My Presentation

1. Epinephrine / Adrenaline
• By Shamin Joshi

2. Its primarily a medication as well as hormone
Its an emergency drug
Its direct sympathomimetics drugs
Its 1st line drug used incardiac arrest
At low dose , beta effect (vasodilators ) on
vascular system predominant
At high dose , alpha effect ( vasoconstrictor )
are strongest

3. Chemical Structure
• molecular weight = 183.2.
• Epinephrine solution deteriorates rapidly
• On exposure to air or light, turning pink from
oxidation to adrenochrome and brown from
the formation of melanin.

4. Routes
• IV
• Intratracheal
• Continous infusion
• nebulisation

5. Metabolism
• Epinephrine is rapidly inactivated in the body and
is degraded by enzymes in the liver and other
tissues.
• The larger portion of injected doses is excreted in
the urine as inactivated compounds and the
remainder either partly unchanged or conjugated.
• The drug becomes fixed in the tissues and is
inactivated chiefly by enzymatic transformation to
metanephrine or normetanephrine either of
which is subsequently conjugated and excreted in
the urine in the form of sulfates and
glucuronides.

6. OrganEffects
• Heart - Increases heart rate
• Lungs - Increases respiratory rate
• Systemic- Vasoconstriction and vasodilation
• Liver - Stimulates glycogenolysis
• Systemic - Triggers lipolysis
• Systemic - Muscle contraction

7. Indication
• Anaphylactic shock
• Prolonged action of LA
• Cardiac arrest
• Bronchospasm
• Chronic orthostatic hypotension
• Topically , to stop bleeding
• Minimal dysfunction of brain

8. Dose
• La without adrenaline is 300mg or 4.4 mg/kg
• With adrenaline is 500mg or 7mg/kg
• Epineprine dilution of 1: 50000and 1: 100000
are considerably more effective

9. Epinephrine in lA
Advantage
• Prolongs duration of action of la by keeping them in
contact with nerve fibers
• Limits systemic absorption
• Decreasing possibility of systemic toxicity cause rate of
metabolism will match rate of absorption
• Decreases bleeding ( improves visualization )
Disadvantage
• Makes injection more painful
• Increase chances of local injury and necrosis
• May raise blood pressure and promote arrhymias

10. ADR
• Stinging
• Alergic lid rxn
• Systemic hypertension
• Arrythmia
• Throbbing headache ,
• Tremor
• Palpitation
• Teratogenic effects

11. Contraindication
• Severe hypertension
• Cardiac disease
• Thyrotoxicosis