Treatment/prophylaxis of cardiac arrest and attacks of transitory atrioventricular (AV) heart block
with syncopal seizures ( Stroke Adams syndrome)


VASSOPRESSORS USED IN SHOCK-  includes-

Inotropic effects -
Isoproternol, Dobutamine, Dopamine, Ephinephrine,

Mixed  effects-
Norephinephrine, Ephedrine, Mephentermine

Pressors effects-
Metaraminol
Methoxamine
Phenylephrine

Cardiovacular- Cardiac arrhythmias and excessive rise in blood pressure. Angina may occur in patients            
with coronary heart disease.

Transcient and minor- Anxiety, headache, fear and palpitations often occur in therapeutic
doses.

Local- Urticaria, wheal and hamoerrhage may occur at the site of injection.

Systemic- Cerebral haemorrhage, hemiplegia, subarachoid hemorrhage, anginal pain.
 

 

Hypersens to the drug, narrow angle glaucoma, shock, anaethesia with halogenated
hydrocarbons or cyclopropane.

Special precautions:
Fibrillation- use with caution in patients with ventricular fibrillation

Diabetic patients receiving epinephrine may require an increase dose of insulin or oral hypoglycemics.

Parkinsons disease- epinephrine may temporarily increase tremor and rigidity.

Tolerance- may occur with prolonged use of epinephrine

Warnings-
Use with caution- elderly patients, cardiovascular disease hypertension, diabetes, hyperthyroidism, psychoneurotic individuals, bronchialasthma, and emphysema with dengeneartive heart disease, thyrotoxicosis

Cardiovascular effects- closely monitor patients. Ephinephrine causes changes in the ECG, even  in normal patients, including a decrase in amplitude of the T-wave.

Injection- ephinephrine must be administerd with great caution and in carefully circumscribed  quantities in areas of the body served by arteries or with otherwise limited blood supply  ( fingers.toes, nose, ears, genitals etc.)

Cerebrovascular hemorrhage- occur from overdosage of inadvertent IV injection of ephinephrine.

Pulmonary edema- may result in fatalities because of peripheral constriction and cardiac stimulation produced.

Renal function- ephinephrine administerd parentrally may produce constriction of renal blood vessels and decrease urine formation.

Pregnancy- use during pregnancy only if potential benefit justifies the potential risk.

Lactation- because of the potential for serious adverse reactions to the nursing infant, decide whether to discontinue nursing or discontinue the drug depending upon the importancce of the drug to the mother.

Children- administer with caution to infants and children.  
    

 

Indications:
Treatment/prophylaxis of cardiac arrest and attacks of transitory atrioventricular (AV) heart block
with syncopal seizures ( Stroke Adams syndrome)

Dosage:
Administer IV injection. SC is the preferred route of administration. If given IM, avoid injection into the buttocks.
SC or IM- 0.02 to 1 ml. Start with a small dose if required.

Overdosage-

                                    Symptoms                                                       

Erroneous administartion of large doses  of epinephrine may lead to precorial distress ,vomiting, headache,  dyspnea, unusaualy elevated blood pressure, extremely elevated arterial pressure,which result in cerbrovascular hemorrhage, partucularly in elderly  patients, severe peripheral constriction and cardiopulmonary edema, and ventricular hyperirritability,  which may result in death from  ventricular           fibrillation                                                                            

                                  Treatment  

 1. Most toxic effects can be counteracted by injection of an alpha-adrenergic blocker and
     beta-adrenergic blocker
2. In the event of a sharp rise in blood pressure rapid acting vasodilators suchas the                   nitrates   alpha- adrenergic blocking agents can counteract the marked pressor effects.
3. If prolonged hypotension follows it may be necessary to administer another pressor drug,     such as  norepinephrine.
4. If an epinephrine overdose induces pulmonary edema that interferes with respiration,           treatment  consists of rapidly acting alpha-adrenergic blocking drug such as                          phentolamine or intermittent  positive pressure respiration
 
5. Treat cardiac arrhythmias with a beta-blocker  eg, propranolol  

Missed dose-
1. If you are using this medicine regularly and you miss a dose, use it as soonas possible.
2. Then use the remaining dose fotbthat day atregularly spaced intervals.
3. Do not double doses.

 

Bronchodiltor  Adrenergic - Inhalation

Also Includes - Albuterol, Bitolterol, Epinephrine. Fenoterol, Isoetharine, Isoproterenol
                          Metaproterenol, Pirbuterol, Procaterol, Racepinephrine, Terbutaline

     Refer - Albuterol
     Refer - Ethynorepinephrine for Oral/Inhaltion


1. Do not exceed the recommended dosage, excessive use may lead to adverse effect or loss of efectiveness.

2. Do not stop or adjust the dose.

3. Do not change brands without consulting the physician or the pharmacist.

4. If more than one inhaltion is necessary,wait for at least one full minute between inhalitions
    (administer the second inhalation at 3 to 5 minutes for isoproternol and epinephrine, 2 minutes for
     metoproternol ).

5. Notify physician of failure to respond to usual dosage or of dizziness or chest pain.

6. Isopreternol may cause the patients saliva to turn pinkish-red.

7. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to               epinephrine or   other     related medicines. Also tell your doctor  if your are allergic to any    other substances such  as foods,  preservatives or dyes.

8. Pregnancy-  studies on effects in pregnancy have not been done in either humans or           animals  
   
9. Breast feeding-  ophthalmic epinephrine may be absorbed into the body. However it is       not known   whether  epinephrine passes into the breast milk.  
       
10. Children-  no specific information comparing use of enoxaparin in children with use in        other age  groups  
   
11. Elderly- this medicine is not expected to cause different side effects or problems in             older people  than it does   in younger adults.

12. Other medicines- tell your doctor if you are taking any of the following-
    
      Bronchial asthma or
      Diabetes mellitus or
      Eye disease or
      Heart or blood vessel disease or
      High blood pressure or
      Overactive thyroid - epinephrine may make the condition worse
    
      Dental surgery - use of ophthalmic epinephrine during this time mauy increase the               chance of side    effects

13. Missed dose-
    If you miss a dose of this medicine take it as soon as possible. However if it is almost            time for   your next dose go back to your regular dosing schedule.
    Do not double doses.

 

VASSOPRESSORS USED IN SHOCK-  includes-

Inotropic effects -
Isoproternol, Dobutamine, Dopamine, Ephinephrine,

Mixed  effects-
Norephinephrine, Ephedrine, Mephentermine

Pressors effects-
Metaraminol
Methoxamine
Phenylephrine


Pharmacology:
The actions of epinephrine  resemble the effects of stimulation of adrenergic nerves. It acts on both alpha and beta receptors sites of sympathetic effector cells. Epinephrine relaxes the smooth muscle of the bronchi and iris and is a physiologic antagonist of histamine

Pharmacokinetics:
Epinephrine crosses the placenta but not the blood-brain barrier. Intervenous injections produce the immediate and intensified response. Epinephrine is rapidly and systematically degraded in the liver and other tissues by the enzyme monoamine oxidase and catechol-O-methyl transferase.

 

Pregnancy:
Use during pregnancy only if the potential justifies the potential risk to the fetus.

Lactation:
Epinephrine is excreted in breast milk. Use with caution and excercise judgement