (2) uncontrolled hypertension, (3) serious ventricular arrhythmias, and (4) second stage of labor

Interactions Sympathomimetics cause additive effects; beta-blockers antagonize therapeutic effects of epinephrine; digitalis potentiates proarrhythmic effect of epinephrine; TCAs and MAOIs potentiate cardiovascular effects of epinephrine; phenothiazine causes a paradoxical decrease in BP

- Usually safe but benefits must outweigh the risks.

Precautions Adverse effects::

include cardiac ischemia or arrhythmias, fear, anxiety, tremor, and hypertension with subarachnoid hemorrhage; use with caution in elderly and in patients that have diabetes mellitus, hyperthyroidism, prostatic hypertrophy, hypertension, cardiovascular disease, and cerebrovascular insufficiency; rapid IV infusions also may cause death from cerebrovascular hemorrhage or cardiac arrhythmias

Epinephrine versus epinephrine molecule adrenaline

While epinephrine is the International Nonproprietary Name (INN) and United epinephrine clearance kidneys States Approved Name (USAN), it is more commonly known as adrenaline, which epinephrine for livestock is the British Approved Name (BAN).

The basis for the name epinephrine in the United States was out of necessity because the name adrenalin was registered as a trademark by Parke, Davis & Co. In other countries where this trademark was not registered, the name adrenaline was adopted racemic epinephrine at the insistence of the British pharmacologist Henry Hallett Dale. Resistance to the adoption of epinephrine has even resulted in some dispute as to the validity epinephrine and standing order of the name (Aronson, 2000).

EPINEPHRINE (ADRENALIN)

Class: Sympathomimetic.

Mechanism of Action

Direct acting alpha and beta agonist

Alpha: bronchial, cutaneous, renal and visceral arteriolar vasoconstriction.

Beta 1: positive inotropic and chronotropic actions, increases automaticity.

Beta 2: bronchial smooth muscle relaxation and dilation of skeletal vasculature

Blocks histamine release.

Indications

Cardiac arrest, asystole, PEA, VF unresponsive to initial defib.

Severe bronchospasm, asthma, bronchiolitis.

Anaphylaxis, acute allergic reactions.

Contraindications

Hypertension, hypothermia, pulmonary edema, coronary insufficiency, hypovolemic

shock.

Adverse Reactions

Hypertension, dysrhythmias, pulmonary edema, anxiety, psychomotor agitation,

nausea, angina, headache, restlessness.

Drug Interactions

Potentiates other sympathomimetics.

Deactivated by alkaline solutions.

MAOIs may potentiate effects of epinephrine.

How Supplied

1 mg / ml (1:1,000) ampules and 0.1 mg / ml (1:10,000) prefilled syringes.

Auto-injectors: EPI-Pen: 0. 3 mg / ml

EPI-Pen Jr.: 0.15mg/ml

Dosage and Administration

Adult

Allergic reactions and asthma: 0.3 - 0.5 mg (0.3 - 0.5 ml 1:1000) SC

Anaphylaxis: 0.3 - 0.5 mg (3- 5 ml 1:10,000) IV

Cardiac: (asystole, PEA, VF)

1 mg IV push (1:10,000) every 3- 5 minutes

Endotracheal: 2.0- 2.5 mg (1:1,000) every 3- 5 minutes in 10ml NS

Pediatric

Allergic reactions and asthma: 0.01 mg/kg (0.01 mL/kg 1:1000) SC to

maximum of 0.5 mg.

Cardiac: (asystole, PEA, VF)

IV, IO: Standard initial dose: 0.01 mg/kg (1:10,000, 0.1mL/kg)

ET: 0.1 mg/kg (1:1,000, 0.1mL/kg)

Second and subsequent doses: 0.1 mg/kg (1:1000, 0.1mL/kg)

Duration of Action

Onset: Immediate.

Peak Effects: Minutes.

Duration: Several minutes.

Special Considerations

Pregnancy safety: category C.

Syncope in asthmatic children.

If given ET, may dilute in sterile NS (10 ml in adults).

EPINEPHRINE RACEMIC (MICRONEFRIN, VAPONEFRIN)

Class

Sympathomimetic.

Mechanism of Action

Stimulates beta -2 receptors in lungs: bronchodilatation with relaxation of bronchial

smooth muscles. Reduces airway resistance. Useful in treating laryngeal edema;

Inhibits histamine release.

Indications

Bronchial asthma, prevention of bronchospasm.

Croup: laryngotracheobronchitis.

Laryngeal edema.

Contraindications

Hypertension, underlying cardiovascular disease, Epiglottitis.

Adverse Reactions

Tachycardia, dysrhythmias.

Drug Interactions

MAOIs may potentiate effects.

Beta-blockers may blunt effects.

How Supplied

MDI: 0.16-0.25 mg/ spray.

Solution: 7.5, 15, 30 ml in 1%, 2.25% solutions

Dosage and Administration

Adult:

MDI: 2-3 inhalations, repeated every 5 minutes PRN.

Solution: dilute 5 ml (1%) in 5.0 ml NS, administer over 15 minutes.

Pediatric:

Solution: Dilute 0.25 ml (0.1%) in 2.5 ml NS (if less than 20 kg);

Dilute 0.5 ml in 2.5 ml NS (if 20-40 kg);

Dilute 0.75 ml in 2.5 ml NS (if greater than 40 kg)

Administer by aerosolization.

Duration of Action

Onset: within 5 minutes.

Peak effect: 5- 15 minutes.

Duration: 1-3 hours.

Special Considerations

May cause tachycardias and other dysrhythmias.

Monitor Vital Signs.

Excessive use may cause bronchospasm.

Hope this helps,

Ace844

[JakeEMTP]

Thanks for the update Ace.

Again, well done :occasion5:

[Ace844]

Thanks for the update Ace.

Again, well done :occasion5:

Thank you

[rcmedic]

Dude, that was great information. Thanks! :-)

[CDC_Dale]

Ace,

Great info. Especially for a newbie, very useful.

Printed all these out for my notebook.

Thank you!

Dale

[Ace844]

Here's a link to the NAEMSP Position paper on 'SUB-Q EPI ADMIN IN ANAPHYLAXSIS'::

http://72.14.209.104/search?q=cache:Q7zmA0...=clnk&cd=17

Hope this Helps,

ACE844

[AZCEP]

Hopefully, the providers that missed this day in class, or didn't have this day, will take the time to read through this information. Then hopefully, we will get some more educated discussions about these things that what has been going on recently. :roll: