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Adrenaline

METABOLISM

EMERGENCY DRUGS - [ METABOLISM ]

Adrenaline is a drug that acts as an agonist on both the α and β adrenergic receptors. Its action on the α adrenergic receptor decreases the vasodilation and the increased vascular permeability which occurs during anaphylaxis. Also via it action on the β adrenergic receptors it relieves the bronchospasm that occurs during anaphylaxis. It also increases blood glucose levels. (1)

Emergency treatment of allergic reactions (Type 1), including anaphylaxis Induction and maintenance of mydriasis during intraocular surgery (2)

Narrow angle glaucoma Organic brain damage Cardiac dilation Coronary insufficiency. (3)

Anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, sweating and respiratory difficulties. Angina, arrhythmias, hypertension, pallor, palpitations, tachyarrhythmia, tachycardia, vasoconstriction, and ventricular ectopy. Respiratory difficulties, disorientation, excitability, impaired memory, lightheadedness, nervousness, panic, psychomotor agitation, sleepiness, tingling, tremor, and weakness. Nausea and vomiting Diabetic patients may experience transient increases in blood sugar Injection into the buttock has resulted in cases of gas gangrene Corneal endothelial damage (2)

Sympathomimetics: Additive effects Cardiac glycosides, digitalis, diuretics, quinidine, halogenated anesthetics and other antiarrhythmics: Cardiac arrhythmias. Imipramine, monoamine oxidase inhibitors (MAOI), levothyroxine sodium, diphenhydramine, tripelannamine, and dexchlorpheniramine: Potentiation of actions of adrenaline Propranolol: cardiostimulating and bronchodilating effects of adrenaline are antagonized. Alpha adrenergic blocking drugs (eg: Phentolamine): vasoconstricting and hypertensive effects of adrenaline are antagonized. Ergot alkaloids: Reversal of pressor effects of adrenaline. Pheothiazine: hypotension (2)

During treatment of anaphylaxis in geriatric patients, lower starting doses are necessary. (2)

Intramuscular injection Anaphylaxis: preferable site is the midpoint in anterior thigh [1:1000 solution]. Slow intravenous injection: When there is doubt regarding adequacy of circulation and absorption from the intramuscular site; slow intravenous injection of 1:10000 (10 mg/ml) solution be injected in severely ill patients only. (3)

1. Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. 2. Adrenalin [Internet]. [cited 2013 Oct 4]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/204200s000lbl.pdf 3. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011